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Outcomes of Bi-unicompartmental Versus Total Knee Arthroplasty for the Treatment of Medial and Lateral Knee Osteoarthritis: A Systematic Review and Meta-analysis of Comparative Studies

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Abstract

Purpose

The aim of this meta-analysis was to evaluate differences in functional outcomes between simultaneous bi-unicompartmental knee arthroplasty (Bi-UKA) and total knee arthroplasty (TKA) for the treatment of medial and lateral knee osteoarthritis.

Material and Methods

According to the PRISMA statement, a comprehensive search was conducted to identify studies reporting comparative results of the Bi-UKA versus the TKA. Of 953 titles, 6 studies met the inclusion criteria.

Results

A total of 286 patients were identified, of which 137 underwent Bi-UKA and 149 TKA. TKA reported a mean hip-knee-ankle (HKA) angle of 179.4 ± 2.4 compared to that in Bi-UKA measuring 177.2 ± 2.7 (p = 0.0001, 95% CI − 3.02 to − 1.38). No difference was found in the Western Ontario and McMaster Universities (WOMAC) pain (4 ± 1.6 and 4.2 ± 1.3 for Bi-UKA and TKA, respectively; p = 0.4996, 95% CI − 0.86 to 0.43). Bi-UKA was favorable in terms of WOMAC function (7.5 ± 1.9 and 9 ± 1.9 for Bi-UKA and TKA, respectively; p = 0.001, 95% CI − 2.29 to − 0.61) and WOMAC stiffness (1.6 ± 1 and 2.4 ± 0.7 for Bi-UKA and TKA, respectively; p = 0.0001, 95% CI − 1.18 to − 0.42). Bi-UKA showed a better Knee Society Score (KSS) in comparison to TKA (79.7 ± 7.8 and 75.4 ± 10.5 for Bi-UKA and TKA, respectively; p = 0.0021, 95% CI 1.58–7.02). The differences in postoperative outcomes scores between Bi-UKA and TKA were lower than their respective minimum clinically important differences.

Conclusions

When Bi-UKA and TKA are compared for the treatment of medial and lateral knee osteoarthritis, Bi-UKA are favorable in terms of WOMAC and KSS even though these values are lower than the minimum clinically important differences; moreover, similar postoperative hip-knee-ankle angle can be expected 3 years after Bi-UKA and TKA.

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References

  1. Argenson, J.-N.A., Blanc, G., Aubaniac, J.-M., & Parratte, S. (2013). Modern unicompartmental knee arthroplasty with cement: A concise follow-up, at a mean of twenty years, of a previous report. Journal of Bone and Joint Surgery. American Volume, 95, 905–909. https://doi.org/10.2106/JBJS.L.00963

    Article  PubMed  Google Scholar 

  2. Winnock de Grave, P., Barbier, J., Luyckx, T., et al. (2018). Outcomes of a fixed-bearing, medial, cemented unicondylar knee arthroplasty design: survival analysis and functional score of 460 cases. Journal of Arthroplasty, 33, 2792–2799. https://doi.org/10.1016/j.arth.2018.04.031

    Article  PubMed  Google Scholar 

  3. Beard, D. J., Davies, L. J., Cook, J. A., et al. (2019). The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet Lond Engl, 394, 746–756. https://doi.org/10.1016/S0140-6736(19)31281-4

    Article  Google Scholar 

  4. Seo, S.-S., Kim, C.-W., Lee, C.-R., et al. (2019). Long-term outcomes of unicompartmental knee arthroplasty in patients requiring high flexion: An average 10-year follow-up study. Archives of Orthopaedic and Trauma Surgery, 139, 1633–1639. https://doi.org/10.1007/s00402-019-03268-7

    Article  PubMed  Google Scholar 

  5. Hauer, G., Sadoghi, P., Bernhardt, G. A., et al. (2020). Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: A comparative case-control study. Archives of Orthopaedic and Trauma Surgery, 140, 231–237. https://doi.org/10.1007/s00402-019-03296-3

    Article  PubMed  Google Scholar 

  6. Lyons, M. C., MacDonald, S. J., Somerville, L. E., et al. (2012). Unicompartmental versus total knee arthroplasty database analysis: Is there a winner? Clinical Orthopaedics, 470, 84–90. https://doi.org/10.1007/s11999-011-2144-z

    Article  Google Scholar 

  7. Gunston, F. H. (1971). Polycentric knee arthroplasty. Prosthetic simulation of normal knee movement. Journal of Bone and Joint Surgery. British Volume, 53, 272–277.

    Article  CAS  Google Scholar 

  8. Goodfellow, J. W., & O’Connor, J. (1986). Clinical results of the Oxford knee. Surface arthroplasty of the tibiofemoral joint with a meniscal bearing prosthesis. Clinical Orthopaedics and Related Research, 205, 21–42.

    Article  Google Scholar 

  9. Pandit, H., Mancuso, F., Jenkins, C., et al. (2017). Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement. Knee Surgery, Sports Traumatology, Arthroscopy, 25, 669–674. https://doi.org/10.1007/s00167-016-4075-4

    Article  CAS  PubMed  Google Scholar 

  10. Heekin, R., & Fokin, A. (2013). Incidence of bicompartmental osteoarthritis in patients undergoing total and unicompartmental knee arthroplasty: is the time ripe for a less radical treatment? The Journal of Knee Surgery, 27, 077–082. https://doi.org/10.1055/s-0033-1349401

    Article  Google Scholar 

  11. Moher, D., Liberati, A., Tetzlaff, J., et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ, 339, b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  12. Grappiolo, G., Bruno, C. F., Loppini, M., et al. (2020). Conversion of fused hip to total hip arthroplasty: long-term clinical and radiological outcomes. Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2020.09.030

    Article  PubMed  Google Scholar 

  13. Salaffi, F., Leardini, G., Canesi, B., et al. (2003). Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage, 11, 551–560. https://doi.org/10.1016/s1063-4584(03)00089-x

    Article  CAS  PubMed  Google Scholar 

  14. Insall, J. N., Dorr, L. D., Scott, R. D., & Scott, W. N. (1989). Rationale of the Knee Society clinical rating system. Clinical Orthopaedics and Related Research, 248, 13–14.

    Article  Google Scholar 

  15. Mercurio, M., Gasparini, G., Carbone, E. A., et al. (2020). Personality traits predict residual pain after total hip and knee arthroplasty. International Orthopaedics, 44, 1263–1270. https://doi.org/10.1007/s00264-020-04553-6

    Article  PubMed  Google Scholar 

  16. Wells, G., Wells, G., & Shea, B. et al. (2014). The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. undefined

  17. Galasso, O., Gasparini, G., De Benedetto, M., et al. (2012). Tenotomy versus tenodesis in the treatment of the long head of biceps brachii tendon lesions. BMC Musculoskeletal Disorders, 13, 205. https://doi.org/10.1186/1471-2474-13-205

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sterne, J. A. C., Savović, J., Page, M. J., et al. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  19. Familiari, F., Castricini, R., Galasso, O., et al. (2021). The 50 highest cited papers on rotator cuff tear. Arthroscopy, 37, 61–68. https://doi.org/10.1016/j.arthro.2020.07.044

    Article  PubMed  Google Scholar 

  20. Slavin, R. E. (1995). Best evidence synthesis: An intelligent alternative to meta-analysis. Journal of Clinical Epidemiology, 48, 9–18. https://doi.org/10.1016/0895-4356(94)00097-a

    Article  CAS  PubMed  Google Scholar 

  21. van Tulder, M., Furlan, A., Bombardier, C., et al. (2003). Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine, 28, 1290–1299. https://doi.org/10.1097/01.BRS.0000065484.95996.AF

    Article  PubMed  Google Scholar 

  22. Fanelli, D., Mercurio, M., Gasparini, G., & Galasso, O. (2021). Predictors of meniscal allograft transplantation outcome: a systematic review. The Journal of Knee Surgery, 34, 303–321. https://doi.org/10.1055/s-0039-1695043

    Article  PubMed  Google Scholar 

  23. Mercurio, M., Castioni, D., Iannò, B., et al. (2019). Outcomes of revision surgery after periprosthetic shoulder infection: A systematic review. Journal of Shoulder and Elbow Surgery. https://doi.org/10.1016/j.jse.2019.02.014

    Article  PubMed  Google Scholar 

  24. Banger, M. S., Johnston, W. D., Razii, N., et al. (2020). Robotic arm-­assisted bi-­unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized. The Bone & Joint Journal, 102, 8.

    Google Scholar 

  25. Biazzo, A., Manzotti, A., & Confalonieri, N. (2018). Bi-unicompartmental versus total knee arthroplasty: Long term results. Acta Orthopaedica Belgica, 84, 237–244.

