Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review
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Due to the lack of comparative studies, a systematic review was conducted to determine revision rates of unicompartmental and total knee arthroplasty (UKA and TKA), and compare functional outcomes, range of motion and activity scores in patients less than 65 years of age.
A literature search was performed using PubMed, Embase, and Cochrane systems since 2000. 27 UKA and 33 TKA studies were identified and included. Annual revision rate (ARR), functional outcomes, and return to activity were assessed for both types of arthroplasty using independent t tests.
Four level I studies, 12 level II, 16 level III, and 29 level IV were included, which reported on outcomes in 2224 UKAs and 4737 TKAs. UKA studies reported 183 revisions, yielding an ARR of 1.00 and extrapolated 10-year survivorship of 90.0%. TKA studies reported 324 TKA revisions, resulting in an ARR of 0.53 and extrapolated 10-year survivorship of 94.7%. Functional outcomes scores following UKA and TKA were equivalent, however, following UKA larger ROM (125° versus 114°, p = 0.004) and higher UCLA scores were observed compared to TKA (6.9 versus 6.0, n.s.).
These results show that good-to-excellent outcomes can be achieved following UKA and TKA in patients less than 65 years of age. A higher ARR was noted following UKA compared to TKA. However, improved functional outcomes, ROM and return to activity were found after UKA than TKA in this young population. Comparative studies are needed to confirm these findings and assess factors contributing to failure at the younger patient population. Outcomes of UKA and TKA in patients younger than 65 years are both satisfying, and therefore, both procedures are not contraindicated at younger age. UKA has several important advantages over TKA in this young and frequently more active population.
Level of evidence
KeywordsAge Survivorship Annual revision rate Functional outcomes Range of motion Unicompartmental knee arthroplasty Total knee arthroplasty
We would like to thank Kara Fields from the Healthcare Research Institute for her assistance in the statistical analysis of this study.
LK performed the literature search, scanned all abstracts and full texts of the included articles and wrote the manuscript. JL screened all abstracts and full texts as a second author, helped to draft the manuscript. HA determined the quality of all included studies and helped to draft the manuscript. AP coordinated this study, participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
Andrew D. Pearle is a consultant and receives research support from Stryker Corp, and has royalties from Zimmer Biomet. The other authors declare that they have no conflict of interests.
No funding has been received for this study.
No ethical approval was obtained, because this study was a systematic review using de-identified data from other cohort studies.
Informed consent was not applicable for this study.
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