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J Arthroplasty. 2017 Nov;32(11):3345-3351. doi: 10.1016/j.arth.2017.06.022. Epub 2017 Jun 19.

Regional Femoral and Tibial Radiolucency in Cemented Unicompartmental Knee Arthroplasty and the Relationship to Functional Outcomes.

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Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
Department of Orthopaedic Surgery, Noordwest Hospital, Alkmaar, The Netherlands.



Femoral and tibial radiolucent lines (RLL) after unicompartmental knee arthroplasty (UKA) can be categorized in physiological and pathological radiolucencies. Although physiological tibial radiolucency is assessed extensively in literature, studies reporting femoral radiolucency are lacking. Therefore, a retrospective study was performed to assess physiological femoral RLL and its relationship to short-term functional outcomes.


A total of 352 patients were included who underwent robotic-assisted medial UKA surgery and received a fixed-bearing metal-backed cemented medial UKA. Radiographic follow-up consisted of standard anteroposterior and lateral radiographs. Functional outcomes, using the Western Ontario and McMaster Universities Arthritis Index questionnaire, of patients with RLL were compared with a matched cohort, based on gender, age, and body mass index.


In this cohort, 101 patients (28.8%) had physiological regional radiolucency around the femoral (10.3%) and/or tibial (25.3%) components, of which 6.8% concerned both components. Tibial RLL were more frequently seen compared with femoral RLL (P < .001). Our data suggest that the time of onset of femoral radiolucency develops later (1.36 years) than tibial radiolucency (1.00 years, P = .02). No difference in short-term functional outcomes was found between the RLL group and the matched cohort group without radiolucency.


This study acknowledges that tibial and femoral physiological radiolucencies may develop after cemented medial UKA. Furthermore, this was the first study showing that physiological femoral RLL occur later than tibial RLL. Prospective studies with longer follow-up and larger numbers are necessary to compare radiolucency in different UKA designs and the relationship to outcomes.


WOMAC; cemented; hip-knee-ankle angle; physiological radiolucency; radiolucent lines; unicompartmental knee arthroplasty

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