Postoperative outcomes of total knee arthroplasty compared to unicompartmental knee arthroplasty: A matched comparison

Blevins, Jason L.; Carroll, Kaitlin M.; Burger, Joost A.; Pearle, Andrew D.; Bostrom, Mathias P.; Haas, Steven B.; Sculco, Thomas P.; Jerabek, Seth A.; Mayman, David J.

doi:10.1016/j.knee.2019.12.005

Cited by 28 publications

(29 citation statements)

References 38 publications

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“…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].…”

Section: Study Selectionmentioning

confidence: 99%

“…Despite these positive effects, 17-19% of patients were dissatisfied after TKR [11]. Lyons et al reported that the UKR survival rates were 95% and 90% over 5 and 10 years respectively in a large retrospective database analysis, which are lower than that of TKR [12]. In contrast, a recent report found that 432 medial UKR patients had a survival rate of up to 97.5% over an average follow-up of 5.7 years [7].…”

Section: Introductionmentioning

confidence: 99%

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

Deng

Zhang

et al. 2021

Arch Orthop Trauma Surg

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Background Since the optimal surgery for isolated medial knee osteoarthritis (OA) is unclear, this study aimed at comparing the effectiveness of unicondylar knee replacement (UKR) with total knee replacement (TKR) for simple medial knee OA. Methods Literature searches of PubMed, Embase, Web of Science, and the Cochrane Library were searched up to 1th April 2020. Only studies comparing UKR with TKR for isolated medial knee OA were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results A total of 13 articles with 1888 patients were included, among which, 944 and 944 underwent UKR and TKR, respectively. The analyzed postoperative outcomes were mostly within 5 years of follow-up. The meta-analysis showed that UKR improved knee general function (P < 0.00001) and health (P = 0.02), moreover, reduced post-operative pain (P = 0.01) and complications (P < 0.05) more than TKR. There were no significant differences in postoperative revision (P = 0.252), high-activity arthroplasty score (HAAS) (P = 0.307) and Oxford knee score (OKS) (P = 0.15) between the two techniques. Conclusions The patients of UKR could achieve better clinical results than that of TKR, moreover, there were negligible differences between the two techniques in postoperative revision in the early and mid-term follow-up and surgeons should be aware of the important reasons for revision of UKR. Thus, UKR instead of TKR should be performed in patients with late-stage isolated medial knee OA.

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Section: Study Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Deng

Zhang

et al. 2021

Arch Orthop Trauma Surg

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“…The results of our study with better function in the UKA group are consistent with prior matched-pair studies. Blevins et al observed that UKA patients suffered less postoperative pain, achieved a higher KSS and were able to return to their workplace sooner than patients receiving TKA [ 17,18 ]. Hauer et al found an improvement in the Tegner Activity Scale (TAS) and a better ROM [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Better Short-term Function After Unicompartmental Compared to Total Knee Arthroplasty

Tille¹,

Beyer²,

Auerbach

et al. 2020

Preprint

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BackgroundUnicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite these facts and it’s proven cost-effectiveness, there are hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported-outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA. MethodsTo assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction were evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)).For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient´s age, BMI and comorbidities. A total of 116 matched-pairs were analysed. ResultsThere was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%).Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019).ConclusionPatients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA. Trial registrationClinicaltrials.gov, NCT04598568. Registered 22 October 2020 - Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/record/NCT04598568?cond=balanSys+Uni&draw=2&rank=1

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“…Furthermore, Siman et al [5] compared UKA with total knee arthroplasty (TKA) in elderly patients (aged ≥75 years) with isolated medial compartmental arthritis and reported that the postoperative Knee Society Score of UKA was unfortunately equivalent to that of TKA. In contrast, some studies reported that the clinical outcomes of UKA were superior to those of TKA over wide age ranges, including elderly patients [6][7][8]. Therefore, the clinical results after UKA in elderly patients could be inferior to those in nonelderly patients.…”

Section: Introductionmentioning

confidence: 96%

Intraoperative Rotational Kinematics and Its Influence on Postoperative Clinical Outcomes Differ According to Age in Unicompartmental Knee Arthroplasty

Kawaguchi

Inui

Taketomi

et al. 2021

Preprint

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Background: Although Oxford unicompartmental knee arthroplasty (UKA) is used in patients of wide age ranges, there is no clear information regarding the age differences in terms of intraoperative femorotibial rotational kinematics and its influence on clinical outcomes. Therefore, this study was conducted to examine the age differences in terms of postoperative clinical outcomes and intraoperative rotational kinematics and to analyze their relationship with classification according to the age group.Methods: We investigated 111 knees of patients who underwent Oxford UKA using a navigation system and divided them into two groups: elderly (aged ≥75 years; 48 knees) and nonelderly (aged <75 years; 63 knees). Intraoperative tibial internal rotational angles relative to the femur during passive knee flexion were measured using a navigation system, and clinical outcomes were evaluated using knee range of motion, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Knee Society Functional Score at 2 years postoperatively. The relationships between intraoperative tibiofemoral rotational angles and clinical outcomes were also evaluated in the two groups. Results: The intraoperative tibial internal rotational angle relative to the femur during knee flexion was significantly larger in the nonelderly group (13.5°) than in the elderly group (9.0°). The intraoperative tibial internal rotational angle showed a positive correlation with the pain subscale of KOOS only in the nonelderly group. Conclusion: Intraoperative rotational kinematics and its influence on clinical outcomes were different between elderly and nonelderly patients, and the tibial internal rotational angle could be a more important factor for successful UKA in nonelderly patients.

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Postoperative outcomes of total knee arthroplasty compared to unicompartmental knee arthroplasty: A matched comparison

Cited by 28 publications

References 38 publications

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

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

Better Short-term Function After Unicompartmental Compared to Total Knee Arthroplasty

Intraoperative Rotational Kinematics and Its Influence on Postoperative Clinical Outcomes Differ According to Age in Unicompartmental Knee Arthroplasty

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