title: Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales.
abstract: Whether to use total or unicompartmental knee replacement (TKA/UKA) for end-stage knee osteoarthritis remains controversial. Although UKA results in a faster recovery, lower rates of morbidity and mortality and fewer complications, the long-term revision rate is substantially higher than that for TKA. The effect of each intervention on patient-reported outcome remains unclear. The aim of this study was to determine whether six-month patient-reported outcome measures (PROMs) are better in patients after TKA or UKA, using data from a large national joint registry (NJR). We carried out a propensity score-matched cohort study which compared six-month PROMs after TKA and UKA in patients enrolled in the NJR for England and Wales, and the English national PROM collection programme. A total of 3519 UKA patients were matched to 10 557 TKAs. The mean six-month PROMs favoured UKA: the Oxford Knee Score was 37.7 (95% confidence interval (CI) 37.4 to 38.0) for UKA and 36.1 (95% CI 35.9 to 36.3) for TKA; the mean EuroQol EQ-5D index was 0.772 (95% CI 0.764 to 0.780) for UKA and 0.751 (95% CI 0.747 to 0.756) for TKA. UKA patients were more likely to achieve excellent results (odds ratio (OR) 1.59, 95% CI 1.47 to 1.72, p < 0.001) and to be highly satisfied (OR 1.27, 95% CI 1.17 to 1.39, p < 0.001), and were less likely to report complications than those who had undergone TKA. UKA gives better early patient-reported outcomes than TKA; these differences are most marked for the very best outcomes. Complications and readmission are more likely after TKA. Although the data presented reflect the short-term outcome, they suggest that the high revision rate for UKA may not be because of poorer clinical outcomes. These factors should inform decision-making in patients eligible for either procedure.
authors.affiliation: University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Liddle
authors.affiliation: University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
authors.forename: H
authors.initials: H
authors.lastname: Pandit
authors.affiliation: University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Judge
authors.affiliation: University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
authors.forename: D W
authors.initials: DW
authors.lastname: Murray
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D017060:Patient Satisfaction; D057216:Propensity Score; D011788:Quality of Life; D012042:Registries; D016896:Treatment Outcome; D014852:Wales
keywords: Patient reported outcome measures; unicompartmental knee arthroplasty; joint registry; total knee arthroplasty; complications