    PubMed  Google Scholar 

  26. Confalonieri, N., Manzotti, A., Cerveri, P., & De Momi, E. (2009). Bi-unicompartmental versus total knee arthroplasty: A matched paired study with early clinical results. Archives of Orthopaedic and Trauma Surgery, 129, 1157–1163. https://doi.org/10.1007/s00402-008-0713-8

    Article  CAS  PubMed  Google Scholar 

  27. Dettmer, M., & Kreuzer, S. W. (2015). Bi-unicompartmental, robot-assisted knee arthroplasty. Operative Techniques in Orthopaedics, 25, 155–162. https://doi.org/10.1053/j.oto.2015.03.004

    Article  Google Scholar 

  28. Fuchs, S., Tibesku, C. O., Genkinger, M., et al. (2004). Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement. Clinical Biomechanics, 19, 263–269. https://doi.org/10.1016/j.clinbiomech.2003.11.004

    Article  CAS  PubMed  Google Scholar 

  29. Blyth, M. J. G., Banger, M. S., Doonan, J., et al. (2021). Early outcomes after robotic arm-assisted bi-unicompartmental knee arthroplasty compared with total knee arthroplasty: a prospective, randomized controlled trial. Bone Jt J, 103B, 1561–1570. https://doi.org/10.1302/0301-620X.103B10.BJJ-2020-1919.R2

    Article  Google Scholar 

  30. Moreland, J. R., Bassett, L. W., & Hanker, G. J. (1987). Radiographic analysis of the axial alignment of the lower extremity. Journal of Bone and Joint Surgery. American Volume, 69, 745–749.

    Article  CAS  Google Scholar 

  31. Winnock de Grave, P., Luyckx, T., Claeys, K., et al. (2020). Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment. Knee Surgery, Sports Traumatology, Arthroscopy. https://doi.org/10.1007/s00167-020-06165-4

    Article  PubMed  PubMed Central  Google Scholar 

  32. Leiss, F., Götz, J. S., Maderbacher, G., et al. (2020). Pain management of unicompartmental (UKA) vs total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases. Scientific Reports, 10, 17660. https://doi.org/10.1038/s41598-020-74986-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Leopold, S. S., & Porcher, R. (2017). Editorial: The minimum clinically important difference-the least we can do. Clinical Orthopaedics, 475, 929–932. https://doi.org/10.1007/s11999-017-5253-5

    Article  Google Scholar 

  34. Clement, N. D., Bardgett, M., Weir, D., et al. (2018). What is the minimum clinically important difference for the WOMAC Index after TKA? Clinical Orthopaedics, 476, 2005–2014. https://doi.org/10.1097/CORR.0000000000000444

    Article  Google Scholar 

  35. Lizaur-Utrilla, A., Gonzalez-Parreño, S., Martinez-Mendez, D., et al. (2020). Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 1473–1478. https://doi.org/10.1007/s00167-019-05543-x

    Article  PubMed  Google Scholar 

  36. Al-Dadah, O., Hawes, G., Chapman-Sheath, P. J., et al. (2020). Unicompartmental vs segmental bicompartmental vs total knee replacement: comparison of clinical outcomes. Knee Surgery & Related Research, 32, 47. https://doi.org/10.1186/s43019-020-00065-0

    Article  Google Scholar 

  37. Parratte, S., Pauly, V., Aubaniac, J.-M., & Argenson, J.-N.A. (2010). Survival of bicompartmental knee arthroplasty at 5 to 23 years. Clinical Orthopaedics, 468, 64–72. https://doi.org/10.1007/s11999-009-1018-0

    Article  Google Scholar 

  38. Dobrescu, A. I., Nussbaumer-Streit, B., Klerings, I., et al. (2021). Restricting evidence syntheses of interventions to English-language publications is a viable methodological shortcut for most medical topics: A systematic review. Journal of Clinical Epidemiology, 137, 209–217. https://doi.org/10.1016/j.jclinepi.2021.04.012

    Article  CAS  PubMed  Google Scholar 

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V. le Europa, 88100, Catanzaro, Italy

    Michele Mercurio, Giorgio Gasparini, Filippo Familiari, Davide Castioni & Olimpio Galasso

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  1. Michele Mercurio
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  3. Filippo Familiari
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  5. Olimpio Galasso
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Contributions

Each author fulfils each of the authorship requirements. MM conceived and designed the study, performed the statistical analysis, participated in the acquisition and interpretation of data, and drafted the manuscript; GG conceived and coordinated the study and approved the final version of the manuscript as submitted; FF participated in the design of the study, in the acquisition and interpretation of data and drafted the manuscript; DC participated in the acquisition of data and drafted the manuscript; and OG conceived and coordinated the study and revised critically the manuscript. All authors read and approved the final manuscript.

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Correspondence to Filippo Familiari.

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Mercurio, M., Gasparini, G., Familiari, F. et al. Outcomes of Bi-unicompartmental Versus Total Knee Arthroplasty for the Treatment of Medial and Lateral Knee Osteoarthritis: A Systematic Review and Meta-analysis of Comparative Studies. JOIO 56, 963–972 (2022). https://doi.org/10.1007/s43465-022-00628-1

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