Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases

Abstract

Unicompartmental knee arthroplasty and total knee arthroplasty are well established treatment options for end-stage osteoarthritis, UKA still remains infrequently used if you take all knee arthroplasties into account. An important factor following knee arthroplasty is pain control in the perioperative experience, as high postoperative pain level is associated with persistent postsurgical pain. There is little literature which describes pain values and the need for pain medication following UKA and/or TKA. So far, no significant difference in pain has been found between UKA and TKA. The aim of the study was to evaluate differences in the postoperative course in unicompartmental knee arthroplasty vs. total knee arthroplasty regarding the need for pain medication and patient-reported outcomes including pain scores and side effects. We hypothesized that unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of postoperative pain values and the need of pain medication. In this project, we evaluated 2117 patients who had unicompartmental knee arthroplasty and 3798 who had total knee arthroplasty performed, from 2015 to 2018. A total of 4144 patients could be compared after performing the matched pair analysis. A professional team was used for data collection and short patient interviews to achieve high data quality on the first postoperative day. Parameters were compared after performing a 1:1 matched pair analysis, multicenter-wide in 14 orthopedic departments. Pain scores were significantly lower for the UKA group than those of the TKA group (p < 0.001 respectively for activity pain, minimum and maximum pain). In the recovery unit, there was less need for pain medication in patients with UKA (p = 0.004 for non-opioids). The opiate consumption was similarly lower for the UKA group, but not statistically significant (p = 0.15). In the ward, the UKA group needed less opioids (p < 0.001). Patient subjective parameters were significantly better for UKA. After implantation of unicompartmental knee arthroplasty, patients showed lower pain scores, a reduced need for pain medication and better patient subjective parameters in the early postoperative course in this study.

The Effects of Periarticular Injection Cocktail in Postoperative Analgesia after Bilateral Unicompartmental Knee Arthroplasty

“…Compared with TKA, UKA has shorter operation time, less surgical trauma, shorter operation, and anesthesia time, all of which conform to the promotion of ERAS concept [ 2 , 4 ]. Leiss et al [ 11 ] compared the parameters after performing a 1 : 1 matched pair analysis, multicenter-wide in 14 orthopedic departments. Pain scores were significantly lower for the UKA group than those for the TKA group.…”

“…The implementation of the double-side single condylar knee arthroplasty can effectively reduce the patient's bleeding and hospital stay and less postoperative morbidity [ 8 , 9 ]. UKA allows patients to return to function more quickly than TKA, but postoperative pain management remains a challenge because there is no significant difference in pain [ 10 , 11 ].…”

Cerebral mechanism of opposing needling for managing acute pain after unilateral total knee arthroplasty: study protocol for a randomized, sham-controlled clinical trial

“…In recent years, pain management has been widely used in the perioperative period as a core concept of accelerated rehabilitation surgery [ 54 , 55 ]. Optimal postoperative pain management can effectively prevent and reduce adverse reactions and stress reactions.…”

Mobile Bearing versus Fixed Bearing for Unicompartmental Arthroplasty in Monocompartmental Osteoarthritis of the Knee: A Meta-Analysis

“…Advanced monocompartmental knee OA impairs quality of life and participation in recreational activities [ 2 , 3 ]. Patients with end-stage monocompartmental OA, along with competent cruciate ligaments, varus deformity <5°, range of motion (ROM) greater than 90° without flexion contracture, and body mass index (BMI) <30 kg/m 2 , are candidates for unicompartmental knee arthroplasty (UKA) [ 4 , 5 , 6 , 7 ]. Mobile-bearing (MB) and fixed-bearing (FB) implants are routinely used for UKA [ 8 , 9 , 10 ].…”