Compartmental knee arthroplasty

Ashraf, Shaafiya; Ackroyd, C. E.; Newman, John H.

doi:10.1054/cuor.2002.0312

Cited by 11 publications

(10 citation statements)

References 57 publications

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“…When compared with nonsurgical treatments, TKR has been found to be highly cost effective [ 3 , 4 ]. However, for those patients with OA predominantly in only one compartment of the knee, unicompartmental knee replacement (UKR) offers an alternative approach, where only the diseased cartilage in an isolated part of the joint is replaced [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Choosing Between Unicompartmental and Total Knee Replacement: What Can Economic Evaluations Tell Us? A Systematic Review

Burn

Liddle

Hamilton

et al. 2017

PharmacoEconomics Open

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Background and objectivePatients with anteromedial arthritis who require a knee replacement could receive either a unicompartmental knee replacement (UKR) or a total knee replacement (TKR). This review has been undertaken to identify economic evaluations comparing UKR and TKR, evaluate the approaches that were taken in the studies, assess the quality of reporting of these evaluations, and consider what they can tell us about the relative value for money of the procedures.MethodsA search of MEDLINE, EMBASE and the Centre for Reviews and Dissemination National Health Service Economic Evaluation Database was undertaken in January 2016 to identify relevant studies. Study characteristics were described, the quality of reporting and methods assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and study findings summarised.ResultsTwelve studies satisfied the inclusion criteria. Five were within-study analyses, while another was based on a literature review. The remaining six studies were model-based analyses. All studies were informed by observational data. While methodological approaches varied, studies generally had either limited follow-up, did not fully account for baseline differences in patient characteristics or relied on previous research that did not. The quality of reporting was generally adequate across studies, except for considerations of the settings to which evaluations applied and the generalisability of the results to other decision-making contexts. In the short-term, UKR was generally associated with better health outcomes and lower costs than TKR. Initial cost savings associated with UKR seem to persist over patients’ lifetimes even after accounting for higher rates of revision. For older patients, initial health improvements also appear to be maintained, making UKR the dominant treatment choice. However, for younger patients findings for health outcomes and overall cost effectiveness are mixed, with the difference in health outcomes depending on the lifetime risk of revision and patient outcomes following revision.ConclusionsUKR appears to be less costly than TKR. For older patients, UKR is also expected to lead to better health outcomes, making it the dominant choice; however, for younger patients health outcomes are more uncertain. Future research should better account for baseline differences in patient characteristics and consider how the relative value of UKR and TKR varies depending on patient and surgical factors.

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Section: Introductionmentioning

confidence: 99%

Choosing Between Unicompartmental and Total Knee Replacement: What Can Economic Evaluations Tell Us? A Systematic Review

Burn

Liddle

Hamilton

et al. 2017

PharmacoEconomics Open

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“…Osteoarthritis (OA) can affect any or all three compartments (medial, lateral, patellofemoral) of the knee joint 1 and about one‐third of patients have OA predominantly in only one compartment of the knee – unicompartmental OA of the knee 2 . Unicompartmental OA usually occurs in the patellofemoral compartment (in approximately 69% of patients with unicompartmental OA).…”

Section: Introductionmentioning

confidence: 99%

Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Systematic Study

Griffin

Rowden

Morgan

et al. 2007

ANZ Journal of Surgery

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Unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA) and high tibial osteotomy (HTO) may all be used to treat unicompartmental osteoarthritis, but they are often used for different patient groups. However, there is considerable overlap in indications for all three options. The aim of this review was to assess the safety and efficacy of UKA compared with TKA and HTO in unicompartmental osteoarthritis. Studies that compared UKA with either TKA or HTO were identified and included for review. For knee function and postoperative pain, UKA appeared similar to TKA and HTO at 5 years follow up. Range of motion was better in UKA compared with TKA. Complication rates after UKA and TKA appeared similar, although deep vein thrombosis was reported more often after TKA. There were more complications after HTO than UKA. Survival of UKA prostheses was approximately 85-95%, compared with at least 90% for TKA at 10 years follow up. Survivorship for HTO appeared to be less than 85%. It was not clear whether there were more revisions after UKA than TKA, but there appeared to be fewer revisions in UKA compared with HTO. UKA is considered at least as safe as TKA and HTO. For function, UKA appears to be at least as efficacious as TKA and HTO. The survival of UKA compared with TKA and HTO cannot be determined based on the available evidence.

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“…Initially, UKA was indicated in elderly, sedentary patients with OA limited to a single tibiofemoral compartment, a correctable deformity and no ligamentous instability. Patients with patellofemoral disease, young patients and obese patients were not indicated for UKA [2,4,5]. As the exploration of newer surgical techniques, such as minimally invasive surgery (MIS) and computer navigation, have furthered expansion of these criteria for UKA, these contraindications have come into question [23].…”

Section: Surgical Indications and Contraindicationsmentioning

confidence: 99%

“…Further potential advantages of UKA include a less invasive approach, less bone resection, less tissue destruction, shorter operative time, less blood loss, shorter rehabilitation, greater extensor strength, more normal knee kinematics and a better range of motion (ROM). However, proper indications and surgical technique are crucial to obtain optimal results [3][4][5]. Expansion of indications is possible based upon more recent studies and techniques, such as computer navigation and robotics, which may be useful adjuncts.…”

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confidence: 99%

Scientific evidence for the use of modern unicompartmental knee arthroplasty

Maduekwe

Zywiel

Bonutti

et al. 2010

Expert Review of Medical Devices

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Unicompartmental knee arthroplasty as a surgical treatment for monocompartmental knee arthritis remains a controversial procedure with questions surrounding the benefits and survivorship of the procedure versus osteotomies or total knee arthroplasties. The authors, by examining the complete body of literature for scientific evidence concerning the procedure, will describe the history of usage of these prostheses, their rationale for usage, modern devices and their results, and why they may have advantages as a treatment modality for monocompartmental knee arthritis. Outcomes of current unicompartmental designs will be presented and evaluated to determine which aspects of the design and patient selection technique are associated with success or failure. Commonly asked questions regarding the use of these devices will be addressed. The authors will also describe some potential modifications that might affect the use of these components in the future, including minimally invasive procedures and robotics, and how these devices may change over the next 5 years.

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Compartmental knee arthroplasty

Cited by 11 publications

References 57 publications

Choosing Between Unicompartmental and Total Knee Replacement: What Can Economic Evaluations Tell Us? A Systematic Review

Choosing Between Unicompartmental and Total Knee Replacement: What Can Economic Evaluations Tell Us? A Systematic Review

Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Systematic Study

Scientific evidence for the use of modern unicompartmental knee arthroplasty

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