Patient outcomes following unicompartmental or bicompartmental knee arthroplasty. A meta-analysis.
The purpose of this study was to summarize the literature describing patient outcomes following unicompartmental and bicompartmental knee arthroplasty. Original studies were included in this meta-analysis if they enrolled 10 or more patients at the time of an initial knee arthroplasty and measured patient outcomes using a global knee rating scale. Forty-six studies on unicompartmental prostheses and 18 studies on bicompartmental prostheses met these criteria. For unicompartmental studies, the total number of enrolled patients was 2,391, with a mean enrollment of 47 patients and a mean follow-up period of 4.6 years. The mean patient age was 66 years; 67% were women, 75% had osteoarthritis, and 16% underwent bilateral knee arthroplasty. The mean postoperative global rating scale score was 80.9. The overall complication rate was 18.5% and the revision rate was 9.2%. Studies published after 1987 reported better outcomes, but also tended to enroll older patients and patients with osteoarthritis and higher preoperative knee rating scores. For bicompartmental studies, the total number of enrolled patients was 884, with a mean enrollment of 44 patients and a mean follow-up period of 3.6 years. The mean patient age was 61 years; 79% were women, 31% had osteoarthritis, and 29% underwent a bilateral arthroplasty. The mean postoperative global rating scale score was 78.3. The overall complication rate was 30% and the revision rate was 7.2%. Although bicompartmental studies reported lower mean postoperative global rating scale scores, these studies tended to enroll patients with worse preoperative knee rating scores. Recent improvements in patient outcomes following unicompartmental knee arthroplasty appear to be due, at least partially, to changes in patient selection criteria. Patient outcomes appear to be worse for bicompartmental arthroplasties than for other prosthetic designs; however, patients enrolled in these studies had more poorly functioning knees before surgery and actually had greater absolute improvements in global knee rating scores.
Callahan
C M
CM
Department of Medicine, Indiana University, Indianapolis, USA.
Drake
B G
BG
Heck
D A
DA
Dittus
R S
RS
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology / Q000601:surgery; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome