FOTO Rehab Outcomes

10 Year Self-Report Outcomes: Total versus Unicompartmental Knee Replacement

 

I'm disappointed in this research design.

I have patients who ask me which is better: a total knee arthroplasty or a unicompartmental knee replacement?

There is a time and place for self-report measures. For this situation, there needs to be more. The questions I want to ask include:

  • how long does the unicompartmental knee replacement last?
  • what happens when a revision is required?
  • is there  a difference in infection rates?

I continue to have these questions.... 

Outcomes_TKA_vs_unicompartmental_replacement

Here's a quick view of the abstract. 

Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis.

 

Abstract

PURPOSE:

For patients with medial compartment arthritis who have failed non-operative treatment, either a total knee arthroplasty (TKA) or a unicompartmental knee arthroplasty (UKA) can be undertaken. This analysis considers how the choice between UKA and TKA affects long-term patient-reported outcome measures (PROMs).

METHODS:

The Knee Arthroplasty Trial (KAT) and a cohort of patients who received a minimally invasive UKA provided data. Propensity score matching was used to identify comparable patients. Oxford Knee Score (OKS), its pain and function components, and the EuroQol 5 Domain (EQ-5D) index, estimated on the basis of OKS responses, were then compared over 10 years following surgery. Mixed-effects regressions for repeated measures were used to estimate the effect of patient characteristics and type of surgery on PROMs.

RESULTS:

Five-hundred and ninety UKAs were matched to the same number of TKAs. Receiving UKA rather than TKA was found to be associated with better scores for OKS, including both its pain and function components, and EQ-5D, with the differences expected to grow over time. UKA was also associated with an increased likelihood of patients achieving a successful outcome, with an increased chance of attaining minimally clinically important improvements in both OKS and EQ-5D, and an 'excellent' OKS. In addition, for both procedures, patients aged between 60 and 70 and better pre-operative scores were associated with better post-operative outcomes.

CONCLUSION:

Minimally invasive UKAs performed on patients with the appropriate indications led to better patient-reported pain and function scores than TKAs performed on comparable patients. UKA can lead to better long-term quality of life than TKA and this should be considered alongside risk of revision when choosing between the procedures.

LEVEL OF EVIDENCE: II.

2016 Dec 29. doi: 10.1007/s00167-016-4404-7. [Epub ahead of print]