Comparison of the effectiveness of unicompartmental arthroplasty and total knee arthroplasty based on patient scale data_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZU Xiangyu , WANG Jun , LU Ming ,  YIN Zongsheng

Department of Joint Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China;

Corresponding author：

YIN Zongsheng, Email: yinzongsheng@sina.com

Keywords：

Unicompartmental knee arthroplasty; total knee arthroplasty; knee joint function; joint amnesia; quality of life

DOI：

10.7507/1002-1892.202108115

Video：

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Objective To compare the patient-reported outcomes regarding function, joint amnesia, and the quality of life after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The clinical data of patients who received UKA or TKA between September 2017 and June 2018 were retrospectively analyzed. After propensity score matching, 40 patients (40 knees) each in TKA group and UKA group were finally included in the study. There was no significant difference between the two groups in gender, age, body mass index, surgical side, preoperative knee range of motion, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, clinical and function scores of knee society score (KSS) (P>0.05). At 2 years after operation, WOMAC score, KSS clinical and function scores were performed on the two groups of patients, and compared with preoperative ones; knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS), short-form 36 health survey scale (SF-36 scale), and forgotten joint score (FJS) were also performed. Results At 2 years after operation, the total score of WOMAC, the clinical and function scores of KSS in the two groups significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in the total score of WOMAC, the individual score of WOMAC, the clinical and function scores of KSS between the two groups (P>0.05). The total KOOS-PS score in the UKA group was significantly lower than that in the TKA group (t=4.243, P=0.000), and the scores of writhing/knee rotation, kneeling, and squatting in the UKA group were significantly lower than those in the TKA group (P<0.05). The total FJS score in the UKA group was significantly higher than that in the TKA group (t=−6.334, P=0.000). In the UKA group, the scores of 7 items were significantly lower than those of the TKA group (P<0.05) including when walking over 15 minutes, when climbing stairs, when walking on uneven ground, when standing for long periods, when doing housework or gardening, when taking a walk or hiking, and when doing your favorite sport. The SF-36 scales of physiological function, energy, social function, emotional function, and mental health in the UKA group were significantly higher than those in the TKA group (P<0.05). Conclusion Compared with TKA, patients treated with UKA may have better knee function recovery, joint amnesia, and higher quality of life.

Citation： ZU Xiangyu, WANG Jun, LU Ming, YIN Zongsheng. Comparison of the effectiveness of unicompartmental arthroplasty and total knee arthroplasty based on patient scale data. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1574-1579. doi: 10.7507/1002-1892.202108115 Copy

