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Unicompartmental versus total knee arthroplasty for knee osteoarthritis

  • Filippo Migliorini
  • Markus Tingart
  • Marc Niewiera
  • Björn Rath
  • Jörg Eschweiler
Up-to date Review and Case Report • KNEE - ARTHOPLASTY
  • 26 Downloads

Abstract

Purpose

In the last couple of years, a significant amount of studies comparing the UKA and TKA for unicompartmental knee osteoarthritis have been published. However, there is a lack of recent meta-analysis comparing the two implants. Since the number of performed UKAs is currently increasing and the indications are obsolete, it becomes important to update current evidences and outcomes. With these premises, a meta-analysis of clinical trials comparing UKA versus TKA was conducted.

Methods

In October 2018, the following databases were accessed: Cochrane Systematic Reviews, Scopus, PubMed and Google Scholar. According to the Oxford Center of Evidence-based Medicine, level of evidence articles I to III were included. Only studies reporting quantitative data concerning the outcomes of interest were included. For the statistical analysis and the methodological quality assessment, we referred to the Review Manager Software 5.3. Dichotomous data were analyzed through the Mantel–Haenszel statistical method with the odd ratio effect measure. For continuous data, the inverse variance statistical method was used with the mean difference effect measure. A confidence interval of 95% was considered for analysis. To evaluate study heterogeneity, both Chi-square and Higgins tests were performed. Values of P < 0.05 were considered statistically significant.

Results

The overall methodological quality assessment was moderate. The risk of publication’s bias was moderate. We enrolled in this study a total of 13,789 patients. The mean follow-up was 42.69 months. The UKA evidenced increased risk of revision’s surgeries (OR 2.16, P > 0.0001). All the other scores of interest were in favor of the UKA: Oxford Knee Score, KSS Clinical, WOMAC overall and related subscales. The UKA also reported better functional outcomes: KSS Function, longer walking distance, improvement of the joint flexion and ROM. Moreover, in the UKA group have been reported a shorter length of stay, reduced estimated total blood loss and shorter surgical duration.

Conclusion

The main findings of this meta-analysis are that UKA reported a reduced survivorship but better clinical and functional performances compared to TKA. Furthermore, shorter surgical duration, lower total estimated blood loss and quicker hospitalization length were observed in the UKA cohort.

Keywords

Osteoarthritis Unicompartimental knee arthroplasty Total knee arthroplasty UKA TKA Survivorship 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent is not required for this type of study.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsRWTH Aachen University ClinicAachenGermany
  2. 2.Department of General SurgeryEifelklinik St. BrigidaSimmerathGermany

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