Long-Term Functional Outcomes and Quality of Life at Minimum 10-Year Follow-Up After Fixed-Bearing Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty for Isolated Medial Compartment Osteoarthritis

Tan, Marcus Wei Ping; Ng, Stacy Wei Ling; Chen, Jerry; Liow, Ming Han Lincoln; Lo, Ngai Nung; Yeo, Seng Jin

doi:10.1016/j.arth.2020.10.049

Cited by 18 publications

(7 citation statements)

References 48 publications

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“…A mid‐term follow‐up study reported that the benefits of lower perioperative complication rate, improved return to function in UKA did not lead to any differences in satisfaction and PROMs between medial OA patients who underwent TKA or UKA. Both TKA and UKA result in significant improvements postoperatively, with a similar ratio who were clinically improved at 10 years postoperatively but had a similar time dependent decline in quality of life and knee function scores 10 . Another large sample study found that most UKA and TKA are appropriate solutions to treat patients with medial OA or osteonecrosis, but UKA has a higher chance of accepting revision surgery than TKA 11 .…”

Section: Introductionmentioning

confidence: 81%

Knee Scores of Patients with Non‐Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed‐Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial

Mayr

Zhang

et al. 2021

Orthopaedic Surgery

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Objective: To evaluate knee scores and clinical efficacies of patients with non-lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile-bearing (MB) unicompartmental knee arthroplasty (UKA), fixed-bearing (FB) UKA, and total knee arthroplasty (TKA).Methods: From September 2015 to February 2017, a prospective, randomized, parallel, single-center trial of 180 patients (78 males and 102 females; 63.3 AE 6.9 years) with non-lateral compartmental knee OA was performed in the first author-affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast-track surgery program was carried out for all patients. The knee scores at 3-year follow-up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared.Results: Primarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3-year follow-up (123.0 > 96.0 ) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0 > 96.0 ) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group. Conclusion:UKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non-lateral compartmental knee OA.

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Section: Introductionmentioning

confidence: 81%

Knee Scores of Patients with Non‐Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed‐Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial

Mayr

Zhang

et al. 2021

Orthopaedic Surgery

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“…The preceding low utilization of UKA may be attributed to high technical difficulty of manual UKA, concerns of osteoarthritis progression, high revision rates, and challenges reported with revising UKA to TKA. 27,28,[37][38][39][40][41][42][43][44] One would anticipate exposure and availability to newer technology combined with institutional enthusiasm to stimulate trial interest, which occurred, yet not all surgeons adopted this resource. The use of robotic arm-assisted technology has been shown to improve UKA outcomes by limiting unforgiving surgical errors and optimizing accuracy of bony resections and implant placement.…”

Section: Discussionmentioning

confidence: 99%

“…45,46 Unicompartmental KA has also demonstrated more rapid rehabilitation, greater range of motion, lower infection rates, and shorter hospital stays compared with primary TKA, all of which may decrease surgeon apprehension to perform UKA. 19,[39][40][41][42][43]45,46 Additionally, surgical indications have broadened to include select patients with anterior knee pain, patellofemoral arthritis, asymptomatic lateral meniscal pathology, obesity, and older patients, thus expanding the pool of potential candidates. 30,47,48 This information, combined with more recent attractive mid-term survivorship data for UKA of 96.7% and 98.4% at 5 years by Park and Burger et al, respectively, are significant improvements on past UKA results, lending further support for increased utilization of UKA in properly selected patients.…”

Section: Discussionmentioning

confidence: 99%

Robotic-Arm Assisted Technology’s Impact on Knee Arthroplasty and Associated Healthcare Costs

