Unicompartmental versus total knee arthroplasty for knee osteoarthritis
- 131 Downloads
In the last couple of years, a significant amount of studies comparing the UKA and TKA for unicompartmental knee osteoarthritis have been published. However, there is a lack of recent meta-analysis comparing the two implants. Since the number of performed UKAs is currently increasing and the indications are obsolete, it becomes important to update current evidences and outcomes. With these premises, a meta-analysis of clinical trials comparing UKA versus TKA was conducted.
In October 2018, the following databases were accessed: Cochrane Systematic Reviews, Scopus, PubMed and Google Scholar. According to the Oxford Center of Evidence-based Medicine, level of evidence articles I to III were included. Only studies reporting quantitative data concerning the outcomes of interest were included. For the statistical analysis and the methodological quality assessment, we referred to the Review Manager Software 5.3. Dichotomous data were analyzed through the Mantel–Haenszel statistical method with the odd ratio effect measure. For continuous data, the inverse variance statistical method was used with the mean difference effect measure. A confidence interval of 95% was considered for analysis. To evaluate study heterogeneity, both Chi-square and Higgins tests were performed. Values of P < 0.05 were considered statistically significant.
The overall methodological quality assessment was moderate. The risk of publication’s bias was moderate. We enrolled in this study a total of 13,789 patients. The mean follow-up was 42.69 months. The UKA evidenced increased risk of revision’s surgeries (OR 2.16, P > 0.0001). All the other scores of interest were in favor of the UKA: Oxford Knee Score, KSS Clinical, WOMAC overall and related subscales. The UKA also reported better functional outcomes: KSS Function, longer walking distance, improvement of the joint flexion and ROM. Moreover, in the UKA group have been reported a shorter length of stay, reduced estimated total blood loss and shorter surgical duration.
The main findings of this meta-analysis are that UKA reported a reduced survivorship but better clinical and functional performances compared to TKA. Furthermore, shorter surgical duration, lower total estimated blood loss and quicker hospitalization length were observed in the UKA cohort.
KeywordsOsteoarthritis Unicompartimental knee arthroplasty Total knee arthroplasty UKA TKA Survivorship
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent is not required for this type of study.
- 2.Richmond J, Hunter D, Irrgang J, Jones MH, Snyder-Mackler L, Van Durme D, Rubin C, Matzkin EG, Marx RG, Levy BA, Watters WC 3rd, Goldberg MJ, Keith M, Haralson RH 3rd, Turkelson CM, Wies JL, Anderson S, Boyer K, Sluka P, St Andre J, McGowan R, Academy American, American Academy of Orthopaedic Surgeons (2010) American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am 92(4):990–993. https://doi.org/10.2106/JBJS.I.00982 CrossRefGoogle Scholar
- 8.Horikawa A, Miyakoshi N, Shimada Y, Kodama H (2015) Comparison of clinical outcomes between total knee arthroplasty and unicompartmental knee arthroplasty for osteoarthritis of the knee: a retrospective analysis of preoperative and postoperative results. J Orthop Surg Res 10:168. https://doi.org/10.1186/s13018-015-0309-2 CrossRefGoogle Scholar
- 9.Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ (2017) Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplasty 32(6):1792–1797. https://doi.org/10.1016/j.arth.2017.01.020 CrossRefGoogle Scholar
- 13.Lum ZC, Lombardi AV, Hurst JM, Morris MJ, Adams JB, Berend KR (2016) Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty. Bone Joint J 98-B(10 Supple B):28–33. https://doi.org/10.1302/0301-620x.98b10.bjj-2016-0414.r1 CrossRefGoogle Scholar
- 15.Zuiderbaan HA, van der List JP, Khamaisy S, Nawabi DH, Thein R, Ishmael C, Paul S, Pearle AD (2017) Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc 25(3):681–686. https://doi.org/10.1007/s00167-015-3868-1 CrossRefGoogle Scholar
- 18.Lombardi AV Jr., Berend KR, Berend ME, Della Valle CJ, Engh GA, Fitz W, Hurst JM, Jinnah RH, Lonner JH, Macaulay WB, Repicci JA, Scuderi GR (2012) Current controversies in partial knee arthroplasty. Instr Course Lect 61:347–381Google Scholar
- 20.Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med 3:e123–e130Google Scholar
- 21.Howick JCI, Glasziou P, Greenhalgh T, Carl H, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford CEBM Levels of Evidence. Oxford Centre for Evidence-Based Medicine. https://www.cebmnet/indexaspx?o=5653. Accessed Sept 2018
- 24.Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
- 26.Ko Y, Narayanasamy S, Wee HL, Lo NN, Yeo SJ, Yang KY, Yeo W, Chong HC, Thumboo J (2011) Health-related quality of life after total knee replacement or unicompartmental knee arthroplasty in an urban asian population. Value Health 14(2):322–328. https://doi.org/10.1016/j.jval.2010.08.005 CrossRefGoogle Scholar
- 27.Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 273:151–156Google Scholar
- 36.Yang KY, Wang MC, Yeo SJ, Lo NN (2003) Minimally invasive unicondylar versus total condylar knee arthroplasty—early results of a matched-pair comparison. Singap Med J 44(11):559–562Google Scholar
- 46.Springer BD, Scott RD, Thornhill TS (2006) Conversion of failed unicompartmental knee arthroplasty to TKA. Clin Orthop Relat Res 446:214–220. https://doi.org/10.1097/01.blo.0000214431.19033.fa CrossRefGoogle Scholar
- 49.Chatellard R, Sauleau V, Colmar M, Robert H, Raynaud G, Brilhault J, Societe d’Orthopedie et de Traumatologie de lO (2013) Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival? Orthop Traumatol Surg Res 99(4 Suppl):S219–S225. https://doi.org/10.1016/j.otsr.2013.03.004 CrossRefGoogle Scholar
- 54.Zhang Q, Zhang Q, Guo W, Liu Z, Cheng L, Yue D, Zhang N (2014) The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res 9:81. https://doi.org/10.1186/s13018-014-0081-8 CrossRefGoogle Scholar