Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis

Burn, Edward; Sanchez‐Santos, Maria T; Pandit, Hemant; Hamilton, Thomas W.; Liddle, Alexander D.; Murray, David; Pinedo-Villanueva, Rafael

doi:10.1007/s00167-016-4404-7

Cited by 76 publications

(48 citation statements)

References 43 publications

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“…Lim and colleagues also found no statistically significant difference in the change of function scores over time for both UKA and TKA [33]. Consistent with that, the other authors confirmed an association between better preoperative scores and better postoperative scores [34,35]. By examining patient-reported outcome measures from the National Joint Registry of England and Wales (NJR), no difference was found in the improvement of either knee-specific or general health outcomes between UKA and TKA in a large cohort [36].…”

Section: Discussionmentioning

confidence: 60%

Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case–control study

Hauer

Sadoghi

Bernhardt

et al. 2019

Arch Orthop Trauma Surg

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Purpose The purpose of this study was to provide a matched cohort comparison of clinical and functional outcome scores, range of motion and quality of life following unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). The hypothesis was that patients receiving UKA report better results than comparable patients who receive conventional TKA. Methods Clinical and functional results of 35 patients with medial end-stage osteoarthritis who had received a fixed-bearing UKA were compared with the results of 35 matched patients who had received a TKA from the same manufacturer by the same surgeon. Outcome scores were measured before surgery and at final follow-up using Tegner Activity Scale (TAS), range of motion (ROM) and Short Form 36 Health Survey (SF-36). The Knee Society Score (KSS) was assessed at final follow-up. The mean observation period was 2.3 years in both groups. Results The preoperative knee scores had no statistically significant differences between the two groups. Postoperatively, however, UKAs performed significantly better regarding TAS and ROM (4 vs. 3 and 118.4 vs. 103.7, respectively). The results of the SF-36 showed significantly better results for the UKA group in the mental component summary score and in the subscale of social function. Conclusions The present study suggests that UKA is associated with higher activity level, higher quality of life, and greater ROM when compared with TKA on comparable patients. Prolonged clinical follow-up in a larger patient cohort with a randomised-controlled study design would be beneficial to confirm these findings. Level of evidence III.

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Section: Discussionmentioning

confidence: 60%

Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case–control study

Hauer

Sadoghi

Bernhardt

et al. 2019

Arch Orthop Trauma Surg

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“…We suggest this may be due to UKA requiring less tissue trauma and resulting in more normal knee mechanics postoperatively than TKA. 25 Thus, less pain, inflammation, and persistent mechanical alteration in knee movements overall may make 2-year functional outcomes less dependent on early pain control. Additionally, there is less surgically altered tissue in UKA, so early pain and diminished rehab would not be expected to result in multicompartmental scarring and stiffness.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Pain Predicts 2-Year Functional Outcomes following Knee Arthroplasty

et al. 2019

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Pain control following knee arthroplasty is extremely important to both patients and surgeons to improve the perioperative experience; however, the implication of early pain control on long-term outcomes following knee arthroplasty remains poorly understood. We hypothesized that poor early pain control results in poor functional outcomes 2 years following total (TKA) and unicondylar knee arthroplasty (UKA). This retrospective study reviewed 242 TKA and 162 UKA performed at a single institution by two surgeons. Mean visual analog scale (VAS) pain scores were collected for first 3 postoperative days. Patients were prospectively evaluated using short form (SF-12), the Western Ontario and McMaster University osteoarthritis index (WOMAC), and the Knee Society functional score (KSFS) questionnaires. Pearson's correlation coefficients were calculated between mean VAS pain scores and functional outcome scores at 2 years. In the TKA group, poorly controlled perioperative pain correlated with poorer functional scores at 2 years. There was a significant negative correlation between early mean VAS pain scores (mean, 3.2 ± 2.0) and most 2-year functional outcomes including SF-12 physical score (r = −0.227, p ≤ 0.01), WOMAC pain scores (r = −0.268, p ≤ 0.01), WOMAC stiffness scores (r = −0.224, p < 0.01), WOMAC function score (r = −0.290, p 0.01), and KSFS (r = −0.175, p = 0.031). Better control of early pain was associated with improved functional outcomes at 2 years following TKA. We also found significant negative correlations between preoperative functional scores and early postoperative pain scores. Collectively, using preoperative and early postoperative pain scores, we identified an “at-risk” patient group that manifested an inferior functional outcome at 2 years; these patients may benefit from closer surveillance and a multidisciplinary approach to pain and function to optimize their clinical outcome following knee arthroplasty.

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“…Compared to total knee replacement, the partial procedure is less invasive and is associated with a faster recovery, reduced risk of blood transfusion, fewer medical complications and lower mortality [10,12,13]. Both procedures significantly reduce pain and improve function for the majority of patients, but comparative evidence suggests that partial replacement is associated with better functional outcome [14,15]. Yet, long-term studies and registry data show that the revision rate is higher following partial than total knee replacement [12,13,16,17].…”

Section: Introductionmentioning

confidence: 99%

Partial or total knee replacement? Identifying patients’ information needs on knee replacement surgery: a qualitative study to inform a decision aid

et al. 2019

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Purpose For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients' experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid. Methods Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis. Results Participants described a process of arriving at 'readiness for surgery' a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. 'Information for decisions' details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery. Conclusions Patients' experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients' understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended.

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Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis

Cited by 76 publications

References 43 publications

Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case–control study

Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case–control study

Early Postoperative Pain Predicts 2-Year Functional Outcomes following Knee Arthroplasty

Partial or total knee replacement? Identifying patients’ information needs on knee replacement surgery: a qualitative study to inform a decision aid

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