Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis
Background: Interest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, w...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-12-01
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| Series: | Arthroplasty Today |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344117300237 |
| _version_ | 1823929138201755648 |
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| author | Sahil Kooner, MD Herman Johal, MD, MPH, PhD(c), FRCSC Marcia Clark, MD, MSc, FRCSC |
| author_facet | Sahil Kooner, MD Herman Johal, MD, MPH, PhD(c), FRCSC Marcia Clark, MD, MSc, FRCSC |
| author_sort | Sahil Kooner, MD |
| collection | DOAJ |
| description | Background: Interest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA. Methods: The databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible. Results: Six studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA. Conclusions: The use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate. Keywords: Total knee arthroplasty, Bicompartmental knee arthroplasty, Medial patellofemoral arthritis, Meta-analysis |
| first_indexed | 2024-12-16T21:04:44Z |
| format | Article |
| id | doaj.art-af4cdbf25a7343d58b23768d88490018 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-16T21:04:44Z |
| publishDate | 2017-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-af4cdbf25a7343d58b23768d884900182022-12-21T22:16:20ZengElsevierArthroplasty Today2352-34412017-12-0134309314Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritisSahil Kooner, MD0Herman Johal, MD, MPH, PhD(c), FRCSC1Marcia Clark, MD, MSc, FRCSC2Department of Orthopedics, University of Calgary Cumming School of Medicine, Foothills Medical Centre, Calgary, Alberta, Canada; Corresponding author. Department of Orthopedics, University of Calgary Cumming School of Medicine, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada. Tel.: +1 403 629 8448.Center for Evidence-Based Orthopaedics, Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, CanadaDepartment of Orthopedics, University of Calgary Cumming School of Medicine, Foothills Medical Centre, Calgary, Alberta, CanadaBackground: Interest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA. Methods: The databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible. Results: Six studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA. Conclusions: The use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate. Keywords: Total knee arthroplasty, Bicompartmental knee arthroplasty, Medial patellofemoral arthritis, Meta-analysishttp://www.sciencedirect.com/science/article/pii/S2352344117300237 |
| spellingShingle | Sahil Kooner, MD Herman Johal, MD, MPH, PhD(c), FRCSC Marcia Clark, MD, MSc, FRCSC Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis Arthroplasty Today |
| title | Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis |
| title_full | Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis |
| title_fullStr | Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis |
| title_full_unstemmed | Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis |
| title_short | Bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis |
| title_sort | bicompartmental knee arthroplasty vs total knee arthroplasty for the treatment of medial compartment and patellofemoral osteoarthritis |
| url | http://www.sciencedirect.com/science/article/pii/S2352344117300237 |
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