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Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis

  • Knee Arthroplasty
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Abstract

Introduction

The role of unicompartmental knee arthroplasty (UKA) in spontaneous osteonecrosis of the knee (SONK) remains controversial, even though SONK involves only one compartment of the knee joint. We aimed to compare the survival rate and clinical outcomes of UKA in SONK and medial compartment osteoarthritis (MOA) via a meta-analysis of previous studies.

Materials and methods

MEDLINE, Embase, and Cochrane Library were searched up to January 2018 with keywords related to SONK and knee arthroplasty. Studies were selected with predetermined inclusion criteria: (1) medial UKA as the primary procedure, (2) reporting implant survival or clinical outcomes of osteonecrosis and osteoarthritis, and (3) follow-up period > 1 year. Quality assessment was performed using the risk of bias assessment tool for non-randomized studies. A random-effects model was used to estimate the pooled relative risk (RR) and standardized mean difference.

Results

The incidence of UKA revision for any reason was significantly higher in SONK than in MOA group (pooled RR = 1.83, p = 0.009). However, the risk of revision due to aseptic loosening was not significantly different between the groups. Moreover, when stratified by the study quality, high-quality studies showed similar risk of overall revision in SONK and MOA (p = 0.71). Subgroup analysis revealed no significant difference in failure between SONK and MOA after cemented mobile and fixed bearing UKA. Results of uncemented UKA were reported only in one study, which showed higher failure of SONK compared to MOA. Clinical outcomes after UKA were similar between SONK and MOA (p = 0.66).

Conclusions

Cemented UKA has similar survival and clinical outcomes in SONK and MOA. Prospective studies designed specifically to compare the UKA outcomes in SONK and MOA are necessary.

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Funding

This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (2017M3A9D8063538).

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Author notes

  1. Chan Yoon and Moon Jong Chang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea

    Chan Yoon

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea

    Moon Jong Chang, Chong Bum Chang, Ji Hye Choi & Seung-Baik Kang

  3. Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea

    Seung Ah Lee

  4. Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea

    Chong Bum Chang & Seung-Baik Kang

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  1. Chan Yoon
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Correspondence to Seung-Baik Kang.

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Yoon, C., Chang, M.J., Chang, C.B. et al. Does unicompartmental knee arthroplasty have worse outcomes in spontaneous osteonecrosis of the knee than in medial compartment osteoarthritis? A systematic review and meta-analysis. Arch Orthop Trauma Surg 139, 393–403 (2019). https://doi.org/10.1007/s00402-019-03125-7

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