Abstract
Unicompartmental knee arthroplasty (UKA) has emerged as a reliable, bone-preserving option for patients with isolated compartment knee osteoarthritis (OA). Initially limited by poor early outcomes and narrow indications, advances in implant design, patient selection, and surgical technique have led to a resurgence in its use. Contemporary diagnostics rely on precise clinical and imaging assessments to confirm unicompartmental disease while ruling out contraindications. Importantly, traditional exclusion criteria, such as age under 60, high body mass index, patellofemoral OA, anterior cruciate ligament deficiency, and chondrocalcinosis, are being re-evaluated in light of newer evidence, suggesting they are not absolute barriers in all patients. Operative options now include cemented and cementless fixation, fixed- and mobile-bearing designs, and all-polyethylene versus metal-backed components, each with specific advantages and limitations. Robotic-assisted techniques offer improved alignment accuracy and reproducibility compared to conventional manual approaches, potentially enhancing survivorship, although cost and learning curve remain considerations. Post-operative protocols support early mobilization and weight-bearing, facilitating faster recovery than total knee arthroplasty (TKA). Return to sports activity is generally higher after UKA, meeting the expectations of increasingly active patient populations. Surgeon-related factors, particularly experience and case volume, significantly influence outcomes, underscoring the importance of appropriate training and patient selection. As the understanding of UKA indications and techniques continues to evolve, it offers a compelling, less invasive alternative to TKA for well-selected patients. This editorial review highlights current best practices, emerging evidence, and ongoing challenges in optimizing outcomes for UKA.