Better Short-term Function After Unicompartmental Compared to Total Knee Arthroplasty

Tille, Eric; Beyer, Franziska Christine; Auerbach, Kai; Tinius, Marco; Lützner, Jörg

doi:10.21203/rs.3.rs-127006/v1

Cited by 6 publications

(7 citation statements)

References 32 publications

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“…On the contrary, some previous demographically (age, sex, BMI) matched control studies [3,6,19,20] showed better functional outcomes in UKA compared to TKA. This does not paint the full picture, as these studies were not matched for preoperative functional scores and preoperative scores were found to be higher in the UKA group, which resulted in more improvement in UKA than in the TKA group.…”

Section: Discussionmentioning

confidence: 70%

“…Some studies [3,6,9,11,19] reported better sports participation and functional outcome in UKA compared to TKA, while other studies [8,10] found similar results between the two groups. Although these studies [3,6,11,19] were matched for demographic variables such as age, BMI, and gender, they were not matched for the preoperative patient-reported functional outcome, which may be a confounding factor for the comparison between the TKA and UKA cohorts. Therefore, it is essential to include preoperative scores along with radiographic and demographic variables for a matched analysis between the two groups.…”

Section: Introductionmentioning

confidence: 97%

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No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study

Meena

Abermann

Hoser

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to compare (1) sports participation and type of sports activity between TKA and UKA patients; (2) functional outcome and activity level between TKA and UKA; and (3) survivorship of the prosthesis in both the groups. Methods Prospectively collected data were obtained from an arthroplasty database to identify patients who underwent primary TKA and UKA. Both the cohorts of TKA and UKA were matched, controlling for age, sex, BMI and preoperative patient-reported outcomes, which include Oxford Knee Score (OKS), Tegner activity level, and visual analog scale (VAS) for pain score. After matching the two groups, 287 TKA and 69 UKA cases were available to be included in the study. Patients were evaluated pre- and postoperatively at 2 years for sports participation and sports preference, patient-reported outcomes, activity levels, and improvement in knee pain. Results The mean age of the TKA and UKA groups were 75.7 ± 8.1 and 74.2 ± 8.8, respectively. There was no significant difference between the two groups concerning the demographic variables. Significant improvement was noted in the weekly sports participation at the final follow-up compared to preoperative sports participation in both the TKA and UKA groups (p < 0.05). All patients were able to return to their desired sporting activity. No significant difference was noted between the two groups in sports participation preoperatively and postoperatively (p > 0.05). OKS, Tegner activity level and VAS for pain demonstrated a significant improvement from preoperative to 2 years postoperatively (p < 0.05). However, preoperative and postoperative patient-reported outcomes did not differ significantly between the TKA and UKA groups (p > 0.05). No case of revision surgery was found at a 2-year follow-up in both groups. Conclusion Traditionally, in isolated medial compartment osteoarthritis, UKA has been considered to be the procedure with better functional outcomes, but the current study demonstrates that when confounding factors are controlled, both TKA and UKA are effective, and offer similar functional outcomes and result in similar improvement in sports participation. These findings will be helpful to counsel the patients to choose the best suitable operative procedure between UKA and TKA. Level of evidence Level 3.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 97%

No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study

Meena

Abermann

Hoser

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…In 3 cases, HTO was performed before UKA, 13.7 years ago ± 6.5 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In all cases, there was a progression of medial OA and varus deformity (Figure 3).…”

