Unicompartmental knee arthroplasty for unicompartmental osteoarthritis: a systematic review. Report no 44.
Australian Safety and Efficacy Register of New Interventional Procedures - Surgical
Record ID 32005000454
The aim of this report is to assess the safety and efficacy of unicompartmental knee arthroplasty (UKA), in comparison to total knee arthroplasty (TKA) and high tibial osteotomy (HTO), on the basis of a systematic assessment of the literature.
Authors' results and conclusions: A total of 14 comparative studies were identified for inclusion in the review. There were nine studies comparing UKA and TKA. Of these, one was a randomised controlled trial (RCT) and eight were non-randomised comparative studies. There were six studies comparing UKA and HTO. Of these, two were RCTs and four were non-randomised comparative studies. The review was limited by the quality and quantity of the available evidence. Many of the included studies had relatively small sample size, substantial losses to follow-up, and relatively short follow-up. Not all studies reported all outcomes, further reducing the size of the evidence base. Knee function and postoperative pain was difficult to compare across studies due to the variability in knee and pain scores used. However, it appeared that UKA was similar to TKA and HTO at five years follow-up although there was much variability. Range of motion was significantly better in UKA compared to TKA. There did not appear to be any significant differences in overall rates of complications between UKA and TKA, although deep vein thrombosis (DVT) appeared to be reported more often after TKA than UKA. It appeared that there may have been more complications after HTO than UKA and the main complications reported were DVT and delayed healing or wound infections. Revision and knee survival was reported in fewer than half of the included studies. Survival of UKA prostheses (based on rate of revision) appeared to be between 85% and 95% in the included studies, compared to a survivorship of around 90% or more for TKA prostheses. By comparison survivorship for HTO appeared to be less than 85%. Hence, it was not clear whether there were more revisions after UKA than TKA up to ten years after implantation, but it appeared there were fewer revisions of UKA compared to HTO.
Authors' recommendations: On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications and recommendations concerning the safety and efficacy of unicompartmental knee arthroplasty: Evidence rating: The evidence-base in this review is rated as average. Safety: Unicompartmental knee arthroplasty is considered at least as safe as total knee arthroplasty and high tibial osteotomy. Efficacy: In terms of function, unicompartmental knee arthroplasty appears to be at least as efficacious as total knee arthroplasty and high tibial osteotomy. In terms of knee survival, the efficacy of unicompartmental knee arthroplasty compared to total knee arthroplasty and high tibial osteotomy can not be determined. Recommendations Current trials in progress should reduce some uncertainty surrounding the treatment of osteoarthritis in the knee. The continuing contribution of data to national joint registries will aid in validating the current trends, particularly in knee survival after unicompartmental or total knee arthroplasty.
Authors' methods: Systematic review
Project Status: Completed
URL for project: http://www.surgeons.org/asernip-s/
Year Published: 2005
English language abstract: An English language summary is available
Publication Type: Not Assigned
- Arthroplasty, Replacement, Knee
- Osteoarthritis, Knee
Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical
Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900
Contact Name: firstname.lastname@example.org
Contact Email: email@example.com
Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.