Abstract
PurposeDespite increased utilization of unicompartmental knee arthroplasty (UKA) for unicompartmental knee osteoarthritis, outcomes in Medicare patients are not well-reported. The purpose of this study is to analyze practice patterns and outcome differences between UKA and TKA in the Medicare population. It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to TKA.MethodsUsing PearlDiver, the Humana Claims dataset and the Medicare Standard Analytic File (SAF) were analyzed. Patients who underwent UKA and TKA were identified by CPT codes. Postoperative complications were identified by ICD-9/ICD-10 codes. Opioid use was analyzed by the number of days patients were prescribed opioids postoperatively. Survivorship was defined as conversion to TKA.ResultsIn the Humana dataset, 7,808 UKA and 150,680 TKA patients were identified. 8-year survivorship was 87.7% (95% CI [0.861,0.894]). Postoperative opioid use was significantly higher after TKA (186.1 days) compared to UKA (144.7 days) (p < 0.01, Δ = 41.1, 95% CI = [30.41, 52.39]). In the SAF dataset, 20,592 UKA patients and 110,562 TKA patients were identified. Survivorship was highest in patients > 80 years old and lowest in patients < 70 years old. In both datasets, postoperative complication rates were higher in TKA patients compared to UKA patients in nearly all categories.ConclusionsUKA represents an increasingly utilized treatment for osteoarthritis in the Medicare population and may be comparatively advantageous to TKA due to reduced opioid use and complication rates after surgery.Level of evidenceLevel III
Highlights
Unicompartmental knee arthroplasty (UKA) represents a surgical treatment option for patients who present with unicompartmental knee osteoarthritis (OA)
It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to total knee arthroplasty (TKA)
The PearlDiver database is a publicly available, Health Insurance Portability and Accountability Act (HIPAA)-compliant national database containing Current Procedural Terminology (CPT), International Classification of Diseases, Ninth Revision (ICD-9), and International Classification of Diseases, Tenth Revision (ICD-10) codes related to orthopedic procedures
Summary
Unicompartmental knee arthroplasty (UKA) represents a surgical treatment option for patients who present with unicompartmental knee osteoarthritis (OA). Medicare beneficiaries undergoing joint arthroplasty procedures has increased as the United States population has aged [7]. There is an increasing incidence of patients with unicompartmental knee arthritis that present at an age and activity level less than ideal for a total knee arthroplasty (TKA) [15]. Morris et al J EXP ORTOP (2021) 8:103 alternative to TKA for many of these patients [1, 2]. Coupled with improved instrumentation and understanding of surgical technique, utilization of UKA in recent years has accelerated [10].
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