Unicompartmental knee arthritis: UKA bests TKA on most outcomes

  • Wilson HA & al.
  • BMJ
  • 21 Feb 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For unicompartmental knee arthritis, unicompartmental knee arthroplasty (UKA) offers shorter hospital stay, better functional outcome, and lower mortality vs total knee arthroplasty (TKA).
  • TKA ends with fewer revisions.

Why this matters

  • Authors say that many patients are not even offered UKA and that these results should spur inclusion of patients in decision-making.

Key results

  • 60 studies grouped into randomized controlled trials (RCTs; 6), registry/database studies (RDs; 17), cohort studies (CSs; 36).
  • UKA vs TKA was associated with shorter hospital stay (mean difference; 95% CIs): 
    • RCTs: –1.20 (–1.67 to –0.73); 
    • RDs: –1.43 (–1.53 to –1.33); 
    • CSs: –1.73 (–2.30 to –1.16). 
  • UKA was associated with better range-of-motion scores (mean difference; 95% CIs):
    • CSs: –0.58 (–0.88 to –0.27);
    • RDs: –0.32 (–0.48 to –0.15).
  • In RD studies, vs UKA, TKA was associated with (risk ratios; 95% CIs):
    • Higher mortality: 0.27 (0.16-0.45);
    • Venous thromboembolic events: 0.39 (0.27-0.57);
    • Major cardiac events: 0.22 (0.06-0.86).
  • TKA had lower 5-year revision rates (risk ratios; 95% CIs):
    • RCTs: 5.95 (1.29-27.59);
    • RDs: 2.50 (1.77-3.54);
    • CSs: 3.13 (1.89-5.17).

Study design

  • Meta-analysis, systematic review, studies published January 1, 1997 to December 31, 2018.
  • Funding: None.

Limitations

  • Studies varied in inclusion criteria, endpoints, etc.
  • RD studies dominated.

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