1.	Koppens D, Stilling M, Munk S, et al. Low implant migration of the SIGMA^® medial unicompartmental knee arthroplasty. Knee Surg Sports TraumatolArthrosc, 2018, 26(6): 1776-1785.
2.	Goh GS, Bin Abd Razak HR, Tay DK, et al. Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplasty, 2018, 33(2): 355-361.
3.	Kleeblad LJ, van der List JP, Zuiderbaan HA, et al. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports TraumatolArthrosc, 2018, 26(6): 1811-1822.
4.	Peersman G, Slane J, Vuylsteke P, et al. Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study. Arch Orthop Trauma Surg, 2017, 137(11): 1557-1563.
5.	Fetzer GB, Callaghan JJ, Templeton JE, et al. Posterior cruciate-retaining modular total knee arthroplasty: a 9- to 12-year follow-up investigation. J Arthroplasty, 2002, 17(8): 961-966.
6.	Lygre SH, Espehaug B, Havelin LI, et al. Pain and function in patients after primary unicompartmental and total knee arthroplasty. J Bone Joint Surg (Am), 2010, 92(18): 2890-2897.
7.	Pandit H, Jenkins C, Gill HS, et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg (Br), 2011, 93(2): 198-204.
8.	Chou DT, Swamy GN, Lewis JR, et al. Revision of failed unicompartmental knee replacement to total knee replacement. Knee, 2012, 19(4): 356-359.
9.	Emerson RH, Higgins LL. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg (Am), 2008, 90(1): 118-122.
10.	Bullens PH, van Loon CJ, de Waal Malefijt MC, et al. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty, 2001, 16(6): 740-747.
11.	Suda AJ, Seeger JB, Bitsch RG, et al. Are patients’ expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics, 2010, 33(2): 76-80.
12.	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
13.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin OrthopRelat Res, 1989, (248): 13-14.
14.	Davis AM, Perruccio AV, Canizares M, et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage, 2009, 17(7): 843-847.
15.	Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Ⅰ. Conceptual framework and item selection. Med Care, 1992, 30(6): 473-483.
16.	Behrend H, Giesinger K, Giesinger JM, et al. The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty, 2012, 27(3): 430-436.
17.	Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1688-1695.
18.	Naal FD, Fischer M, Preuss A, et al. Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med, 2007, 35(10): 1688-1695.
19.	Scott CEH, Wade FA, MacDonald D, et al. Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg, 2018, 138(5): 719-729.
20.	Goodfellow JW, O’Connor JJ, Murray DW. A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg (Br), 2010, 92(12): 1628-1631.
21.	Na SE, Ha CW, Lee CH. A new high-flexion knee scoring system to eliminate the ceiling effect. Clin OrthopRelat Res, 2012, 470(2): 584-593.
22.	Antoniadis A, Dimitriou D, Canciani JP, et al. A novel preoperative scoring system for the indication of unicompartmental knee arthroplasty, as predictor of clinical outcome and satisfaction. Arch Orthop Trauma Surg, 2019, 139(1): 113-120.
23.	Waldstein W, Kolbitsch P, Koller U, et al. Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports TraumatolArthrosc, 2017, 25(3): 717-728.
24.	Walker T, Gotterbarm T, Bruckner T, et al. Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports TraumatolArthrosc, 2015, 23(11): 3281-3287.
25.	Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports TraumatolArthrosc, 2008, 16(10): 973-979.
26.	Thienpont E, Opsomer G, Koninckx A, et al. Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint score. J Arthroplasty, 2014, 29(1): 48-51.
27.	Zuiderbaan HA, van der List JP, Khamaisy S, et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 681-686.
28.	Clement ND, MacDonald D, Burnett R. Primary total knee replacement in patients with mental disability improves their mental health and knee function: a prospective study. Bone Joint J, 2013, 95-B(3): 360-366.
29.	Pérez-Prieto D, Gil-González S, Pelfort X, et al. Influence of depression on total knee arthroplasty outcomes. J Arthroplasty, 2014, 29(1): 44-47.
30.	Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin OrthopRelat Res, 2010, 468(1): 57-63.
31.	Lee M, Huang Y, Chong HC, et al. Predicting satisfaction for unicompartmental knee arthroplasty patients in an Asian population. J Arthroplasty, 2016, 31(8): 1706-1710.
32.	Goh GS, Liow MHL, Pang HN, et al. Patients with poor baseline mental health undergoing unicompartmental knee arthroplasty have poorer outcomes. J Arthroplasty, 2018, 33(8): 2428-2434.

