Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis

Abstract

BackgroundInterest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA.MethodsThe databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible.ResultsSix studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA.ConclusionsThe use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate.

Patellofemoral arthroplasty in combination with high tibial osteotomy can achieve good outcome for patients with medial-patellofemoral osteoarthritis

“…During clinical practice, the question of how to treat patients with MPFOA is still somewhat controversial. Although TKA remains a successful treatment choice for patients with severe MPFOA ( 2 , 3 , 26 ), TKA is not ideal for younger people who are employed and/or active ( 27 , 28 ). Because TKA sacrifices the cruciate ligaments and the healthy lateral compartment.…”

“…But, opponents have pointed out that these advantages have not been shown to be sustained after 1 year postoperatively and that they are in fact minimal after adjusting for age, sex, BMI, and baseline status ( 33 ). BKA is also more technically demanding, resulting in increased operation duration ( 3 ). Overall revision rates of UKA are high ( 11 ).…”

“…Osteoarthritis (OA) is the degeneration of a joint's articular cartilage and subchondral bone – results in pain and loss of function ( 1 – 3 ). The most commonly affected joint is the knee, and OA can affect three compartments of the knee individually or simultaneously.…”

“…Total knee arthroplasty (TKA) is one surgical option for patients with MPFOA ( 2 , 3 ). However, TKA sacrifices both the cruciate ligaments and the healthy lateral compartment and leads to the disruption of the biomechanics of the knee joint ( 4 ).…”

“…However, TKA sacrifices both the cruciate ligaments and the healthy lateral compartment and leads to the disruption of the biomechanics of the knee joint ( 4 ). Another type of treatment, and one that has begun to receive renewed interest, is combining bicompartmental knee arthroplasty (BKA) implants to treat bicompartmental disease ( 3 , 5 ). Compared to TKA, BKA is related to fewer perioperative complications and retains more knee function ( 1 , 6 ).…”