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The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study

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Abstract

Purpose

The purpose of this study was to assess whether unicompartmental knee arthroplasty (UKA) results in better patient-reported and clinical outcome than total knee arthroplasty (TKA). The study hypothesis was UKA yields better patient-reported and clinical outcomes than TKA.

Methods

Our prospective cohort study compared patients who underwent medial UKA or TKA from February 2014 through June 2015. Forgotten Joint Score (FJS), the short form of the Knee Injury and Osteoarthritis Outcome Score (KOOS PS), EuroQOL Five Dimensions Questionnaire (EQ-5D), and the Knee Society Score (KSS) were completed at two weeks, six weeks, three months, six months, and one year post-operatively. The KOOS PS, EQ-5D, and the KSS were also documented pre-operatively.

Results

Fifty-seven patients (57 knees) were allocated to the UKA group and 62 patients (62 knees) to the TKA group. At baseline, no statistically significant differences were observed between groups regarding patient demographics and pre-operative scores. Except for FJS at 2 weeks (p = 0.326), all postoperative scores revealed significant differences as early as two weeks and up to 12 months (p < 0.05).

Conclusions

Our findings suggest UKA patients are less aware of their joint replacements than TKA patients for medial osteoarthritis of the knee. UKA conserves more soft tissue and bone than TKA, which may be the reason for the differences observed.

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References

  1. Murphy L (2008) Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 59(9):1207–1213

    Article  Google Scholar 

  2. Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP (2009) Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 16(6):473–478

    Article  Google Scholar 

  3. Rajasekaran RB, Palanisami DR, Natesan R, Rajasekaran S (2018) Minimal under-correction gives better outcomes following total knee arthroplasty in severe varus knees-myth or reality?-analysis of one hundred sixty two knees with varus greater than fifteen degrees. Int Orthop

  4. Affatato S, Caputo D, Bordini B (2018) Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-centre study. Int Orthop

  5. Cho KJ, Seon JK, Jang WY, Park CG, Song EK (2018) Robotic versus conventional primary total knee arthroplasty: clinical and radiological long-term results with a minimum follow-up of ten years. Int Orthop

  6. Choi YJ, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28(1):1–15

    Article  Google Scholar 

  7. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63

    Article  Google Scholar 

  8. Puliero B, Favreau H, Eichler D, Adam P, Bonnomet F, Ehlinger M (2019) Total knee arthroplasty in patients with varus deformities greater than ten degrees: survival analysis at a mean ten year follow-up. Int Orthop 43(2):333–341

    Article  Google Scholar 

  9. Liebensteiner M, Wurm A, Gamper D, Oberaigner W, Dammerer D, Krismer M (2018) Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse. Int Orthop

  10. Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP (2001) Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplast 16(6):740–747

    Article  CAS  Google Scholar 

  11. Suda AJ, Seeger JB, Bitsch RG, Krueger M, Clarius M (2010) Are patients' expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics 33(2):76–80

    Article  Google Scholar 

  12. Chatellard R, Sauleau V, Colmar M, Robert H, Raynaud G, Brilhault J, Societe d’ Orthopedie et de Traumatologie de lO (2013) Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival? Orthop Traumatol Surg Res 99 (4 Suppl):S219–S225

    CAS  Google Scholar 

  13. Lee JK, Kim HJ, Park JO, Yang JH (2018) Inferior outcome of revision of unicompartmental knee arthroplasty to total knee arthroplasty compared with primary total knee arthroplasty: systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc

  14. Cho WJ, Kim JM, Kim WK, Kim DE, Kim NK, Bin SI (2018) Mobile-bearing unicompartmental knee arthroplasty in old-aged patients demonstrates superior short-term clinical outcomes to open-wedge high tibial osteotomy in middle-aged patients with advanced isolated medial osteoarthritis. Int Orthop

  15. Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J (2015) Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 25(5):799–806

    Article  Google Scholar 

  16. Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW (2012) Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res 470(1):84–90

    Article  Google Scholar 

  17. Koskinen E, Eskelinen A, Paavolainen P, Pulkkinen P, Remes V (2008) Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop 79(4):499–507

    Article  Google Scholar 

  18. Murray DW, Liddle A, Dodd CA, Pandit H (2015) Unicompartmental knee arthroplasty: is the glass half full or half empty? Bone Joint J 97-b(10 Suppl A):3–8

    Article  CAS  Google Scholar 

  19. Baker PN, Petheram T, Jameson SS, Avery PJ, Reed MR, Gregg PJ, Deehan DJ (2012) Comparison of patient-reported outcome measures following total and unicondylar knee replacement. J Bone Joint Surg (Br) 94(7):919–927

    Article  CAS  Google Scholar 

  20. Pearse AJ, Hooper GJ, Rothwell A, Frampton C (2010) Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg (Br) 92(4):508–512

    Article  CAS  Google Scholar 

  21. Wynn Jones H, Chan W, Harrison T, Smith TO, Masonda P, Walton NP (2012) Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary? Knee 19(4):339–343

    Article  Google Scholar 

  22. Hooper N, Snell D, Hooper G, Maxwell R, Frampton C (2015) The five-year radiological results of the uncemented Oxford medial compartment knee arthroplasty. Bone Joint J 97-B(10):1358–1363

