Abstract
PurposeCombined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively.Materials and methodsThis prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively.ResultsSignificant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p < 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups.ConclusionThe magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.
Highlights
The management of young adults with symptomatic osteoarthritis of the knee that is refractory to conservative measures is challenging
This study found no significant differences of outcomes at 2 years after surgery among Unicompartmental knee replacement (UKR), bicompartmental knee replacement (BKR) and Total knee replacement (TKR)
Unicompartmental knee replacement (UKR) has been shown to be an effective surgical option in patients with localised disease confined to one compartment that can obviate the need for TKR, with studies reporting up to 91% survivorship at 20 years [1]
Summary
The management of young adults with symptomatic osteoarthritis of the knee that is refractory to conservative measures is challenging. Total knee replacement (TKR) can successfully treat arthritis albeit at the expense of bone stock and intra-articular ligaments. This can represent theoretical disadvantages, for young patients with high functional demands and high risk for potential revision surgery within their lifetime. Unicompartmental knee replacement (UKR) has been shown to be an effective surgical option in patients with localised disease confined to one compartment that can obviate the need for TKR, with studies reporting up to 91% survivorship at 20 years [1]. Studies have shown that the main indication for revision of UKR is progression of PFJ arthritis [4, 5]. The improvement of PFJ replacement surgery is attributable to improved implant designs, better patient selection and improved surgical technique [12]
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