Kolessar

Hayes

Harding

et al. 2022

Journal of Health Economics and Outcomes Research

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Background: The number of total knee arthroplasties (TKA) carried out globally is expected to substantially rise in the coming decades. Consequently, focus has been increasing on improving surgical techniques and minimizing expenses. Robotic arm–assisted knee arthroplasty has garnered interest to reduce surgical errors and improve precision. Objectives: Our primary aim was to compare the episode-of-care cost up to 90 days for unicompartmental knee arthroplasty (UKA) and TKA performed before and after the introduction of robotic arm–assisted technology. The secondary aim was to compare the volume of UKA vs TKA. Methods: This was a retrospective study design at a single healthcare system. For the cost analysis, we excluded patients with bilateral knee arthroplasty, body mass index >40, postoperative infection, or noninstitutional health plan insurance. Costs were obtained through an integrated billing system and affiliated institutional insurance company. Results: Knee arthroplasty volume increased 28% after the introduction of robotic-assisted technology. The TKA volume increased by 17%, while the UKA volume increased 190%. Post introduction, 97% of UKA cases used robotic arm–assisted technology. The cost analysis included 178 patients (manual UKA, n = 6; robotic UKA, n = 19; manual TKA, n = 58, robotic TKA, n = 85). Robotic arm–assisted TKA and UKA were less costly in terms of patient room and operating room costs but had higher imaging, recovery room, anesthesia, and supply costs. Overall, the perioperative costs were higher for robotic UKA and TKA. Postoperative costs were lower for robotic arm–assisted surgeries, and patients used less home health and home rehabilitation. Discussion: Surgeons performed higher volumes of UKA, and UKA comprised a greater percentage of total surgical volume after the introduction of this technology. The selective cost analysis indicated robotic arm–assisted technology is less expensive in several cost categories but overall more expensive by up to $550 due to higher cost categories including supplies and recovery room. Conclusions: Our findings show a change in surgeons’ practice to include increased incidence and volume of UKA procedures and highlights several cost-saving categories through the use of robotic arm–assisted technology. Overall, robotic arm–assisted knee arthroplasty cost more than manual techniques at our institution. This analysis will help optimize costs in the future.

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“…General clinical data included incision length, operation time, blood loss, and postoperative drainage volume. The knee function scores included: HSS ( 11 ), JFS ( 12 ), and KOOS ( 13 ). KOOS has 42 items that are divided across 5 categories, with 0∼4 points assigned for each item.…”

Section: Methodsmentioning

confidence: 99%

The mid-term outcomes of mobile bearing unicompartmental knee arthroplasty versus total knee arthroplasty in the same patient

Zhang

Wang

et al. 2023

Front. Surg.

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ObjectiveTo compare the mid-term outcomes of unicompartmental knee arthroplasty (UKA) that was performed in one knee and total knee arthroplasty (TKA) performed in the other knee in the same stage.MethodsThis is a retrospective study. A total of 63 patients (126 knees) scheduled for one-stage knee surgery due to osteoarthritis of both knees were selected, and all patients underwent one-stage mobile platform UKA and TKA of the other knee. Differences in general clinical data, functional recovery, complications, and prosthesis revision rates were assessed after UKA and TKA, respectively. The evaluation indicators for knee joint function recovery included the hospital for special surgery knee score (HSS), Joint Forgotten Score (JFS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual analog scale (VAS). Patient preference between UKA and TKA was also recorded.ResultsDuring a mean follow-up of 76.95 months (range, 65.00 to 87.00 months), there were no significant differences in postoperative complications between the two groups (P = 0.299); however, the prosthesis revision rate was higher in the UKA group than in the TKA group (P = 0.023). The incision length, operation time, blood loss, and postoperative drainage volume in the UKA group were significantly (P < 0.001) lower than those in the TKA group: JFS, ROM, and VAS in the UKA group were higher than those in the TKA group (P < 0.001, P = 0.023, P = 0.032), HSS and KOOS in TKA group were significantly (P < 0.001) higher than those in UKA group. At the last follow-up, 40% and 24% of patients preferred TKA and UKA, respectively.ConclusionsTKA was found to be superior to UKA in terms of HSS, KOOS, and VAS, while UKA had more significant advantages in terms of less surgical trauma, better ROM, and higher JFS. Complications were not different between groups, but UKA had a higher rate of prosthesis revision. After a follow-up of at least 5 years, more patients preferred TKA.

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Long-Term Functional Outcomes and Quality of Life at Minimum 10-Year Follow-Up After Fixed-Bearing Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty for Isolated Medial Compartment Osteoarthritis

Cited by 18 publications

References 48 publications

Knee Scores of Patients with Non‐Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed‐Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial

Knee Scores of Patients with Non‐Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed‐Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial

Robotic-Arm Assisted Technology’s Impact on Knee Arthroplasty and Associated Healthcare Costs

The mid-term outcomes of mobile bearing unicompartmental knee arthroplasty versus total knee arthroplasty in the same patient

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