The Interaction of Caseload and Usage in Determining Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis

Hamilton, Thomas W.; Rizkalla, James; Kontochristos, Leonidas; Marks, Barbara; Mellon, Stephen; Dodd, Christopher; Pandit, Hemant; Murray, David

doi:10.1016/j.arth.2017.04.063

Cited by 81 publications

(73 citation statements)

References 92 publications

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“…For any new orthopaedic implant, favourable results would be expected from developing centres, and whilst it might be rational to assume that similar outcomes will not be achieved by the wider surgical community, our series forms part of a growing number of independent reports of good results and favourable revision rates [6, 7, 9, 10]. There are also reports from other units with less success [11–14], but the main contrast comes from concerns raised primarily by registry data [30].…”

Section: Discussionmentioning

confidence: 99%

“…There are also reports from other units with less success [11–14], but the main contrast comes from concerns raised primarily by registry data [30]. Inevitably the performance of an implant is dependent on the technique used to implant it, and studies have demonstrated the effect of a significant learning curve for UKA [31–34] with some authors advocating minimum numbers to be undertaken in order to maintain competence [7]. …”

Section: Discussionmentioning

confidence: 99%

“…14 bilateral UKA procedures were performed sequentially. This corresponds to a usage of 30% in keeping with recommendations that 30% of a surgeon’s total knee arthroplasties should be UKAs to achieve optimum results [7, 21, 22]. …”

Section: Introductionmentioning

confidence: 88%

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Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon

Hutt

Sur

et al. 2018

BMC Musculoskelet Disord

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BackgroundThis prospective study evaluates outcomes and reoperation rates for unicompartmental knee arthroplasty (UKA) from a single non-designer surgeon using relatively extended criteria of degenerative changes of grade 2 or above in either or both non-operated compartments.Methods187 consecutive medial mobile bearing UKA implants were included after history, clinical assessment and radiological evaluation. 91 patients had extended clinical outcomes. Post-operative assessment included functional scoring with the Oxford Knee Score (OKS) and radiographic review. Survivorship curves were constructed using the life-table method, with 95% confidence intervals calculated using Rothman’s equation. Separate endpoints were examined: revision for any reason and revision for confirmed loosening.ResultsThe mean follow-up was 3.5 years. The pre-operative OKS improved from a mean of 21.2 to 38.9 (Mann-Whitney U Test, p = < 0.001). Twelve Patients required further operations including 9 revisions. No patients developed deep infection and no surviving implants were loose radiographically. Survivorship at 7 years with endpoints of re-operation, revision and aseptic loosening at surgery or radiographically was 88.4% (95% CI 79.6–93.7), 93.1% (95% CI 85.5–96.9) and 97.3% (95% CI 91.2–99.2) respectively. The presence of pre-operative mild contralateral tibiofemoral or any extent of patellofemoral joint degeneration was of no consequence.DiscussionThe indications for UKA are being expanded to include patients with greater deformity, more advanced disease in the patellofemoral joint and even certain features in the lateral compartment indicative of an anteromedial pattern of osteoarthritis (OA). However, much of the supporting literature remains available only from designer centres. This study represents a group of patients with what we believe to be wider indications, along with decisions to treat made on clinical grounds and radiographs alone.ConclusionThis study shows comparable clinical outcomes of UKA for extended indications from a high volume, high-usage non-designer unit.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2099-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon

Hutt

Sur

et al. 2018

BMC Musculoskelet Disord

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“…As was expected, higher rates were found in younger patients. The youngest modelled patient age was 55, and patients of this age were found to have a lifetime revision risk of 15% (CI [12][13][14][15][16][17][18][19]. This reduced to a lifetime risk of 4% (CI 3-5) for those of 85 years of age at operation.…”

Section: Discussionmentioning

confidence: 99%

Lifetime revision risk for medial unicompartmental knee replacement is lower than expected