Section: High Tibial Osteotomymentioning

confidence: 99%

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

Derreveaux

Schmidt

Shatrov

et al. 2022

SICOT-J

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Introduction: Unicompartmental knee arthroplasty (UKA) has traditionally been contraindicated in the presence of an ACL deficient knee, bi-compartmental disease, or significant coronal deformity due to concerns regarding increased risk of persisted pain, knee instability, tibial loosening, or progression of osteoarthritis. The aim of this study was to evaluate the outcomes of patients undergoing UKA with an associated surgical procedure in these specific indications. Method: This was a retrospective cohort study of patients undergoing UKA between December 2015 and October 2020. Patients were categorized into groups based on associated procedures: UKA + ACL, UKA + HTO, and bicompartmental arthroplasty. Outcomes were assessed using the Knee Society Score (KSS) knee and function scores and the Forgotten Joint Score. Radiological and complication analysis was performed at the last clinical follow-up. Results: Thirty-two patients (13 men and 19 women) were included. The mean age was 56.2 years ± 11.1 (range, 33–84) with a mean follow-up of 26.3 months ± 15 (7.3–61.1). There was a significant improvement between the pre-and postoperative KSS Knee (+34.3 ± 16.5 [12–69]), Function (+34.3 ± 18.6 [0–75]), and Total scores (+68.5 ± 29.4 [24–129]) (p = 0.001). Seven patients (21.8%) required an arthroscopic arthrolysis for persistent stiffness. Two patients (UKA + PFA and UKA + ACL) underwent revision to TKA. Patient satisfaction was 90%, and mean flexion at last follow-up was 122° ± 6 (120–140). The implant survival rate was 94%. Discussion: This study found performing UKA with an additional procedure to address relative contraindications to the arthroplasty in physically active patients with monocompartmental knee arthritis is an efficient strategy with good results at short-term follow-up. It should be reserved for patients where TKA is likely to have unsatisfactory results, and the patient has been fully counseled regarding the management options. Even if there is a high rate of complications with stiffness requiring a re-intervention, the final results are very satisfying with no impact of the reintervention on the clinical result in the short term.

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“…The required sample size for patients with osteoarthritis of the knee is also calculated using data from the literature [30,34,35]. Similar to the results on the hip, we derived an average change score of 9 points with a standard deviation of ± 15 points in the total score of the KOOS yielding to an expected effect size of 0.6.…”

Section: Sample Size Calculation For Patients With Osteoarthritis Of ...mentioning

confidence: 96%

Evaluation of the patient-accompanying app “alley ortho companion” for patients with osteoarthritis of the knee and hip: study protocol for a randomized controlled multi-center trial

Strahl

Graichen

Haas

et al. 2022

Trials

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Background Osteoarthritis (OA) is one of the most common disabilities in the elderly. When conservative management fails, total joint arthroplasty (TJA) is the treatment of choice for end-stage OA. Since quality and durability of implants has steadily improved, pre -and postsurgical processes moved into the focus of research. Hence, eHealth approaches offer an opportunity to provide a more available continuity of care. Regarding individualized pre-, peri-, and postsurgical stages, eHealth is expected to improve patient engagement, self-care, and outcomes across the surgical pathway. Aim of this study is to evaluate the effectiveness of the eHealth application “alley” as an adjuvant intervention to TJA. The app provides comprehensive information to empower patient with hip or knee OA to prepare and accompany them for their TJA surgery. Our primary hypothesis is that the pre- and postoperative adjuvant use of the eHealth application “alley” (intervention group, IG) leads to improved functional outcome. Methods Prospective, randomized, controlled, multi-center trial including n = 200 patients diagnosed with hip and n = 200 patients with knee OA (n = 200) scheduled for TJA. Patients of both groups will be randomly assigned to one of two study arms. Patients in the intervention group will receive access to the functions of the “alley” app. The app presents informative (e.g., information about osteoarthritis), organizational (e.g., information about medical rehabilitation), and emotional/empowerment (e.g., information about the relationship between mood and pain) content. Patients evaluate their condition and functional level by means of standardized digitally questionnaires. Patients in the control group will not receive any functions of the app. Assessments will be performed at baseline before, 10 days after, 1 months after, 3 months after, 6 months after, and 12 months after TJA. Primary outcome is change from baseline measured by the Hip Osteoarthritis Outcome Score or Knee injury and Osteoarthritis Outcome Score 3 months after TJA. The statistical analysis (t-test for independent variables with effect size Cohen’s d) is performed separately for patients with TKA and THA. Discussion Overall, the study aims to improve the understanding of the benefits of eHealth applications in the treatment of elderly patients with knee or hip arthroplasty. The approach is novel since a health care companion is combined with a digital information platform enabling direct and continuous feedback from the patients to the therapeutic treatment team. As the study investigate the effectiveness under everyday conditions, it is not feasible to control whether the patients in the IG read the educational information of the app respectively the control group consume additional information from other sources. However, this increases the external validity of the study if significant effects for the app can be demonstrated. Trial registration German Clinical Trials Register: DRKS00025608. Registered on 21 June 2021.

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Better Short-term Function After Unicompartmental Compared to Total Knee Arthroplasty

Cited by 6 publications

References 32 publications

No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study

No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study

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

Evaluation of the patient-accompanying app “alley ortho companion” for patients with osteoarthritis of the knee and hip: study protocol for a randomized controlled multi-center trial

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