Better immediate and early postoperative outcomes of unicompartmental knee replacement comparing with total knee replacement: A matched cohort of patients with medial knee osteoarthritis

Abstract

Introduction: This study compared the immediate and early postoperative outcomes of medial compartment knee osteoarthritis patients receiving unicompartmental knee replacement (UKR) with a matched cohort of total knee replacement (TKR). Methods: 26 UKR patients were matched with 26 TKR patients based on age, body mass index, pre-operative radiographic severity, range of motion (ROM), Knee Society score (KSS) and Feller patella score. Immediate postoperative outcomes were reflected by postoperative pain, blood loss, length of stay and the number of physiotherapy sessions attended. Early postoperative outcomes (ROM and KSS) were measured at 3 months and 1 year post-operatively. Results: UKR patients had less hemoglobin drop (UKR: 1.2 g/dL, TKR: 1.6 g/dL, p = 0.04), shorter length of stay (UKR: 4.3 days, TKR: 6.0 days, p < 0.001) and required less physiotherapy sessions for recovery (UKR: 6.9 sessions, TKR: 9.3 sessions, p < 0.05). There were no statistically significant differences in early post-operative pain score and postoperative analgesia use ( p > 0.05) between the two groups. Patients receiving UKR had significantly higher post-operative KSS (UKR: 155.9, TKR: 142.4, p = 0.005) and ROM (UKR: 115.8o, TKR: 98.8o, p < 0.001) at 3 months. The KSS and ROM of UKR group at 3 months was better than TKR group at 1-year follow-up. Conclusion: In patients with medial knee osteoarthritis, UKR showed less postoperative analgesic use and blood loss, shorter length of stay, shorter course of rehabilitation and faster recovery with better early KSS and ROM than TKR. Follow up is necessary for comparison in long term outcome and survivorship between the two groups.

A Meta-Analysis of the Effects of Otago Exercise in Patients after Hip and Knee Replacement

“…A total of 252 literature were searched, 196 were initially de-weighted remaining, 177 literature unrelated to the content of this study were excluded after reading the title abstract, and 14 literature were finally included after reading the full-text re-screening [8,9,10,11,12,13,14,15,16,17,18,19,20,21] , see Figure 1. A total of 14 studies [8,9,10,11,12,13,14,15,16,17,18,19,20,21] were included in this paper, from China and Malaysia; the published literature was from 2016-2022, of which 6 papers were included in the 2022 literature, which is relatively new. 1202 cases were included in the 14 papers, of which 602 cases were in the intervention group and 600 cases were in the control group.…”

“…The results of seven studies [9,10,11,13,14,19,21] showed the effect of OEP on balance function in hip/knee arthroplasty patients, with a total of 671 cases included. Since the equilibrium function was evaluated by the Berg scale, WMD was selected for the synthesis of effect size, the results were heterogeneous, (P<0.00001, I²=97%), and the random-effects model was selected for meta-analysis, and the pooled effect was statistically significant [WMD=6.2, 95%CI (2.97, 9.43), P=0.0002], and the forest plot was shown in Figure 4.…”

“…Since the equilibrium function was evaluated by the Berg scale, WMD was selected for the synthesis of effect size, the results were heterogeneous, (P<0.00001, I²=97%), and the random-effects model was selected for meta-analysis, and the pooled effect was statistically significant [WMD=6.2, 95%CI (2.97, 9.43), P=0.0002], and the forest plot was shown in Figure 4. After sensitivity analysis, the heterogeneity test was (P<0.00001, I²=90%) by excluding the study by Yu Qing [9] ; (P<0.00001, I²=97%) by excluding the study by Fan Linlin et al [19] ; and (P<0.00001, I²=97%) by excluding 2 studies at the same time. P=0.53, I²=0%), with less heterogeneity, and a fixedeffects model was selected for Meta-analysis, which showed that OEP improved the combined effect of balance in hip/knee arthroplasty patients with statistical significance [WMD=4.05, 95% CI (3.38,4.73), P<0.00001], and the forest plot is shown in Figure 5.…”

“…Five studies of knee function [9,12,14,17,19] showed the effect of OEP on knee function scores in patients undergoing hip/knee replacement. Since HSS was used to evaluate knee function, WMD was selected for the synthesis of effect size, and the results were heterogeneous, (P<0.00001, I²=86%), and the random-effects model was selected for meta-analysis, and the pooled effect was statistically significant [WMD=10.21, 95% CI (7.21, 13.22), P<0.0001], forest plot shown in Figure 7.…”

“…Since HSS was used to evaluate knee function, WMD was selected for the synthesis of effect size, and the results were heterogeneous, (P<0.00001, I²=86%), and the random-effects model was selected for meta-analysis, and the pooled effect was statistically significant [WMD=10.21, 95% CI (7.21, 13.22), P<0.0001], forest plot shown in Figure 7. After sensitivity analysis, the heterogeneity test was (P=0.92, I²=0%) with less heterogeneity by excluding the studies of Yu Qing [9] and Fan Linlin et al [19] , and the fixed-effect model was selected for Meta-analysis, which showed that OEP could promote hip/knee function recovery in patients with hip/knee replacement with a statistically significant combined effect [WMD=6.87,95% CI (4.52,9.23),P<0.00001], and the forest plot is shown in Figure 8.…”