Partial versus total knee arthroplasty for isolated antero-medial osteoarthritis – An analysis of PROMs and satisfaction

Abstract

Aim: This study aimed to compare the patient-reported functional outcomes and patient satisfaction after medial Unicompartmental Knee Arthroplasty (UKA) versus Total Knee Arthroplasty (TKA), performed for anteromedial osteoarthritis (AMOA) of the knee in patients from an Indian population, at a minimum 3-year follow-up. Methods: This is a prospective matched cohort study (1:2 ratio). One hundred and one UKA cases were matched to 206 TKA cases by propensity score matching for age, body mass index (BMI), gender distribution, and the Charlson Comorbidity Index (CCI). The primary outcome (Oxford knee score, OKS) was assessed at a 3-year follow-up, along with secondary outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] Score, Forgotten Joint Score (FJS), Anterior Knee Pain (Kujala) score, patient satisfaction, and revision rate at the final follow-up). Results: The UKA group was superior to the TKA group in patient-reported functional outcomes based on the OKS (p = 0.004). Using the FJS score, UKA was more likely to be a forgotten joint compared to TKA (p < 0.001). However, differences in the OKS and FJS did not meet the reported minimal clinically important difference (MCID) thresholds. Quality of life (EuroQol-5D VAS scale) was found to be significantly higher in the UKA group (p < 0.001). Patients in the UKA group were more likely to be very satisfied (75.2%) versus the TKA group (62.1%, p = 0.023). Conclusion: For AMOA, UKA was associated with improved patient satisfaction compared to TKA. Although patient-reported outcome measures were statistically in favour of UKA over TKA, the differences were not clinically significant. Multicenter and randomized studies comparing the two procedures are warranted. Evidence: Level-II Therapeutic

What’s New in Adult Reconstructive Knee Surgery

“…Nevertheless, patients undergoing UKA exhibited higher odds of mechanical loosening 10 . In a prospective, matched-cohort study comparing patient-reported outcome measures and satisfaction between medial UKA and TKA, patients who underwent UKA were significantly more likely to consider the knee as a forgotten joint (according to the Forgotten Joint Score [FJS]) and exhibited improved satisfaction 11 . In a matched comparison study applying the FJS and the Knee Society score, Brilliant et al 12 found that, at 5 years postoperatively, patients who had undergone medial UKA had less joint awareness and higher function than patients who had undergone TKA.…”

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications

“…Unicompartmental knee replacement (UKR) is generally not recommended in the presence of concomitant anterior cruciate ligament (ACL) deficiency, and traditionally, total knee replacement (TKR) has been safely done in this setting [ 2 ]. However, considering these surgical options, UKR has advantages over TKR, including less invasiveness, lower blood loss, bone stock preservation, a quicker recovery, and improved joint kinematics [ 3 – 5 ].…”

The efficacy of unicondylar knee arthroplasty for medial compartment arthritis of the knee combined with anterior cruciate ligament dysfunction

“…There are two main views, namely primary knee OA secondary to ACL injury and primary ACL injury secondary to knee OA. This study focuses on the former, in which the ACL is generally intact at the early stage of the lesion and is dominated by wear of the anterior medial cartilage of the tibial plateau [ 6 ]. As degeneration increases, the ACL is subjected to wear and tear of the surrounding bones and secondary rupture occurs, while wear and tear of the tibial plateau progresses further posteriorly with the combination of medial collateral ligament contracture and lateral compartment OA.…”