Unicompartmental knee replacement – Current perspectives

Campi, Stefano; Tibrewal, Saket; Cuthbert, Rory

doi:10.1016/j.jcot.2017.11.013

Cited by 40 publications

(28 citation statements)

References 62 publications

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“…This was thought to be around 6-12% of patients undergoing knee replacement surgery. 126 However, more recently, Campi et al, 126 reported that surgeons have widened the indications, especially for weight, age and activity, and up to 50% of patients may now be eligible for UKA.…”

Section: Overview Of the Trial Findings And Key Messagesmentioning

confidence: 99%

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Barker

Room

Knight

et al. 2020

Health Technol Assess

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Background Over 100,000 primary knee arthroplasty operations are undertaken annually in the UK. Around 15–30% of patients do not report a good outcome. Better rehabilitation strategies may improve patient-reported outcomes. Objectives To compare the outcomes from a traditional outpatient physiotherapy model with those from a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty. Design An individually randomised, two-arm controlled trial with a blinded outcome assessment, a parallel health economic evaluation and a nested qualitative study. Setting The trial took place in 14 NHS physiotherapy departments. Participants People identified as being at high risk of a poor outcome after knee arthroplasty. Interventions A multicomponent home-based rehabilitation package delivered by rehabilitation assistants with supervision from qualified therapists compared with usual-care outpatient physiotherapy. Main outcome measures The primary outcome was the Late Life Function and Disability Instrument at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function); Knee injury and Osteoarthritis Outcome Score; Quality of Life subscale; Physical Activity Scale for the Elderly; EuroQol-5 Dimensions, five-level version; and physical function assessed using the Figure-of-8 Walk Test, 30-Second Chair Stand Test and Single Leg Stance. Data on the use of health-care services, time off work and informal care were collected using participant diaries. Results In total, 621 participants were randomised. A total of 309 participants were assigned to the COmmunity based Rehabilitation after Knee Arthroplasty (CORKA) home-based rehabilitation programme, receiving a median of five treatment sessions (interquartile range 4–7 sessions). A total of 312 participants were assigned to usual care, receiving a median of four sessions (interquartile range 2–6 sessions). The primary outcome, Late Life Function and Disability Instrument function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual-care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference 0.49 points, 95% confidence interval –0.89 to 1.88 points; p = 0.48). There were no statistically significant differences between the groups in any of the patient-reported or physical secondary outcome measures at 6 or 12 months post randomisation. The health economic analysis found that the CORKA intervention was cheaper to provide than usual care (£66 less per participant). Total societal costs (combining health-care costs and other costs) were lower for the CORKA intervention than usual care (£316 less per participant). Adopting a societal perspective, CORKA had a 75% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year. Adopting the narrower health and social care perspective, CORKA had a 43% probability of being cost-effective at the same threshold. Limitations The interventions were of short duration and were set within current commissioning guidance for UK physiotherapy. Participants and treating therapists could not be blinded. Conclusions This randomised controlled trial found no important differences in outcomes when post-arthroplasty rehabilitation was delivered using a home-based, rehabilitation assistant-delivered rehabilitation package or a traditional outpatient model. However, the health economic evaluation found that when adopting a societal perspective, the CORKA home-based intervention was cost-saving and more effective than, and thus dominant over, usual care, owing to reduced time away from paid employment for this group. Further research could look at identifying the risk of poor outcome and further evaluation of a cost-effective treatment, including the workforce model to deliver it. Trial registration Current Controlled Trials ISRCTN13517704. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 65. See the NIHR Journals Library website for further project information.

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Section: Overview Of the Trial Findings And Key Messagesmentioning

confidence: 99%

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Barker

Room

Knight

et al. 2020

Health Technol Assess

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“…9 Contraindicaciones para la artroplastia unicompartimental son: infección activa, enfermedad articular inflamatoria, ausencia de ligamento cruzado anterior, inestabilidad ligamentaria o contractura del ligamento colateral medial, e historia de osteotomía tibial previa. 10,11 Cirugía Robótica vs Cirugía Convencional En la actualidad, existe evidencia cada vez más sólida indicando que la cirugía robótica es una herramienta que mejora, en tiempo real, la precisión en el posicionamiento y elección de tamaño del implante.…”

Section: Indicaciones Y Contraindicaciones Para El Uso De La Técnica unclassified

Cirugía Robótica en Artroplastia de Rodilla

Negrín

Duboy

Iñiguez

et al. 2019

Rev Chil Ortop Traumatol

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ResumenLa cirugía protésica de rodilla es un procedimiento ampliamente aceptado como etapa final del tratamiento de la artrosis de rodilla, con sobrevida que supera el 90% a 10–15 años. Dentro de las principales causas de fallo, se encuentran la infección (20,4%) y el aflojamiento mecánico (20,3%). El uso de ayudas tecnológicas en cirugía está en constante desarrollo, con el objetivo de mejorar la precisión del acto quirúrgico. En ese escenario, la Cirugía Asistida por Computador (CAS) en artroplastia de rodilla, crece de forma exponencial, y apunta a mejorar el posicionamiento y selección del tamaño de los componentes protésicos, aumentar la precisión de las resecciones óseas y mejorar el balance de los tejidos blandos, logrando así una mayor sobrevida del implante. En comparación a las técnicas convencionales, la cirugía robótica ha mostrado mejores resultados funcionales, al primer año de seguimiento, en términos de rango articular, menor dolor post-operatorio y menor tiempo de estadía hospitalaria. Pero todavía es necesario establecer si, a largo plazo, esas diferencias funcionales se traducirán en mejores resultados clínicos que permitan, de forma consistente, inclinar la balanza en favor de la técnica asistida por robot por sobre las técnicas tradicionales.

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“…Unicompartmental knee arthroplasty (UKA) is a valid treatment for end-stage knee osteoarthritis (OA), affecting a single femoro-tibial compartment [1]. The popularity of unicompartmental knee replacement (UKR) has increased as excellent functional outcomes and survival have been reported in long-term follow-up studies.…”

Section: Introductionmentioning

confidence: 99%

Unicompartmental Knee Replacement in Obese Patients: A Systematic Review and Meta-Analysis

Campi

Papalia

Esposito

et al. 2021

JCM

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Thanks to modern surgical techniques and implants, traditional exclusion criteria for unicompartmental knee arthroplasty (UKA) are no longer considered contraindications. The aim of this study is to clarify the impact of obesity on functional outcomes and revision rates of UKA. We performed a comprehensive systematic review using PubMed–Medline, Google Scholar and Cochrane Central. Then, we extracted data related to body mass index (BMI), age and follow-up, functional outcome scores and rate of revisions (all-cause, aseptic and septic). Patients were stratified according to BMI into two groups: non-obese (BMI < 30) and obese (BMI ≥ 30). We identified 22 eligible studies, of which 13 were included in the meta-analysis. Patients with a BMI > 30 had a significantly higher likelihood for revision (p = 0.02), while the risk of septic revision was similar (p = 0.79). The clinical outcome measures showed a significant difference in favor of patients with a BMI < 30 (p < 0.0001). The improvements in Oxford Knee Score and Knee Society Score were significant in both obese and non-obese patients, although the latter showed inferior results. The results of this systematic review and meta-analysis show that BMI is not a contraindication to UKA. However, obese patients have a higher risk for aseptic failure and lower improvement in clinical scores compared to non-obese patients.

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Unicompartmental knee replacement – Current perspectives

Cited by 40 publications

References 62 publications

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT

Cirugía Robótica en Artroplastia de Rodilla

Unicompartmental Knee Replacement in Obese Patients: A Systematic Review and Meta-Analysis

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