Adult Reconstruction

In this issue of Orthopedic Clinics of North America , we cover two current and relevant topics in joint arthroplasty: lateral unicompartmental knee arthroplasty and metal-on-metal total hip arthroplasty. In the first article by Berend and coauthors, it becomes apparent that while osteoarthritis affects the knee in a significant amount of the population, not all degenerative arthritis affects more than one compartment of the knee. In fact, isolated medial compartment arthritis is seen in approximately 25% of the affected population, while isolated lateral compartment disease is seen in 5% to 10% of patients. It is in this later group of patients with lateral compartment arthritis that the authors report on their clinical experience with isolated lateral unicompartmental knee arthroplasty. It is their observation that this approach is associated with less morbidity, a more rapid recovery, and more normal knee kinematics. With the limited number of reports on lateral unicompartmental knee arthroplasty, this article enhances the literature with a focus on patient selection, implant selection, and surgical technique.

The second article focuses on total hip arthroplasty (THA) and the modes of failure with metal-on-metal designs. In the last decade, metal-on-metal THA made resurgence with an expectation of improved wear, improved longevity, and lower dislocation rates. However, in recent years, new modes of failure, such as adverse local tissue reaction, with these bearings have been identified. In the article by Fehring and Fehring, the authors report on the modes of failure with metal-on-metal THA and discuss the evaluation and treatment modes of failure unique to this implant design. When evaluating a patient with a painful THA, the authors stress that it is important to consider all common modes of failure associated with conventional THA, in addition to the modes of failure unique to metal-on-metal THA. A systematic approach to these patients involves a careful history, physical examination, serology tests, and both radiographic and advanced imaging. Based on the findings of these multiple diagnostic variables, a treatment plan can be determined.

Both of these articles provide the reader with valuable insight on two different but contemporary topics in joint arthroplasty. Knowing that reading provides the mind with knowledge, I believe that these articles will be useful references.

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