A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty

Bottomley, Nicholas; Jones, Leanne A. H.; Rout, R; Alvand, Abtin; Rombach, Ines; Evans, Tim; Jackson, Wayne; Beard, David; Price, Andrew

doi:10.1302/0301-620x.98b10.bjj-2016-0483.r1

Cited by 45 publications

(47 citation statements)

References 28 publications

(10 reference statements)

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“…Furthermore, single centre cohort studies, which used methods outside the scope of the present study, have shown that similar revision rates can be achieved for TKA and UKA 911 12 121 Hamilton and colleagues133 showed a reduced revision rate in those studies undertaken in high volume centres, although the strength of this evidence was weak. These results are considered to be related to the expertise and experience of the operating surgeons, producing better results, and their units having a higher threshold for revision surgery for unexplained pain and better postoperative support.…”

Section: Discussionmentioning

confidence: 52%

“…But recent literature has shown that the higher failure rates of UKA are associated with centres and surgeons performing low numbers of the procedure 89 10 11 12 Some evidence in the UK also suggests that UKA has significant advantages over TKA, with fewer serious medical complications, reduced mortality rates, faster recovery, and superior functional outcome 1314 15…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Wilson

Middleton

Abram

et al. 2019

BMJ

223

206

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Objective To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making. Design Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies. Data sources Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018. Eligibility criteria for selecting studies Studies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available. Results 60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (−1.20 days (95% confidence interval −1.67 to −0.73), −1.43 (−1.53 to −1.33), and −1.73 (−2.30 to −1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (standard mean difference −0.58 (−0.88 to −0.27) and −0.29 (−0.46 to −0.11), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively). Conclusions TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options. Systematic review registration PROSPERO number CRD42018089972.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Wilson

Middleton

Abram

et al. 2019

BMJ

223

206

View full text Add to dashboard Cite

show abstract

“…Complication rates may also be higher when surgery is performed by trainees. For example, in 1 study of unicompartmental knee replacements, there were more reoperations for bearing dislocation in the trainee group, although there were similar TKR survival rates for attending and trainee surgeons .…”

Section: Discussionmentioning

confidence: 98%

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Bass

Mehta

Szymonifka

et al. 2019

Arthritis Care & Research

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Objective To determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Methods Black and white New York state residents, enrolled in a prospective single‐institution TKR registry January 1, 2008 to February 6, 2012, who underwent primary unilateral TKR (n = 4,062) were linked to the New York Statewide Planning and Research Cooperative System database (January 1, 2008 to December 31, 2014) to capture revisions performed at outside institutions. Patients were linked by geocoded addresses to residential census tracts. Multivariable Cox regression was used to assess predictors of TKR revision. Multivariable logistic regression was used to analyze predictors of TKR failure, defined as TKR revision in New York state ≤2 years after surgery, or as Hospital for Special Surgery (HSS) TKR quality of life score “not improved” or “worsened” 2 years after surgery. Results The mean ± SD age was 68.4 ± 10 years, 64% of patients were female, 8% lived in census tracts with >20% of the population under the poverty line, and 9% were black. Median follow‐up time was 5.3 years. A total of 3% of patients (122 of 4,062) required revision a median 454 days (interquartile range 215–829) after surgery. TKR revision risk was higher in blacks than whites, with a hazard ratio of 1.69 (95% confidence interval 1.01–2.81), but in multivariable analysis, only younger age, male sex, and constrained prosthesis were predictors of TKR revision. TKR failure occurred in 200 of 2,832 cases (7%) with 2‐year surveys. Risk factors for TKR failure were non‐osteoarthritis TKR indication, low surgeon volume, and low HSS Expectations Survey score, but not black race. Community poverty was not associated with TKR revision or failure. Conclusion There was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.

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“…From December 2016 to May 2017, twenty patients (20 osteoarthritic knees) scheduled to undergo Oxford medial UKA were included as the OA group. The inclusion criteria were the current indications for Oxford medial UKA:[ 4 7 ] isolated anteromedial OA producing pain, preserved full-thickness cartilage in the lateral compartment (joint space width >5 mm on valgus stress radiography), an intact anterior cruciate ligament (ACL), posterior cruciate ligament and medial collateral ligament (MCL), range of motion >90°, and varus and flexion deformity <15°. Age, obesity, and patellofemoral OA were not considered contraindications to surgery.…”

Section: Ethodsmentioning

confidence: 99%

Glycosaminoglycan Content of the Lateral Compartment Cartilage in Knees Conforming to the Indications for Oxford Medial Unicompartmental Knee Arthroplasty

Wan

Yue

Guo

et al. 2018

Chinese Medical Journal

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Background:The quality of the lateral compartment cartilage is important to preoperative evaluation and prognostic prediction of unicompartmental knee arthroplasty (UKA). Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables noninvasive assessment of glycosaminoglycan (GAG) content in cartilage. This study aimed to determine the GAG content of the lateral compartment cartilage in knees scheduled to undergo Oxford medial UKA.Methods:From December 2016 to May 2017, twenty patients (20 osteoarthritic knees) conforming to the indications for Oxford medial UKA were included as the osteoarthritis (OA) group, and 20 healthy volunteers (20 knees) paired by sex, knee side, age (±3 years), and body mass index (BMI) (±3 kg/m2) were included as the control group. The GAG contents of the weight-bearing femoral cartilage (wbFC), the posterior non-weight-bearing femoral cartilage (pFC), the lateral femoral cartilage (FC), and tibial cartilage (TC) were detected using dGEMRIC. The dGEMRIC indices (T1Gd) were calculated in the middle three consecutive slices of the lateral compartment. Paired t-tests were used to compare the T1Gd in each region of interest between the OA group and control group.Results:The average age and BMI in the two groups were similar. In the OA group, T1Gd of FC and TC was 386.7 ± 50.7 ms and 429.6 ± 59.9 ms, respectively. In the control group, T1Gd of FC and TC was 397.5 ± 52.3 ms and 448.6 ± 62.5 ms, respectively. The respective T1Gd of wbFC and pFC was 380.0 ± 47.8 ms and 391.0 ± 66.3 ms in the OA group and 400.3 ± 51.5 ms and 393.6 ± 57.9 ms in the control group. Although the T1Gd of wbFC and TC tended to be lower in the OA group than the control group, there was no significant difference between groups in the T1Gd in any of the analyzed cartilage regions (P value of wbFC, pFC, FC, and TC was 0.236, 0.857, 0.465, and 0.324, respectively).Conclusions:The GAG content of the lateral compartment cartilage in knees conforming to indications for Oxford medial UKA is similar with those of age- and BMI-matched participants without OA.

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A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty

Cited by 45 publications

References 28 publications

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Racial Disparities in Total Knee Replacement Failure As Related to Poverty

Glycosaminoglycan Content of the Lateral Compartment Cartilage in Knees Conforming to the Indications for Oxford Medial Unicompartmental Knee Arthroplasty

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