Unicompartmental Knee Arthroplasty: Does a Selection Bias Exist?

Howell, Robert E.; Lombardi, Adolph V.; Crilly, Ryan; Opolot, Shem; Berend, Keith R.

doi:10.1016/j.arth.2015.05.010

Cited by 12 publications

(9 citation statements)

References 13 publications

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“…Data from one study95 could be included in group 2, which showed a mean difference of −5.00 degrees (−7.28 to −2.72). Data from 13 cohort studies15 54 85 86 87 90 91 95 96 99 104 106 111 in the group 3 analysis showed an overall mean difference of −8.71 degrees (−11.77 to −5.64).…”

Section: Resultsmentioning

confidence: 96%

“…In study group 2, data from five studies70 72 88 92 98 showed a standard mean difference of −0.05 (−0.25 to 0.15). In group 3, data from 18 cohort studies15 54 86 89 90 91 94 95 96 99 100 103 105 106 108 112 120 showed an overall standard mean difference of −0.19 (−0.31 to −0.06).…”

Section: Resultsmentioning

confidence: 99%

“…Of 1289 studies eligible for inclusion in the abstract screen, 1201 were excluded for not meeting the inclusion criteria and repetition. After full text review, a further 28 studies were excluded,32 34 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 and 60 were included in the final analysis (fig 1).…”

Section: Resultsmentioning

confidence: 99%

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Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Wilson

Middleton

Abram

et al. 2019

BMJ

221

206

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Objective To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making. Design Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies. Data sources Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018. Eligibility criteria for selecting studies Studies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available. Results 60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (−1.20 days (95% confidence interval −1.67 to −0.73), −1.43 (−1.53 to −1.33), and −1.73 (−2.30 to −1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (standard mean difference −0.58 (−0.88 to −0.27) and −0.29 (−0.46 to −0.11), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively). Conclusions TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options. Systematic review registration PROSPERO number CRD42018089972.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Wilson

Middleton

Abram

et al. 2019

BMJ

221

206

View full text Add to dashboard Cite

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“…Pre-operative findings revealed that patients in the UKA group had higher functional scores, lower BMI, and lower age indicating a selection bias toward opting for the UKA procedure in healthier, more active patients. 49 Although a selection bias is commonly seen in comparison studies between UKA and TKA, analysis of the improvement between pre-operative and post-operative levels indicated benefits for the choice of UKA over TKA. Greater BMI may no longer be a risk factor for adverse events and increased failure in UKA surgery, as demonstrated by recent studies.…”

Section: Discussionmentioning

confidence: 99%

“…Although this may be true, our study looked at the specific change in functional score before and after surgery, which may mitigate that benefit. Howell et al 49 demonstrated that patients selected and planned for UKA but converted intra-operatively to TKA have outcomes similar to patients who received UKA and better results than patients originally planned and selected to receive TKA. An additional confounding factor is the inclusion of eight rheumatoid arthritic and three post-traumatic arthritis patients in the TKA cohort which may skew our results.…”

Section: Discussionmentioning

confidence: 99%

Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

Lum

Lombardi

Hurst

et al. 2016

The Bone & Joint Journal

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AimsSince redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts.Patients and Methods A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed.ResultsThe mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively).ConclusionWe found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28–33.

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Biomechanics of the Knee

Wang

Liu

et al. 2020

Frontiers in Orthopaedic Biomechanics

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Unicompartmental Knee Arthroplasty: Does a Selection Bias Exist?

Cited by 12 publications

References 13 publications

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

Biomechanics of the Knee

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