Should patients aged 75 years or older undergo medial unicompartmental knee arthroplasty? A propensity score-matched study

Abstract

Introduction

With increasing life expectancies worldwide, more elderly patients with isolated medial compartment osteoarthritis may become suitable UKA candidates. However, there is a paucity of literature comparing outcomes between older patients (≥ 75 years) and younger patients undergoing UKA. The aim of this study was to determine if there were differences in functional and HRQoL measures between older patients (≥ 75 years) and younger controls (< 75 years) undergoing primary UKA.

Materials and methods

Prospectively collected registry data of 1041 patients who underwent primary, cemented, fixed-bearing medial UKA at a single institution from 2002–2013 were reviewed. Propensity scores generated using logistic regression was used to match older patients (≥ 75 years, n = 94) to controls (< 75 years, n = 188) in a 1:2 ratio. Knee Society Scores, Oxford Knee Score, Short Form-36, satisfaction/expectation scores, proportion of patients attaining OKS/SF-36 PCS MCID and survivorship were analysed.

Results

Patients ≥ 75 years had significantly lower KSFS (67.1 ± 17.9 vs 79.4 ± 18.2, p < 0.001) and SF-36 PCS (47.3 ± 10.1 vs 50.4 ± 9.1, p = 0.01) as compared to the control group. In addition, a significantly lower proportion of patients ≥ 75 years attained MCID for SF-36 PCS when compared to the controls (50.0% vs 63.8%, p = 0.04). Survival rates at mean 8.3 ± 3.0 years were 98.9% (95% CI, 96.7–100) in the older group versus 92.8% (95% CI, 86.8–98.8) in the younger group (p = 0.31).

Conclusions

Our findings highlight the need to counsel older patients regarding potentially reduced improvements in functional outcomes, despite advantages of lower revision. However, UKA in older patients continues to be a viable option for isolated medial compartment osteoarthritis

Level of evidence

Level III Propensity score matched study

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References

  1. 1.

    Antoniadis A, Dimitriou D, Canciani JP, Helmy N (2019) A novel preoperative scoring system for the indication of unicompartmental knee arthroplasty, as predictor of clinical outcome and satisfaction. Arch Orthop Trauma Surg 139:113–120

    PubMed  Article  Google Scholar 

  2. 2.

    Badawy M, Espehaug B, Indrekvam K, Havelin LI, Furnes O (2014) Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Acta Orthop 85:342–347

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Biswas D, Van Thiel GS, Wetters NG, Pack BJ, Berger RA, Della Valle CJ (2014) Medial unicompartmental knee arthroplasty in patients less than 55 years old: minimum of two years of follow-up. J Arthrop 29:101–105

    Article  Google Scholar 

  4. 4.

    Bolognesi MP, Greiner MA, Attarian DE, Watters TS, Wellman SS, Curtis LH, Berend KR, Setoguchi S (2013) Unicompartmental knee arthroplasty and total knee arthroplasty among medicare beneficiaries, 2000 to 2009. J Bone Jt Surg 95:e174

    Article  Google Scholar 

  5. 5.

    Brown NM, Sheth NP, Davis K, Berend ME, Lombardi AV, Berend KR, Della Valle CJ (2012) Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthrop 27:86–90

    Article  Google Scholar 

  6. 6.

    Burn E, Liddle AD, Hamilton TW, Judge A, Pandit HG, Murray DW, Pinedo-Villanueva R (2018) Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales. BMJ Open 8:e020977

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CAF, Gill HS, Murray DW (2009) Tibial component overhang following unicompartmental knee replacement—does it matter? Knee 16:310–313

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Chawla H, Ghomrawi HM, van der List JP, Eggman AA, Zuiderbaan HA, Pearle AD (2017) Establishing age-specific cost-effective annual revision rates for unicompartmental knee arthroplasty: a meta-analysis. J Arthrop 32:326–335

    Article  Google Scholar 

  9. 9.

