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

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

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.

Arthroplasty, Knee osteoarthritis, Knee prosthesis, Knee replacement
0942-2056
1455-1464
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Sanchez-Santos, Maria T.
04817dfd-fc86-4801-88f4-e3d54319fe39
Pandit, Hemant G.
786468fe-77e9-4bc9-996d-74c173e882d6
Hamilton, Thomas W.
d83cacde-820f-4b1b-a069-e6ee97271d4e
Liddle, Alexander D.
3c68d279-8e28-4714-bf05-503be6b447a2
Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Sanchez-Santos, Maria T.
04817dfd-fc86-4801-88f4-e3d54319fe39
Pandit, Hemant G.
786468fe-77e9-4bc9-996d-74c173e882d6
Hamilton, Thomas W.
d83cacde-820f-4b1b-a069-e6ee97271d4e
Liddle, Alexander D.
3c68d279-8e28-4714-bf05-503be6b447a2
Murray, David W.
fa0e1764-e600-42bd-937d-6d7e5d623bbc
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131

Burn, Edward, Sanchez-Santos, Maria T., Pandit, Hemant G., Hamilton, Thomas W., Liddle, Alexander D., Murray, David W. and Pinedo-Villanueva, Rafael (2018) Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 26 (5), 1455-1464. (doi:10.1007/s00167-016-4404-7).

Record type: Article

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.

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More information

Accepted/In Press date: 7 December 2016
e-pub ahead of print date: 29 December 2016
Published date: 1 May 2018
Keywords: Arthroplasty, Knee osteoarthritis, Knee prosthesis, Knee replacement

Identifiers

Local EPrints ID: 420243
URI: https://eprints.soton.ac.uk/id/eprint/420243
ISSN: 0942-2056
PURE UUID: 0beb085f-99b0-48d7-a7e4-3bc58503d11c

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Date deposited: 03 May 2018 16:30
Last modified: 10 Apr 2019 16:33

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