Abstract
BACKGROUND: Isolated anteromedial osteoarthritis (AMOA) is prevalent in 46.94 % of the Indian population undergoing primary total knee arthroplasty (TKA). Compared with TKA, medial unicompartmental knee arthroplasty (UKA) has shown superior functional outcomes in such patients but remains underutilised in India. This study aimed to assess the midterm functional and clinical outcomes, long-term survival, and complications of cemented Oxford UKA in Indian patients with isolated AMOA and to analyse the factors influencing its acceptance and success. METHODS: This prospective, observational study was conducted at a single center from September 2014 to September 2024 and included 191 knees from 180 patients. Preoperative and follow-up assessments included clinical and patient-reported outcome measures (PROMs), such as the American Knee Society (KSS), the Oxford Knee Score (OKS), and the forgotten joint score (FJS). The complication and revision rates were also monitored. RESULTS: Significant improvement in all PROMs and clinical outcomes was observed at 5 years post-surgery. The mean preoperative KSS improved from 48.2 to 88.3, the mean OKS improved from 28.7 to 40.5, the mean FJS improved from 38.1 to 73.6, and the mean ROM improved from 91.5° to 120.4° at 5 years post-surgery (p < 0.001). Majority patients could squat, sit on the floor, and sit cross-legged within one-year post-surgery. The 5-year survivorship was 96.85 %. Six knees required revision surgery, with progression of osteoarthritis to the lateral compartment being the most common cause. The frequency of complications was inversely related to surgeon experience and case volume. CONCLUSIONS: Cemented Oxford UKA yields excellent clinical and functional outcomes for Indian patients with isolated AMOA, with 96.85 % 5-year survival and significant improvements in PROMs and range of motion. The procedure enables patients to resume traditional activities requiring a high range of motion. Enhanced patient and surgeon education is needed to increase the acceptance of UKA in India.