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J Knee Surg 2024; 37(01): 079-083
DOI: 10.1055/s-0042-1760388
Original Article

Patients With Significant Medical Comorbidities May Benefit from Unicompartmental Knee Arthroplasty Over Total Knee Arthroplasty

Nicolas Pascual-Leone 
1   Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania
2   Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Matthew Sloan
3   Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
4   Emerson Center for Specialty Care, Concord, Massachusetts
,
Vivek M. Shah
3   Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Neil P. Sheth
1   Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania
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Abstract

Many studies have compared outcomes in total knee arthroplasty (TKA) versus unicompartmental knee arthroplasty (UKA); however, to the authors' knowledge, there is no study evaluating complication rates in patients with significant comorbidities. The purpose of this retrospective study was to compare the incidence of postoperative complications, readmission and reoperation rates, length of stay (LOS), and discharge location for patients with significant medical comorbidities undergoing TKA versus UKA. Using the NSQIP database from 2008 to 2018, patients were identified by CPT code (27447 or 27446) and admission diagnostic code of primary osteoarthritis and included in the study if they had an American Society of Anesthesia score greater than or equal to 3. Chi-square test was used to compare categorical variables and t-test for continuous variables. Multivariate regression was used to compare outcomes of interest between groups. A total of 167,054 patients were analyzed with 97.3% undergoing TKA. TKA patients had a greater overall complication rate than those undergoing UKA (p < 0.001). Readmission rates were approximately 1.5 times higher in TKA compared with UKA (p = 0.002), while no statistically significant difference was discovered in reoperation rates (p = 0.868). TKA was also associated with decreased rates of same day discharge, discharge within 24 hours of surgery, and discharge home (p < 0.001, <0.001, and <0.001, respectively). This study found an increase in complication rates, readmission rates, and LOS, along with a lower likelihood of discharge home when undergoing a TKA. These findings suggest that patients with significant medical comorbidities at baseline may benefit from UKA over TKA when anatomically indicated.

Keywords

unicompartmental knee arthroplasty - total knee arthroplasty - complication rates


Publication History

Received: 28 April 2022

Accepted: 15 November 2022

Article published online:
19 January 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CAF, Murray DW. The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Joint J 2015; 97-B (11) 1493-1500
    CrossrefPubMedGoogle Scholar
  • 2 Lisowski LA, Meijer LI, van den Bekerom MPJ, Pilot P, Lisowski AE. Ten- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group. Bone Joint J 2016; 98 B (10, Supple B): 41-47
    CrossrefPubMedGoogle Scholar
  • 3 Emerson RH, Alnachoukati O, Barrington J, Ennin K. The results of Oxford unicompartmental knee arthroplasty in the United States: a mean ten-year survival analysis. Bone Joint J 2016; 98-B (10, Supple B): 34-40
    CrossrefPubMedGoogle Scholar
  • 4 Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J. 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 2015; 25 (05) 799-806
    CrossrefPubMedGoogle Scholar
  • 5 Lombardi Jr AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty?. Clin Orthop Relat Res 2009; 467 (06) 1450-1457
    CrossrefPubMedGoogle Scholar
  • 6 Siman H, Kamath AF, Carrillo N, Harmsen WS, Pagnano MW, Sierra RJ. Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplasty 2017; 32 (06) 1792-1797
    CrossrefPubMedGoogle Scholar
  • 7 Liddle AD, Pandit H, Judge A, Murray DW. 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. Bone Joint J 2015; 97-B (06) 793-801
    CrossrefPubMedGoogle Scholar
  • 8 Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD. 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 2018; 26 (06) 1811-1822
    CrossrefPubMedGoogle Scholar
  • 9 Wilson HA, Middleton R, Abram SGF. et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364: l352
    CrossrefPubMedGoogle Scholar
  • 10 Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. Eur J Orthop Surg Traumatol 2019; 29 (04) 947-955
    CrossrefPubMedGoogle Scholar
  • 11 Fisher DA, Dalury DF, Adams MJ, Shipps MR, Davis K. Unicompartmental and total knee arthroplasty in the over 70 population. Orthopedics 2010; 33 (09) 668
    CrossrefPubMedGoogle Scholar
  • 12 Amin AK, Patton JT, Cook RE, Gaston M, Brenkel IJ. Unicompartmental or total knee arthroplasty?: Results from a matched study. Clin Orthop Relat Res 2006; 451 (451) 101-106
    CrossrefPubMedGoogle Scholar
  • 13 Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G. Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 2007; 77 (04) 214-221
    CrossrefPubMedGoogle Scholar
  • 14 Bolognesi MP, Greiner MA, Attarian DE. et al. Unicompartmental knee arthroplasty and total knee arthroplasty among Medicare beneficiaries, 2000 to 2009. J Bone Joint Surg Am 2013; 95 (22) e174
    CrossrefPubMedGoogle Scholar
  • 15 Ode Q, Gaillard R, Batailler C. et al. Fewer complications after UKA than TKA in patients over 85 years of age: a case-control study. Orthop Traumatol Surg Res 2018; 104 (07) 955-959
    CrossrefPubMedGoogle Scholar
  • 16 Fryhofer GW, Sloan M, Sheth NP. Hypoalbuminemia remains an independent predictor of complications following total joint arthroplasty. J Orthop 2019; 16 (06) 552-558
    CrossrefPubMedGoogle Scholar
  • 17 Sikov M, Sloan M, Sheth NP. Effect of operative time on complications following primary total hip arthroplasty: analysis of the NSQIP database. Hip Int 2021; 31 (02) 231-236
    CrossrefPubMedGoogle Scholar
  • 18 Khuri SF. The NSQIP: a new frontier in surgery. Surgery 2005; 138 (05) 837-843
    CrossrefPubMedGoogle Scholar
  • 19 Brown NM, Sheth NP, Davis K. et al. Total knee arthroplasty has higher postoperative morbidity than unicompartmental knee arthroplasty: a multicenter analysis. J Arthroplasty 2012; 27 (8, Suppl): 86-90
    CrossrefPubMedGoogle Scholar
  • 20 Admir MŠ, Jankovic MS, Marina K. Risk factors for hospital-acquired urinary tract infections in patients with acute stroke. J Infect Dis Epidemiol 2021; 7 (06) 5-9
    CrossrefPubMedGoogle Scholar
  • 21 Carr BG, Kaye AJ, Wiebe DJ, Gracias VH, Schwab CW, Reilly PM. Emergency department length of stay: a major risk factor for pneumonia in intubated blunt trauma patients. J Trauma 2007; 63 (01) 9-12
    PubMedGoogle Scholar
  • 22 Kim YH, Yoon SH, Park JW. Does Robotic-assisted TKA result in better outcome scores or long-term survivorship than conventional TKA? A randomized, controlled trial. Clin Orthop Relat Res 2020; 478 (02) 266-275
    CrossrefPubMedGoogle Scholar
  • 23 Banger M, Doonan J, Rowe P, Jones B, MacLean A, Blyth MJB. Robotic arm-assisted versus conventional medial unicompartmental knee arthroplasty: five-year clinical outcomes of a randomized controlled trial. Bone Joint J 2021; 103-B (06) 1088-1095
    CrossrefPubMedGoogle Scholar