Kennedy

Burn

Mohammad

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Unicompartmental knee replacement (UKR) is widely considered to be a pre-total knee replacement (TKR) particularly in the young. The implication of this is that it is sensible to do a UKR, even though it will be revised at some stage, as it will delay the need for a TKR. The chance of a UKR being revised during a patient's life time has not previously been calculated. The aim of this study was to estimate this lifetime revision risks for patients of different ages undergoing UKR. Methods Calculations were based on data from a designer series of 1000 medial Oxford UKR with mean 10-year follow up. These UKR were implanted for the recommended indications using the recommended surgical technique. Parametric survival models were developed for patients of different ages based on observed data, and were extrapolated using a Markov model to estimate lifetime revision risk. Results The estimated lifetime revision risk reduced with increasing age at surgery. Lifetime revision risk at age 55 was 15% (95% CI 12-19), at 65 it was 11% (8-13), at 75 it was 7% (5-9), and at 85 it was 4% (3-5). Conclusion Provided UKR is used appropriately, the lifetime revision risk is markedly lower than expected. UKR should be considered to be a definitive knee replacement rather than a Pre-TKR even in the young. These lifetime estimates, alongside established benefits for UKR in speed of recovery, morbidity, mortality and function, can be discussed with appropriate patients when considering whether to implant a UKR or TKR. Level of evidence III.

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“…It is estimated that approximately 14% of US UKA surgeries were performed with robotic assistance as of 2012 and this rate is expected to increase [11]. Studies have also observed an association between high-volume centres and better outcomes, in particular revision rates [15][16][17]. e capital costs of robotic assistance mean that a crude comparison of procedural costs of traditional instrumentation versus robotic-assisted UKA would favour the traditional procedure [12].…”

Section: Introductionmentioning

confidence: 99%

Early Economic Evaluation Demonstrates That Noncomputerized Tomography Robotic-Assisted Surgery Is Cost-Effective in Patients Undergoing Unicompartmental Knee Arthroplasty at High-Volume Orthopaedic Centres

Nherera

Verma²,

Trueman

et al. 2020

Advances in Orthopedics

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Background. For over fifty years, unicompartmental knee arthroplasty (UKA) has been used to treat single-compartment osteoarthritis of the knee and is considered a safe alternative to total knee arthroplasty (TKA). The development and use of robotic-assisted surgery (r-UKA) have made the execution of the procedure more precise, and various studies have reported improved radiographic outcomes and implant survival rates; however, its cost-effectiveness is unknown. This study aimed at assessing the cost-effectiveness of noncomputerized tomography (non-CT) r-UKA compared to the traditional unicompartmental knee arthroplasty (t-UKA) method in patients with unicompartmental knee osteoarthritis from the UK payer’s perspective. Methods. We developed a 5-year four-state Markov model to evaluate the expected costs and outcomes of the two strategies in patients aged 65 years. Failure rates for t-UKA were taken from the British National Joint Registry while data for non-CT r-UKA were obtained from a 2-year observational study. Cost was obtained from the NHS reference cost valued at 2018/19 GBP£, and a discount rate of 3.5% was applied to both costs and benefits. Results. For a high-volume orthopaedic centre that performs 100 UKA operations per year, non-CT r-UKA was more costly than t-UKA but offered better clinical outcomes, and the estimated cost per QALY was £2,831. The results were more favourable in younger patients aged less than 55 and sensitive to case volumes and follow-up period. Conclusion. Non-CT r-UKA is cost-effective compared with t-UKA over a 5-year period. Results are dependent on case volumes and follow-up period and favour younger age groups.

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The Interaction of Caseload and Usage in Determining Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis

Abstract: Title: The interaction of caseload and usage in determining outcomes of unicompartmental 1 knee arthroplasty: A meta-analysis 2 Abstract 3Background: Outcomes following UKA are variable and influenced by surgical caseload 4

Cited by 81 publications

References 92 publications

Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon

Outcomes and early revision rate after medial unicompartmental knee arthroplasty: prospective results from a non-designer single surgeon

Lifetime revision risk for medial unicompartmental knee replacement is lower than expected

Early Economic Evaluation Demonstrates That Noncomputerized Tomography Robotic-Assisted Surgery Is Cost-Effective in Patients Undergoing Unicompartmental Knee Arthroplasty at High-Volume Orthopaedic Centres

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