| Yhteenveto: | We recently published a paper comparing the incidence of adverse outcomes after Unicompartmental and Total Knee replacement (UKR & TKR). The conclusion of this study, which was in favour of UKR, was dismissed as biased in a review in Bone & Joint 360 1 that was subsequently reprinted in the Bone and Joint Journal 2. Although this study is one of the least biased comparisons of UKR and TKR, this episode highlights the biases that exist both towards and against UKR. In this review we give examples of different sources of bias and how they can be avoided based on our published paper, National Registry data and a meta-analysis of published data. Our conclusion is that comparisons between UKR and TKR are open to bias. These biases are so marked in comparisons made by National Registers based on revision rate that the conclusions are misleading. For a fair comparison data from randomised studies or well matched prospective observational cohort studies, which may be based on registry data, are required and multiple outcome measures should be used. The data of this type that already exists is in favour of UKR.
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