Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty
Aims: Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for pat...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-05-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.35.BJO-2021-0174.R1 |
| _version_ | 1818518926197260288 |
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| author | Mette Mikkelsen Hannah A. Wilson Kirill Gromov Andrew J. Price Anders Troelsen |
| author_facet | Mette Mikkelsen Hannah A. Wilson Kirill Gromov Andrew J. Price Anders Troelsen |
| author_sort | Mette Mikkelsen |
| collection | DOAJ |
| description | Aims: Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA. Methods: A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences. Results: The matched cohort included 400 patients (mean age 67 years (SD 9.55), 213 (53%) female, mean BMI 30.2 kg/m2, 337 (84%) American Society of Anesthesiologists grade ≤ 2). We found a mean adjusted difference in change score of 3.02 points (95% confidence interval (CI) 1.41 to 4.63; p < 0.001) and a significantly larger likeliness of achieving PASS (odds ratio 3.67 (95% CI 1.73 to 8.45); p = 0.001) both in favour of the UKA strategy. Conclusion: UKA and TKA are both good strategies for treating end-stage AMOA. However, when compared as a strategy, UKA achieved larger improvements in OKS, and were more likely to reach the PASS value at one-year follow-up. Cite this article: Bone Jt Open 2022;3(5):441–447. |
| first_indexed | 2024-12-11T01:16:58Z |
| format | Article |
| id | doaj.art-ac239beec14c40f4b4fec0a20c4fcdc7 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-12-11T01:16:58Z |
| publishDate | 2022-05-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
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| series | Bone & Joint Open |
| spelling | doaj.art-ac239beec14c40f4b4fec0a20c4fcdc72022-12-22T01:25:50ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-05-013544144710.1302/2633-1462.35.BJO-2021-0174.R1Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplastyMette Mikkelsen0Hannah A. Wilson1Kirill Gromov2Andrew J. Price3Anders Troelsen4Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, DenmarkNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UKDepartment of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, DenmarkNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UKDepartment of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, DenmarkAims: Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA. Methods: A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences. Results: The matched cohort included 400 patients (mean age 67 years (SD 9.55), 213 (53%) female, mean BMI 30.2 kg/m2, 337 (84%) American Society of Anesthesiologists grade ≤ 2). We found a mean adjusted difference in change score of 3.02 points (95% confidence interval (CI) 1.41 to 4.63; p < 0.001) and a significantly larger likeliness of achieving PASS (odds ratio 3.67 (95% CI 1.73 to 8.45); p = 0.001) both in favour of the UKA strategy. Conclusion: UKA and TKA are both good strategies for treating end-stage AMOA. However, when compared as a strategy, UKA achieved larger improvements in OKS, and were more likely to reach the PASS value at one-year follow-up. Cite this article: Bone Jt Open 2022;3(5):441–447.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.35.BJO-2021-0174.R1unicompartmental knee arthroplastyknee replacementpatient-reported outcome measurementoxford knee scoreanteromedial osteoarthritisanteromedial osteoarthritisunicompartmental knee arthroplasty (uka)total knee arthroplasty (tka)patient-acceptable symptom state (pass)oxford knee scorespropensity score matchingbmikneeanesthesiologistspreoperative radiographs |
| spellingShingle | Mette Mikkelsen Hannah A. Wilson Kirill Gromov Andrew J. Price Anders Troelsen Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty Bone & Joint Open unicompartmental knee arthroplasty knee replacement patient-reported outcome measurement oxford knee score anteromedial osteoarthritis anteromedial osteoarthritis unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) patient-acceptable symptom state (pass) oxford knee scores propensity score matching bmi knee anesthesiologists preoperative radiographs |
| title | Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty |
| title_full | Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty |
| title_fullStr | Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty |
| title_full_unstemmed | Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty |
| title_short | Comparing surgical strategies for end-stage anteromedial osteoarthritis: total versus unicompartmental knee arthroplasty |
| title_sort | comparing surgical strategies for end stage anteromedial osteoarthritis total versus unicompartmental knee arthroplasty |
| topic | unicompartmental knee arthroplasty knee replacement patient-reported outcome measurement oxford knee score anteromedial osteoarthritis anteromedial osteoarthritis unicompartmental knee arthroplasty (uka) total knee arthroplasty (tka) patient-acceptable symptom state (pass) oxford knee scores propensity score matching bmi knee anesthesiologists preoperative radiographs |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.35.BJO-2021-0174.R1 |
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