Better short-term function after unicompartmental compared to total knee arthroplasty

Abstract

Background Unicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite the aforementioned facts and it’s proven cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA. Methods To assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction was evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)). For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient’s age, BMI and comorbidities. A total of 116 matched-pairs were analysed. Results There was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%). Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was also higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019). Conclusion Patients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA. Trial registration Clinicaltrials.gov, NCT04598568. Registered 22 October 2020 - Retrospectively registered.

Combined procedures with unicompartmental knee arthroplasty: High risk of stiffness but promising concept in selected indications

“…The most important finding of this study was the good final clinical results despite reintervention for stiffness being required in a high proportion of cases (21.8%). UKA with additional procedures is a promising solution to the physically active patient with monocompartmental knee arthritis in the presence of associated relative contraindications of an ACL deficient knee, coronal plane deformity, or bi-compartmental disease with good clinical outcomes at short term follow-up comparable to isolated UKA [ 13 ].…”

Using MRI Measurement to Improve Accuracy of Femoral Component Sizing in Oxford Unicompartmental Knee Arthroplasty

“…According to previous studies, UKA walked 10% faster than TKA. In addition, stride length and stance time are both much closer to normal than TKA [ 19 , 20 ]. However, no reliable and universal method was available to correctly select the femoral component in all kinds of patients.…”

Similar survivorship at the 5-year follow-up comparing robotic-assisted and conventional lateral unicompartmental knee arthroplasty

“…Both patient groups followed the same rehabilitation protocol, which involved passive mobilisation on the same day of surgery; from day one, patients were started on active progressive joint mobilisation and assisted walking with two crutches. Gradually and according to each patient, recommendations were made to increase the load during walking and continue with isometric muscle toning exercises until patients could walk independently without the use of walking aids [ 9 ].…”