Free Floating Interpositional Devices
In the absence of reliable or new evidence, it is the opinion of the work group not to use free-floating (un-fixed) interpositional devices in patients with symptomatic medial compartment osteoarthritis of the knee.

Rationale

One study met inclusion criteria, and no additional studies were available for review since the prior edition OAK CPG was published.  The single study was a case series and retrospective review of outcomes in patients receiving the surgical intervention for isolated medial compartment OA. The study indicated high reoperation rates in the patients who were followed, with 32% of patients being revised to total knee arthroplasty during the study period.  Regarding pain and functional improvement, the study reported no statistical difference in preoperative and postoperative Knee Society Scores. Given the lack of evidence to support use, the AAOS workgroup modified the grade of this recommendation to consensus, because of the high revision rates in this study, and the potential harm associated with surgical intervention (anesthesia risks, VTE, infection, and reoperation).

Cost Effectiveness/Resource Utilization

No economic analyses or resource utilization studies have been reported on this treatment option.

Future Research

Future research should be aimed at producing level one randomized control trials to define clinical efficacy and risk of complication.