Higher Function Scores and Satisfaction in Patients with Anteromedial Osteoarthritis Compared with Other Wear Patterns of the Knee: 2 Years after Both Total and Unicondylar Knee Arthroplasties

Abstract

Anteromedial osteoarthritis (AMOA) is a common wear pattern in primary osteoarthritic knees. In patients with bone-on-bone disease, the most appropriate surgical intervention is still a matter of debate. Knee arthroplasty is a well-accepted treatment to relieve symptoms and regain function. Unfortunately, satisfaction is limited, especially related to activities. A cross-sectional study was performed among patients treated with total knee arthroplasty (TKA) and unicondylar arthroplasty (UKA) to determine if the osteoarthritis wear pattern or type of prosthesis affects knee-specific function scores and satisfaction related to activities. All UKA patients (N = 100) were treated for AMOA. Based on radiological assessment of the wear pattern, TKA patients were divided into two groups: TKA for AMOA (N = 68) and true TKA (N = 99). The Knee injury and Osteoarthritis Outcomes Score (KOOS), new Knee Society score (KSS), anterior knee pain scale, visual analog scales (VASs) for satisfaction about activities, and net promoter score were collected. After 2 years' follow-up, the anterior knee pain scale and VAS satisfaction showed significantly better scores for patients treated with TKA for AMOA compared with the true TKA group. Also in the KOOS subscales, some differences were seen in favor of the TKA for AMOA group. The new KSS was not in favor of a specific wear pattern, but patients with AMOA treated with UKA performed better on the symptoms subscale compared with patients treated with TKA. In conclusion, patients treated with TKA for AMOA showed better knee-specific function scores and satisfaction scores compared with patients treated with TKA for other wear patterns, and only slight differences were found between both the AMOA groups (TKA for AMOA and UKA). Thus, the radiologic assessment of wear patterns might be useful to take into account the shared decision-making process, when discussing expectations, timing, and outcomes with knee osteoarthritis patients considering knee arthroplasty. When AMOA is present, it might be beneficial to choose UKA over TKA.

Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: a systematic review and meta-analysis

“…After screening the titles and abstracts, 44 related studies were first screened out. After conducting a full-text review on the remaining studies, 13 studies were left in the final analysis, including 4 RCTs and 9 non-RCTs (cohort and case-control studies) [3,5,9,12,13,[23][24][25][26][27][28][29][30].…”

“…UKR accounts for only 9% of all knee replacements in the UK [3]. On the contrary, TKR is a widely accepted, reliable, cost-effective and suitable surgical method for patients with end-stage OA targeting at pain reduction, function restoration and improvement of healthrelated life quality [9,10]. Despite these positive effects, 17-19% of patients were dissatisfied after TKR [11].…”

Partial versus total knee arthroplasty for isolated antero-medial osteoarthritis – An analysis of PROMs and satisfaction

“…Previous studies have evaluated differences in objective functional outcome scores (Knee Society Score or HSS score) and most studies have reported comparable outcomes [ 11 , 13 – 15 ]. Only a few studies have reported patient-reported outcomes (PROMs) [ 16 – 18 ]. To the best of our knowledge, there is only one study published, that objectively compares patellofemoral symptoms, reporting the incidence of anterior knee pain and the Anterior Knee Pain Score (AKPS), after either procedure [ 18 ].…”

“…Only a few studies have reported patient-reported outcomes (PROMs) [ 16 – 18 ]. To the best of our knowledge, there is only one study published, that objectively compares patellofemoral symptoms, reporting the incidence of anterior knee pain and the Anterior Knee Pain Score (AKPS), after either procedure [ 18 ].…”

Safety and Efficacy of Single Condylar Knee Prosthesis When Treating Knee Single Compartment Osteoarthritis: A Prospective, Case-Randomized Controlled Study

“…It accounts for about half of all patients with knee osteoarthritis. However, at present, for some patients with medial compartment, whether it is suitable for direct total knee arthroplasty, there are still objections at home and abroad [13][14][15]. For this reason, as early as the late 1960s, some scholars had proposed a surgical treatment for single compartment osteoarthritis of the knee joint, which was called single condylar replacement [16].…”