    Escobar A, Quintana JM, Bilbao A, Aróstegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthr Cartil 15:273–280

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Fabre-Aubrespy M, Ollivier M, Pesenti S, Parratte S, Argenson J-N (2016) Unicompartmental knee arthroplasty in patients older than 75 results in better clinical outcomes and similar survivorship compared to total knee arthroplasty a matched controlled study. J Arthrop 31:2668–2671

    Article  Google Scholar 

  11. 11.

    Ghomrawi HM, Eggman AA, Pearle AD (2015) Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Jt Surg Am 97:396–402

    Article  Google Scholar 

  12. 12.

    Goh GS-H, Bin Abd Razak HR, Tay DK-J, Chia S-L, Lo N-N, Yeo S-J (2018) Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplasty 33:355–361

    PubMed  Article  Google Scholar 

  13. 13.

    Goh GS-H, Liow MHL, Bin Abd Razak HR, Tay DK-J, Lo N-N, Yeo S-J (2017) Patient-reported outcomes, quality of life, and satisfaction rates in young patients aged 50 years or younger after total knee arthroplasty. J Arthroplasty 32:419–425

    PubMed  Article  Google Scholar 

  14. 14.

    Goh GS-H, Liow MHL, Lim WS-R, Tay DK-J, Yeo SJ, Tan MH (2016) Accelerometer-based navigation is as accurate as optical computer navigation in restoring the joint line and mechanical axis after total knee arthroplasty. J Arthrop 31:92–97

    Article  Google Scholar 

  15. 15.

    Goh GS-H, Liow MHL, Pang H-N, Tay DK-J, Lo N-N, Yeo S-J (2018) Patients with poor baseline mental health undergoing unicompartmental knee arthroplasty have poorer outcomes. J Arthrop 33:2428–2434

    Article  Google Scholar 

  16. 16.

    Hitt K, Shurman JR, Greene K, McCarthy J, Moskal J, Hoeman T, Mont M, a. (2003) Anthropometric measurements of the human knee. J Bone Jt Surg-Am 85:115–122

    Article  Google Scholar 

  17. 17.

    Howieson A, Farrington W (2015) Unicompartmental knee replacement in the elderly: a systematic review. Acta Orthop Belg 81:565–571

    PubMed  Google Scholar 

  18. 18.

    Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW (2014) 45-day mortality after 467\hphantom,779 knee replacements for osteoarthritis from the national joint registry for England and Wales: an observational study. The Lancet 384:1429–1436

    Article  Google Scholar 

  19. 19.

    Insall JN, Dorr LD, Scott RD, Scott NW (1989) Rationale of the knee society clinical rating system. Clin Orthop (248):13–14

  20. 20.

    Jeschke E, Gehrke T, Günster C, Hassenpflug J, Malzahn J, Niethard FU, Schräder P, Zacher J, Halder A (2016) Five-year survival of 20,946 unicondylar knee replacements and patient risk factors for failure. J Bone Jt Surg 98:1691–1698

    Article  Google Scholar 

  21. 21.

    Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Jt Surg 71:145–150

    CAS  Article  Google Scholar 

  22. 22.

    Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. Clin Orthop (273):151–156

  23. 23.

    Liddle AD, Judge A, Pandit H, Murray DW (2014) Determinants of revision and functional outcome following unicompartmental knee replacement. Osteoarthr Cartil 22:1241–1250

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty. Bone Jt J 97-B(6):793–801

    CAS  Article  Google Scholar 

  25. 25.

    Liddle AD, Pandit H, Judge A, Murray DW (2016) Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Jt Surg 98:1–8

    Article  Google Scholar 

  26. 26.

    Liow MHL, Goh GS-H, Wong MK, Chin PL, Tay DK-J, Yeo S-J (2017) Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 25:2942–2951

    PubMed  Article  Google Scholar 

  27. 27.

    van der List JP, Chawla H, Zuiderbaan HA, Pearle AD (2016) The Role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 31:2617–2627

    PubMed  Article  Google Scholar 

  28. 28.

    Lombardi AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA (2009) Is Recovery faster for mobile-bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res 467:1450–1457

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89-B:1010–1014

    Article  Google Scholar 

  30. 30.

