Knee osteoarthritis: partial knee replacement as good as total replacement

  • The Lancet

  • International Clinical Digest
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Takeaway

  • A randomized controlled trial (RCT) finds that partial knee replacement (PKR) is similar to total knee replacement (TKR) for pain and function 5 years postsurgery in patients with late-stage medial compartment osteoarthritis (OA) of the knee.
  • PKR had fewer complications and was less costly.

Why this matters

  • The authors suggest that PKR "should be considered the first choice for patients with late-stage isolated medial compartment osteoarthritis."
  • 47% of patients with this kind of OA are suitable candidates for PKR.

Study design

  • Multicenter RCT of patients (n=528) at 27 UK sites who satisfied general requirements for a medial PKR were allocated to PKR or TKR.
  • Primary outcome was the Oxford Knee Score (OKS), a self-reported measure of pain and function, 5 years after surgery.
  • Funding: National Institute for Health Research Health Technology Assessment Programme.

Key results

  • No difference between groups on OKS (mean difference, 1.04; P=.159).
  • No difference between groups in number of reoperations and revisions.
  • The PKR group had fewer complications (risk ratio, 0.72; P=.036).
  • The PKR group had better QoL on the EuroQol EQ-5D-3L (0.240 additional quality-adjusted life-years; 95% CI, 0.046-0.434).
  • PKR was less costly (−£910; 95% CI, −£1503 to −£317).

Limitations

  • No masking.