    Article  CAS  Google Scholar 

  23. Thienpont E (2017) Conversion of a unicompartmental knee arthroplasty to a total knee arthroplasty: can we achieve a primary result? Bone Joint J 99-b(1 Supple A):65–69

    Article  CAS  Google Scholar 

  24. Sugita T, Miyatake N, Aizawa T, Sasaki A, Kamimura M, Takahashi A (2018) Quality of life after staged bilateral total knee arthroplasty: a minimum five-year follow-up study of seventy-eight patients. Int Orthop

  25. Liddle AD, Judge A, Pandit H, Murray DW (2014) 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 18(314):1437–1445

    Article  Google Scholar 

  26. Kim MK, Yoon JR, Yang SH, Shin YS (2018) Unicompartmental knee arthroplasty fails to completely restore normal gait patterns during level walking. Knee Surg Sports Traumatol Arthrosc

  27. Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD (2018) 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 Traumatol Arthrosc 26(6):1811–1822

    Article  Google Scholar 

  28. Burn E, Sanchez-Santos MT, Pandit HG, Hamilton TW, Liddle AD, Murray DW, Pinedo-Villanueva R (2018) Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis. Knee Surg Sports Traumatol Arthrosc 26(5):1455–1464

    Article  Google Scholar 

  29. Peersman G, Jak W, Vandenlangenbergh T, Jans C, Cartier P, Fennema P (2014) Cost-effectiveness of unicondylar versus total knee arthroplasty: a Markov model analysis. Knee 21(Suppl 1):S37–S42

    Article  Google Scholar 

  30. Ghomrawi HM, Eggman AA, Pearle AD (2015) Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the u.s. J Bone Joint Surg Am 97(5):396–402

    Article  Google Scholar 

  31. Soohoo N, Sharifi H, Kominski G, Lieberman J (2006) Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am 88(9):1975–1982

    PubMed  Google Scholar 

  32. Peersman G, Taeymans K, Jans C, Vuylsteke P, Fennema P, Heyse T (2016) Malrotation deformities of the lower extremity and implications on total knee arthroplasty: a narrative review. Arch Orthop Trauma Surg 136(11):1491–1498

    Article  Google Scholar 

  33. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplast 27(3):430–436 e431

    Article  Google Scholar 

  34. Thienpont E, Opsomer G, Koninckx A, Houssiau F (2014) Joint awareness in different types of knee arthroplasty evaluated with the forgotten joint score. J Arthroplast 29(1):48–51

    Article  Google Scholar 

  35. Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

    Article  Google Scholar 

  36. Reina N, Fennema P, Hourlier H (2017) The impact of mild peri-operative hypothermia on the effectiveness of tranexamic acid in total hip arthroplasty. Int Orthop 41(1):55–60

    Article  Google Scholar 

  37. Davis AM, Perruccio AV, Canizares M, Hawker GA, Roos EM, Maillefert JF, Lohmander LS (2009) Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthr Cartil 17(7):843–847

    Article  CAS  Google Scholar 

  38. The EuroQol Group (1990) EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208

    Article  Google Scholar 

  39. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248(11):13–14

    Google Scholar 

  40. Perruccio AV, Stefan Lohmander L, Canizares M et al (2008) The development of a short measure of physical function for knee OA KOOS-physical function Shortform (KOOS-PS) - an OARSI/OMERACT initiative. Osteoarthr Cartil 16(5):542–550

    Article  CAS  Google Scholar 

  41. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol group. Ann Med 33(5):337–343

    Article  CAS  Google Scholar 

  42. Verbeke G, Molenberghs G (2000) Linear mixed models for longitudinal data, Springer Series in Statistics. Springer, New York

    Google Scholar 

  43. Kulshrestha V, Datta B, Kumar S, Mittal G (2017) Outcome of unicondylar knee arthroplasty vs total knee arthroplasty for early medial compartment arthritis: a randomized study. J Arthroplast 32(5):1460–1469

    Article  Google Scholar 

  44. Zuiderbaan HA, van der List JP, Khamaisy S, Nawabi DH, Thein R, Ishmael C, Paul S, Pearle AD (2017) Unicompartmental knee arthroplasty versus total knee arthroplasty: which type of artificial joint do patients forget? Knee Surg Sports Traumatol Arthrosc 25(3):681–686

    Article  Google Scholar 

  45. Lygre SH, Espehaug B, Havelin LI, Furnes O, Vollset SE (2010) Pain and function in patients after primary unicompartmental and total knee arthroplasty. J Bone Joint Surg Am 92(18):2890–2897

    Article  Google Scholar 

  46. Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ (2017) Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplast 32(6):1792–1797

    Article  Google Scholar 

  47. Liddle AD, Pandit H, Judge A, Murray DW (2016) Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 98(1):1–8

    Article  Google Scholar 

  48. Hamilton TW, Rizkalla J, Kontochristos L, Marks B, Mellon S, Dodd CAF, Pandit HG, Murray DW (2017) The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplast

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Correspondence to Geert Peersman.

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GP is a Consultant for Zimmer Biomet. The other authors have no conflicts of interest.

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Peersman, G., Verhaegen, J. & Favier, B. The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study. International Orthopaedics (SICOT) 43, 2739–2745 (2019). https://doi.org/10.1007/s00264-019-04342-w

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