    Patil S, Colwell CW, Ezzet KA, D’Lima DD (2005) Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Jt Surg-Am 87:332–338

    Article  Google Scholar 

  31. 31.

    Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P (2014) Fixed-versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 23:3296–3305

    PubMed  Article  Google Scholar 

  32. 32.

    Razak HRBA, Tan C-S, Chen YJD, Pang H-N, Tay K-JD, Chin P-L, Chia S-L, Lo N-N, Yeo S-J (2016) Age and preoperative knee society score are significant predictors of outcomes among asians following total knee arthroplasty. J Bone Jt Surg 98:735–741

    Article  Google Scholar 

  33. 33.

    Sah AP, Springer BD, Scott RD (2006) Unicompartmental knee arthroplasty in octogenarians. Clin Orthop 451:107–112

    PubMed  Article  Google Scholar 

  34. 34.

    Seng CS, Ho DC, Chong HC, Chia SL, Chin PL, Lo NN, Yeo SJ (2014) Outcomes and survivorship of unicondylar knee arthroplasty in patients with severe deformity. Knee Surg Sports Traumatol Arthrosc 25:639–644

    PubMed  Article  Google Scholar 

  35. 35.

    Smith WB, Steinberg J, Scholtes S, Mcnamara IR (2015) Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:924–933

    PubMed  Article  Google Scholar 

  36. 36.

    Song EK, Mohite N, Lee SH, Na BR, Seon JK (2016) Comparison of outcome and survival after unsicompartmental knee arthroplasty between navigation and conventional techniques with an average 9-year follow-up. J Arthrop 31:395–400

    Article  Google Scholar 

  37. 37.

    Thompson SAJ, Liabaud B, Nellans KW, Geller JA (2013) Factors associated with poor outcomes following unicompartmental knee arthroplasty. J Arthrop 28:1561–1564

    Article  Google Scholar 

  38. 38.

    Tsai TY, Dimitriou D, Hosseini A, Liow MHL, Torriani M, Li G, Kwon YM (2016) Assessment of accuracy and precision of 3D reconstruction of unicompartmental knee arthroplasty in upright position using biplanar radiography. Med Eng Phys 38:633–638

    PubMed  Article  Google Scholar 

  39. 39.

    Tsai T-Y, Dimitriou D, Liow MHL, Rubash HE, Li G, Kwon Y-M (2016) Three-Dimensional imaging analysis of unicompartmental knee arthroplasty evaluated in standing position: component alignment and in vivo articular contact. J Arthrop 31:1096–1101

    Article  Google Scholar 

  40. 40.

    Von Keudell A, Sodha S, Collins J, Minas T, Fitz W, Gomoll A (2014) Patient satisfaction after primary total and unicompartmental knee arthroplasty: an age-dependent analysis. Knee 21:180–184

    Article  Google Scholar 

  41. 41.

    Walker T, Gotterbarm T, Bruckner T, Merle C, Streit MR (2014) Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3281–3287

    PubMed  Article  Google Scholar 

  42. 42.

    Walker T, Streit J, Gotterbarm T, Bruckner T, Merle C, Streit MR (2015) Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthrop 30:1911–1916

    Article  Google Scholar 

  43. 43.

    Ware JE, Kosinski M (2005) SF-36 physical & mental health summary scales: a manual for users of version 1. QualityMetric, Lincoln

    Google Scholar 

  44. 44.

    Zuiderbaan HA, van der List JP, Chawla H, Khamaisy S, Thein R, Pearle AD (2016) Predictors of subjective outcome after medial unicompartmental knee arthroplasty. J Arthroplas 31:1453–1458

    Article  Google Scholar 

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Correspondence to Graham S. Goh.

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Liow, M.H.L., Goh, G.S., Pang, H. et al. Should patients aged 75 years or older undergo medial unicompartmental knee arthroplasty? A propensity score-matched study. Arch Orthop Trauma Surg 140, 949–956 (2020). https://doi.org/10.1007/s00402-020-03440-4

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Keywords

  • Unicompartmental
  • Knee arthroplasty
  • Minimally clinical important difference
  • Patient-reported outcome measures
  • Quality of life