Comparison of the therapeutic effect between the simultaneous and staged unicompartmental knee arthroplasty (UKA) for bilateral knee medial compartment arthritis

Abstract

Background To compare the efficacy and safety of simultaneous vs staged unicompartmental knee arthroplasty (UKA) for bilateral unicompartmental osteoarthritis of the knee. Methods We performed a retrospective analysis of prospectively collected data on 93 patients with bilateral knee medial compartment arthritis underwent simultaneous UKA (Group A, 39) or staged UKA (Group B, 54 cases) from January 2008 to December 2015. Group A: 6 males and 33 females aged 64.9 ± 7.7 years; Group B: 5 males and 49 females aged 64.2 ± 6.4 years. There were no statistically significant differences in pre-operative age, sex ratio, or body weight index between the groups ( P > 0.05). Groups were compared in terms of total anesthesia time, volume of drainage, blood transfusion rate, hemoglobin level on post-operative day 3, total post-operative inpatient days, treatment expenses, post-operative therapeutic effect (KSS scores), and complications. Results All patients had follow-up visits post-operatively. The follow-up visit interval was 32–133 months and 41.9 months on average. Total anesthesia time, postoperative length of hospital stay, and hospitalization expenses in Group A were significantly less than those of Group B ( P < 0.05). Hemoglobin levels in Group A were significantly lower than those of Group B at post-op day 3 ( P < 0.05). However, no significant differences in volume of drainage, the rate of transfusion, complications, and KSS scores were detected between Groups A and B ( P > 0.05). Conclusions Both simultaneous and staged UKA achieved the desired therapeutic effect in treatment of bilateral knee medial compartment arthritis. However, simultaneous UKA reduced the cost and the postoperative length of hospital stay without increasing post-operative complications.

One-stage bilateral unicompartmental knee arthroplasty is a suitable option vs. the two-stage approach: a meta-analysis

“… 15 , 22 - 35 All the retrieved articles were published between March 2009 and July 2020, three were conducted in Italy, 26 , 31 , 33 three in the US, 15 , 25 , 35 two in the UK, 22 , 24 two in France, 29 , 30 one in China, 32 one in India, 27 one in Turkey, 34 one in Korea, 28 and one in Singapore. 23 Among the retrieved studies, six were case-controls comparing one-stage vs. two-stage UKA, 15 , 22 , 23 , 30 - 32 five were case-controls comparing one-stage bilateral UKA vs. unilateral UKA, 26 , 29 , 33 - 35 two were case-controls comparing one-stage bilateral UKA vs. TKA, 25 , 28 one RCT compared one-stage bilateral UKA vs. TKA, 27 and one was a case series about bilateral single-stage UKA ( Table 1 ). 24 …”

“…According to the Newcastle-Ottawa Scale, 19 two studies have awarded a total of 7 stars, 31 , 35 three studies 8 stars, 26 , 30 , 34 and the other 10 the maximum possible score of 9 stars. 15 , 22 - 25 , 27 - 29 , 32 , 33 …”

“…Considering that these data were retrieved from a pool of more than 850 patients, this allows us to suggest the safety and feasibility of single-stage bilateral UKA, with the meta-analysis results supporting what other authors have previously suggested in smaller series. 15 , 23 , 30 - 32 To further strengthen these findings, pooled complications were investigated also including cohorts of patients not included in comparative trials versus two-stage UKA, thus allowing us to draw evidence on complications from 15 studies on 1052 patients undergoing bilateral one-stage UKA. The major complication rate was 2.6% and the minor complication rate was 5.4%, confirming the overall low risks of complications.…”

“…Moreover, other elements also favour it with regard to the patient-management healthcare perspective. In light of the increasing pressure toward cost reduction, an important aspect is the analysis of the days to discharge: the meta-analysis on one-stage vs. two-stage case-control studies 15 , 22 , 23 , 30 - 32 provided solid evidence for this parameter because patients in both groups were treated at the same hospital, by the same staff and with the same protocol. The overall result retrieved was a mean of 4.8 days for one-stage surgery and 5.3 days for two-stage surgery.…”

“…Moreover, the one-time hospitalization implies numerous advantages; on the one hand, patients solve two problems at once with all the consequent benefits such as one-time sick leave and follow-up visits halved; on the other hand, the hospital has to plan only one operating room, with all the positive logistic and economical consequences such as the need for only one surgical team organization and one instrument set. In this regard, when evaluating the retrieved studies about bilateral single-stage UKA, nine articles stated that bilateral UKAs were performed by the same team, 24 - 26 , 28 , 29 , 32 - 35 while only three articles 22 , 27 , 30 declared that two teams were involved (all the remaining articles did not clarify this detail). In addition, the operatory time in the two procedures, quantified by pooling the literature data, shows an advantage of the one-stage approach, at an average of 112.3 min vs. the 125.4 min taken for the two-stage surgeries.…”