Unicompartmental Knee Arthroplasty Provides Significantly Greater Improvement in Function than Total Knee Arthroplasty Despite Equivalent Satisfaction for Isolated Medial Compartment Osteoarthritis

Casper, David S.; Fleischman, Andrew N.; Papas, Paraskevi Vivian; Grossman, Jamie M.; Scuderi, Giles R.; Lonner, Jess H.

doi:10.1016/j.arth.2019.04.005

“…First, the UKR in previous studies could be constrained by techniques at that time, to a large extent, not as good as the present techniques. This could lead to the high revision rate of UKR since it is in consensus that surgical proficiency was inversely proportional to UKR revision rate in published studies [26,39,40]. The results in this study were obtained from the latest studies with the most up-to-date techniques and the impact of learning curves of UKR can be significantly minimized.…”

Section: Discussionmentioning

confidence: 92%

“…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%

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

Deng

¹

,

Hu

²

,

Zhang

³

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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“…Presently, UKA serves as a viable surgical alternative to total knee arthroplasty (TKA) when joint degeneration is limited to either the medial or lateral tibiofemoral compartment. Though UKA has undergone periods of criticism since its inception, namely, questioning its survival in comparison to TKA [ 4 , 5 ], it may offer faster recovery [ 6 , 7 , 8 ], reduced complication rates [ 7 , 8 , 9 , 10 ], improved patient-reported functional outcomes [ 11 , 12 , 13 ], and a more normal feeling knee [ 14 , 15 ] in appropriately selected patients. The importance of continuing to study UKA and its technological developments is highlighted by the significant and increasing healthcare burden that osteoarthritis (OA) poses across the world and the increasing number of patients with OA-related knee disorders who seek to maintain a high level of activity [ 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty

Pumilia

¹

,

Schroeder

²

,

Sarpong

³

et al. 2021

JPM

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Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1–3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1–8.7) and 97.9% at an average of 4.8 years (range: 2.0–8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were “very satisfied,” 26% were “satisfied,” 4% were “neutral,” 2% were “dissatisfied,” and 1% were “very dissatisfied.” When asked if the knee felt “natural,” 60% responded with “always,” 35% responded with “sometimes,” and 5% responded with “never.” After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.

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“…Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) in patients with osteoarthritis (OA) localized to a single tibiofemoral compartment of the knee [1][2][3]. UKA has several potential advantages over TKA including faster recovery times, superior postoperative function, more physiological gait, shorter hospital stay, lower blood loss, decreased postoperative morbidity, reduced postoperative opioid consumption, and lower perioperative costs [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations

Crizer

¹

,

Haffar

²

,

Battenberg

³

et al. 2021

Advances in Orthopedics

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Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR.), VR/SF-12, Visual Analog Scale (VAS) pain scores, and perioperative opioid consumption. Patients in the robotic cohort had superior early functional outcomes, with greater LEFS (conventional = 23; robotic = 31) at 1 week post-op p = 0.015 and KOOS-JR (conventional = 74; robotic = 81) at up to 6 months post-op p = 0.037 ; these two values remained statistically significant after mixed-model regression analysis p = 0.010 ; p = 0.023 , respectively. At 1 year post-op, expectations were more likely to be met in those who received robotic assistance p = 0.06 . No differences were reported with respect to postoperative opioid usage p = 0.320 , reoperations p = 1.00 , and complications p = 0.628 . Robotic-assisted UKA resulted in more rapid recovery and less early postoperative pain and were more likely to meet expectations than conventional UKA, although functional differences equilibrated by 1 year postoperatively. Further follow-up is necessary to determine if implant durability is impacted by robotics.

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Unicompartmental Knee Arthroplasty Provides Significantly Greater Improvement in Function than Total Knee Arthroplasty Despite Equivalent Satisfaction for Isolated Medial Compartment Osteoarthritis

Cited by 56 publications

References 24 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

Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty

Robotic Assistance in Unicompartmental Knee Arthroplasty Results in Superior Early Functional Recovery and Is More Likely to Meet Patient Expectations

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