BlueCross BlueShield of Tennessee Medical Policy Manual

Unicompartmental Knee Replacement

DESCRIPTION

Unicompartmental knee replacement is a procedure done to replace one of the knee's three parts (thighbone, shinbone, or kneecap). The goal of the procedure is to restore knee function that has diminished due to disorders that cause chronic knee pain. An incision is made over the area of the knee that is damaged. The damaged bone is removed and replaced with a prosthetic implant. The thighbone and shinbone may be slightly sculpted to fit the implant. Once the implant is in the proper place, it is secured (e.g., with bone cement), and the wound is closed with stitches.

This procedure is also referred to as unicondylar or partial knee replacement because only part of the damaged knee is replaced.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

The lack of randomized controlled trials and studies provide little evidence of the safety and efficacy for the treatment of other conditions/diseases.

SOURCES 

Ali, A. M., Pandit, H., Liddle, A. D., Jenkins, C., Mellon, S., Dodd, C. A., et al. (2016). Does activity affect the outcome of the Oxford unicompartmental knee replacement? Knee, Epub ahead of print. Abstract retrieved February 2, 2016 from the PubMed database.

American Academy of Orthopaedic Surgeons (AAOS). (2010, September). Knee implants. Retrieved April 18, 2011 from http://orthoinfo.aaos.org/topic.cfm?topic=A00221&return_link=0.

American Academy of Orthopaedic Surgeons (AAOS). (2013, December). Treatment of osteoarthritis of the knee: Evidence-based guideline 2nd edition.). Retrieved September 29, 2014 from http://www.aaos.org/research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf.

Borgwardt, L., Zerahn, B., Bliddal, H., Christiansen, C., Sylvest, J., & Borgwardt, A. (2009). Similar clinical outcome after unicompartmental knee arthroplasty using a conventional or accelerated care program. A randomized, controlled study of 40 patients. Acta Orthopaedica, 80 (3), 334-337. (Level 4 evidence - Independent study)

Dettoni, F., Bonasia, D. E., Castoldi, F., Bruzzone, M., Blonna, D., & Rossi, R. (2010). High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: A review of the literature. The Iowa Orthopaedic Journal, 30, 131-140. (Level 4 evidence - Independent)

Emerson, R. H., Alnachoukati, O., Barrington, J., & Ennin, K. (2016). The results of Oxford unicompartmental knee arthroplasty in the United States. The Bone & Joint Journal, 98-B (10 Supple B), 34-40.  (Level 2 evidence - Independent)

Hamilton, T. W., Choudhary, R., Jenkins, C., Mellon, S. J., Dodd, C. A., Murray, D. W., et al. (2016). Lateral osteophytes do not represent a contraindication to medial unicompartmental knee arthroplasty: a 15-year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy, 2016, Sept, Epub ahead of print. Abstract retrieved November 21, 2016 from PubMed database.

Hawi, N., Plutat, J., Kendoff, D., Suero, E. M., Cross, M. B., Gehrke, T., et al. (2016). Midterm results after unicompartmental knee replacement with all-polyethylene tibial component: a single surgeon experience. Archives of Orthopaedic and Trauma Surgery, 136 (9), 1303-1307. Abstract retrieved November 21, 2016 from PubMed database.

Murray, D. W., Liddle, A. D., Dodd, C. A., & Pandit, H. (2015). Unicompartmental knee arthroplasty: is the glass half full or half empty? Bone & Joint Journal, 97-B (10 Supplement A), 3-8. (Level 5 evidence - Independent)

National Institute for Health and Care Excellence (NICE). (2014, September). Management of osteoarthritis. Retrieved September 30, 2014 from http://pathways.nice.org.uk/pathways/osteoarthritis/management-of-osteoarthritis.

National Institute for Health and Care Excellence (NICE). (2009, September). Individually magnetic resonance imaging-designed unicompartmental interpositional implant insertion for osteoarthritis of the knee. Retrieved November 21, 2016 from http://nice.org.uk/guidance/ipg317.

Ollivier, M., Abdel, M., Parratte, S., & Argenson, J. N. (2014). Lateral unicondylar knee arthroplasty (UKA): Contemporary indications, surgical technique, and results. International Orthopedics, 38 (2), 449-455. (Level 5 evidence - Independent)

Pandit, H., Liddle, A. D., Kendrick, B. J., Jenkins, C., Price, A. J., Gill, H. S., et al. (2013). Improved fixation in cementless unicompartmental knee replacement: five-year results of a randomized controlled trial. Journal of Bone and Joint Surgery, 95 (15), 1365-1372. Abstract retrieved November 21, 2016 from PubMed database.

Parmaksizoglu, A. S., Kabukcuoglu, Y., Ozkava, U., Bilgili, F., & Aslan, A. (2010). Short-term results of the Oxford phase 3 unicompartmental knee arthroplasty for medial arthritis. Acta Orthopaedica Traumatologica Turcica, 44 (2), 135-142. (Level 3 evidence - Independent study)

Schmidt-Braekling, T., Pearle, A. D., Mayman, D. J., Westrich, G. H., Waldstein, W., & Boettner, F. (2016). Deep venous thrombosis prophylaxis after unicompartmental knee arthroplasty: a prospective study on the safety of aspirin. Journal of Arthroplasty, 2016, September, Epub ahead of print. Abstract retrieved from PubMed database.

U. S. Food and Drug Administration. (2004, April). Center for Devices and Radiological Health. Oxford™ meniscal unicompartmental knee system - P010014. Retrieved April 18, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf/P010014b.pdf.

U. S. Food and Drug Administration. (2008, February). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K072704. Retrieved April 18, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K072704.pdf.

Volpin, G. (2009). Unicompartmental knee replacement for localized osteoarthritis of the medial or lateral compartment. The Israel Medical Association Journal, 11 (5), 308-310. (Level 5 evidence - Independent)

W-Dahl, A., Robertsson, O., Lidgren, L., Miller, L., Davidson, D., & Graves, S. (2010). Unicompartmental knee arthroplasty in patients aged less than 65. Acta Orthopaedica, 81 (1), 90-94. (Level 4 evidence - Independent)

Zengerink, I., Duivenvoorden, T., Niesten, D., Verburg, H., Bloem, R., & Mathijssen, N. (2015). Obesity does not influence the outcome after unicompartmental knee arthroplasty. Acta Orthopaedica Belgica, 81 (4), 776-783. Abstract retrieved February 2, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  10/1/2002

MOST RECENT REVIEW DATE:  1/12/2017  

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