patient's anatomy;
• surgeons better understand who is going to be a good candidate
for the surgery; and
• surgeons can better perform the surgery, thanks to shifts in technolo-
gy and technique.
Let's examine 4 factors that have helped to fuel the demand for unis.
1
Patient selection
In 1989, Brigham and Women's Hospital orthopods Stuart C.
Kozinn, MD, and Richard Scott, MD, wrote a landmark paper
about the indications used to determine who was a good candidate
for this surgery (osmag.net/bKQ6vX). In it, the 2 surgeons offered a
rather conservative definition of an ideal candidate: no one weighing
more than 180 pounds; no one younger than 60; no one who had more
than minimal erosive changes in patellofemoral articulation; and no
one who was physically active or performing heavy labor. Based on
those strict criteria, the field of acceptable candidates was limited to
less than 15% of patients with osteoarthritic knees.
Thankfully, our understanding has grown considerably in the years
since. Take obesity as just one example. Obesity is now a relative con-
traindication, as the patient's bone quality and weight distribution —
not just BMI — must also be considered. In my practice, we encour-
age patients to lose weight before surgery for 2 reasons: First, obese
patients are more likely to experience perioperative complications,
such as infection and blood clots; and second, having a patient trim
down to a healthier weight is critical for not only the longevity of the
knee but also for the overall well-being of the patient. And as for the
age factor, both younger and older patients have shown excellent
medium- and long-range results with unis.
With a uni, there's less opportunity to change the anatomy. So if the
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