Better Quality of Life After Medial Versus Lateral Unicondylar Knee Arthroplasty
- 530 Downloads
The number of unicompartmental knee arthroplasties (UKAs) is growing worldwide. Because lateral UKAs are performed much less frequently than medial UKAs, the limited information leaves unclear whether UKAs have comparable survival and health-related quality of life (HRQoL) of the lateral UKA to medial UKAs.
We therefore compared the (1) survivorship and (2) HRQoL after lateral versus medial cemented mobile-bearing UKAs and (3) determined whether there is an association of survival to modifications of surgical technique in one of three phases.
We retrospectively reviewed 558 patients who underwent mobile-bearing UKAs from 2002 to 2009. From the records we determined revision of the joint for any reason and revision for aseptic loosening. Patients reported their physical function, pain, and stiffness as measured by the WOMAC, SF-36 physical-component summary (PCS), and Lequesne knee score. Information regarding implant survival was collected for 93% of the patients. We analyzed the patients separately by three phases based on surgical changes associated with each phase (1: initial technique; 2: improved cementing; 3: additional bone resection to ensure backward sliding of the inlay without impingement). The minimum followup was 2.1 years (mean, 6 years; range, 2.1–9.8 years).
Implant survival was 88% at 9 years. We found similar implant survival rates for medial (90%) and lateral UKAs (83%). In all HRQoL measures, patients receiving a medial UKA had better mean scores compared with patients who had a lateral UKA: WOMAC physical function (23 versus 34, respectively) and pain (21 versus 34) and SF-36 PCS (41 versus 38). There were no survival differences by surgical phase.
Our observations suggest a medial UKA is associated with superior HRQoL when compared with a lateral UKA, although implant survival is similar.
Level of Evidence
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
- 3.Altuntas AO, Alsop H, Cobb JP. Early results of a domed tibia, mobile bearing lateral unicompartmental knee arthroplasty from an independent centre. Knee. 2012 Dec 28. pii: S0968-0160(12)00230-X. doi: 10.1016/j.knee.2012.11.008 [Epub ahead of print].
- 7.Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. 2009. Adelaide, Australia: Australian Orthopaedic Association. Available at: https://aoanjrr.dmac.adelaide.edu.au/de/annual-reports-2009. Accessed March 13, 2013.
- 8.Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. 2012. Adelaide, Australia: Australian Orthopaedic Association. Available at: https://aoanjrr.dmac.adelaide.edu.au/de/annual-reports-2012. Accessed March 13, 2013.
- 9.Barret M, Wilson E, Whalen D. Summary 2007 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. Report # 2010-03. Washington, DC, USA: Agency for Healthcare Research and Quality; September 9, 2010. HCUP Method Series Report.Google Scholar
- 10.Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
- 12.Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ, USA: Lawrence Erlbaum Associates Inc; 1988.Google Scholar
- 28.National Joint Registry for England and Wales. 9th Annual Report 2012. Hernel Hempstead, Hertfordshire, UK: NJR Centre; 2012.Google Scholar
- 29.NIH Consensus Panel. NIH Consensus Statement on Total Knee Replacement Dec 8–10, 2003. J Bone Joint Surg Am. 2004;86:1328–1335.Google Scholar
- 33.Sackett DL, Richardson WS, Rosenberg W. Evidence-based Medicine: How to Practice and Teach EBM. New York, NY, USA: Churchill Livingstone; 1997.Google Scholar