Unicompartmental knee arthroplasty: current surgical approaches, indications, outcomes, and future perspectives

Abstract

Abstract. Background. Unicompartmental knee arthroplasty (UKA) is increasingly recognized as a suitable alternative to total knee arthroplasty (TKA) for patients with osteoarthritis limited to a single tibiofemoral compartment. Once considered appropriate only for older, less physically active individuals, its use has broadened to include younger and more active patients, supported by advances in implant design and refinement of surgical methods. This review aims to outline the current indications, operative techniques, clinical results, and complications of UKA, while addressing emerging evidence and evolving practices. Materials and methods. A narrative literature review was conducted using PubMed, Scopus, and Web of Science, covering publications from 2000 to 2025. Key historical studies were included to provide context on UKA development. Studies were selected based on methodological quality and relevance to clinical decision-making. Results. Studies indicate that UKA can achieve excellent survivorship and often allows quicker rehabilitation and more natural knee motion than TKA, particularly in carefully selected patients. Bone preservation and minimally invasive approaches facilitate future revision if necessary. Results still depend on the careful patient selection and surgeon experience. The main complications reported include bearing dislocation, infections, polyethylene wear, and component loosening. Conclusion. Unicompartmental knee arthroplasty represents a reliable surgical solution for isolated compartment osteoarthritis when performed in carefully selected patients. The growing use of robotic assistance and newer implant designs, along with broader indications, may further strengthen the role of UKA in managing knee arthritis. Although long-term evidence is still emerging, recent studies show promising results.