1. Koppens D, Stilling M, Munk S, et al. Low implant migration of the SIGMA^® medial unicompartmental knee arthroplasty. Knee Surg Sports TraumatolArthrosc, 2018, 26(6): 1776-1785.
2. Goh GS, Bin Abd Razak HR, Tay DK, et al. Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplasty, 2018, 33(2): 355-361.
3. Kleeblad LJ, van der List JP, Zuiderbaan HA, et al. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports TraumatolArthrosc, 2018, 26(6): 1811-1822.
4. Peersman G, Slane J, Vuylsteke P, et al. Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study. Arch Orthop Trauma Surg, 2017, 137(11): 1557-1563.
5. Fetzer GB, Callaghan JJ, Templeton JE, et al. Posterior cruciate-retaining modular total knee arthroplasty: a 9- to 12-year follow-up investigation. J Arthroplasty, 2002, 17(8): 961-966.
6. Lygre SH, Espehaug B, Havelin LI, et al. Pain and function in patients after primary unicompartmental and total knee arthroplasty. J Bone Joint Surg (Am), 2010, 92(18): 2890-2897.
7. Pandit H, Jenkins C, Gill HS, et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg (Br), 2011, 93(2): 198-204.
8. Chou DT, Swamy GN, Lewis JR, et al. Revision of failed unicompartmental knee replacement to total knee replacement. Knee, 2012, 19(4): 356-359.
9. Emerson RH, Higgins LL. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg (Am), 2008, 90(1): 118-122.
10. Bullens PH, van Loon CJ, de Waal Malefijt MC, et al. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty, 2001, 16(6): 740-747.
11. Suda AJ, Seeger JB, Bitsch RG, et al. Are patients’ expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics, 2010, 33(2): 76-80.
12. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
13. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin OrthopRelat Res, 1989, (248): 13-14.
14. Davis AM, Perruccio AV, Canizares M, et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage, 2009, 17(7): 843-847.
15. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Ⅰ. Conceptual framework and item selection. Med Care, 1992, 30(6): 473-483.
16. Behrend H, Giesinger K, Giesinger JM, et al. The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty, 2012, 27(3): 430-436.
17. Liddle AD, Judge A, Pandit H, et al. Adverse outcomes after total and unicompartmental knee replacement in 101, 330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet, 2014, 384(9952): 1688-1695.
18. Naal FD, Fischer M, Preuss A, et al. Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med, 2007, 35(10): 1688-1695.
19. Scott CEH, Wade FA, MacDonald D, et al. Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg, 2018, 138(5): 719-729.
20. Goodfellow JW, O’Connor JJ, Murray DW. A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg (Br), 2010, 92(12): 1628-1631.
21. Na SE, Ha CW, Lee CH. A new high-flexion knee scoring system to eliminate the ceiling effect. Clin OrthopRelat Res, 2012, 470(2): 584-593.
22. Antoniadis A, Dimitriou D, Canciani JP, et al. A novel preoperative scoring system for the indication of unicompartmental knee arthroplasty, as predictor of clinical outcome and satisfaction. Arch Orthop Trauma Surg, 2019, 139(1): 113-120.
23. Waldstein W, Kolbitsch P, Koller U, et al. Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports TraumatolArthrosc, 2017, 25(3): 717-728.
24. Walker T, Gotterbarm T, Bruckner T, et al. Return to sports, recreational activity and patient-reported outcomes after lateral unicompartmental knee arthroplasty. Knee Surg Sports TraumatolArthrosc, 2015, 23(11): 3281-3287.
25. Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports TraumatolArthrosc, 2008, 16(10): 973-979.
26. Thienpont E, Opsomer G, Koninckx A, et al. Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint score. J Arthroplasty, 2014, 29(1): 48-51.
27. Zuiderbaan HA, van der List JP, Khamaisy S, et al. Unicompartmental knee arthroplasty versus total knee arthroplasty: Which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 681-686.
28. Clement ND, MacDonald D, Burnett R. Primary total knee replacement in patients with mental disability improves their mental health and knee function: a prospective study. Bone Joint J, 2013, 95-B(3): 360-366.
29. Pérez-Prieto D, Gil-González S, Pelfort X, et al. Influence of depression on total knee arthroplasty outcomes. J Arthroplasty, 2014, 29(1): 44-47.
30. Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin OrthopRelat Res, 2010, 468(1): 57-63.
31. Lee M, Huang Y, Chong HC, et al. Predicting satisfaction for unicompartmental knee arthroplasty patients in an Asian population. J Arthroplasty, 2016, 31(8): 1706-1710.
32. Goh GS, Liow MHL, Pang HN, et al. Patients with poor baseline mental health undergoing unicompartmental knee arthroplasty have poorer outcomes. J Arthroplasty, 2018, 33(8): 2428-2434.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of the effectiveness of unicompartmental arthroplasty and total knee arthroplasty based on patient scale data

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