Effects of Unicompartmental Keen Arthroplasty versus Total Keen Arthroplasty for Unicompartmental Osteoarthritis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 XUBin ,  PEIFu-xing , MAJun , XIEJin-wei , XIEXiao-wei , YAOHuan , YUEChen

Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

PEIFu-xing, Email: peifuxing@163.vip.com

Keywords：

Unicompartmental keen arthroplasty; Total keen arthroplasty; Unicompartmental osteoarthritis; Meta-analysis; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.20150109

Video：

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Objective To systematically review the effects of unicompartmental keen arthroplasty (UKA) and total keen arthroplasty (TKA) in patients with unicompartmental osteoarthritis of the keen. Methods We electronically searched PubMed, MEDLINE (Ovid), ProQuest, EBSCO, The Cochrane Library (Issue 10, 2014), EMbase, CNKI, VIP, CBM and WanFang Data from inception to November 2014, to collect randomized controlled trials (RCTs) and cohort studies of UKA versus TKA for patients with unicompartmental osteoarthritis of the keen. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 6 RCTs and 6 cohort studies involving 940 keens were included. The results of meta-analysis indicated that patients underwent UKA enjoyed a quicker rehabilitation to achieve a flexion of 90° (RCT:P<0.05; cohort study:SMD=-1.70, 95%CI -2.07 to -1.34, P<0.000 01), had better range of motion (cohort study:SMD=0.59, 95%CI 0.41 to 0.78, P=0), and were less likely to get DVT (RCT:RR=0.31, 95%CI 0.12 to 0.82, P=0.02), but the patients underwent UKA were more likely to have a revision (RCT:RR=7.59, 95%CI 1.76 to 32.85, P=0.007). The keen scores of the UKA group were similar to the TKA group (RCT:P=0.626; cohort study:MD=1.78, 95%CI -0.09 to 3.65, P=0.06). Conclusion Current evidence shows that, compared with patients underwent TKA, patients underwent UKA have a quicker rehabilitation and fewer rates of DVT, and are more likely to have a revision. The medium to long-term follow up result of keen scores in both groups was equivalent. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： XUBin, PEIFu-xing, MAJun, XIEJin-wei, XIEXiao-wei, YAOHuan, YUEChen. Effects of Unicompartmental Keen Arthroplasty versus Total Keen Arthroplasty for Unicompartmental Osteoarthritis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 652-658. doi: 10.7507/1672-2531.20150109 Copy

1.	Ledingham J,Regan M,Jones A,et al.Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital.Ann Rheum Dis,1993,52(7):520-526.
2.	Amin AK,Patton JT,Cook RE,et al.Unicompartmental or total knee arthroplasty? Results from a matched study.Clinical Orthopaedics and Related Research,2006(451):101-6.
3.	Berman AT,Bosacco SJ,Kirshner S,et al.Factors influencing long-term results in high tibial osteotomy.Clin Orthop Relat Res,1991(272):192-198.
4.	Barrett WP,Scott RD.Revision of failed unicondylar unicompartmental knee arthroplasty.J Bone Joint Surg Am,1987,69(9):1328-1335.
5.	Berger RA,Meneghini RM,Jacobs JJ,et al.Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up.J Bone Joint Surg Am,2005,87(5):999-1006.
6.	Griffin T,Rowden N,Morgan D,et al.Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis:a systematic study.ANZ J Surg,2007,77(4):214-221.
7.	Luscombe KL,Lim J,Jones PW,et al.Minimally invasive Oxford medial unicompartmental knee arthroplasty.A note of caution!.Int Orthop,2007,31(3):321-324.
8.	Argenson JN,Chevrol-Benkeddache Y,Aubaniac JM.Modern unicompartmental knee arthroplasty with cement:a three to ten-year follow-up study.J Bone Joint Surg Am,2002,84-A (12):2235-2239.
9.	Tabor OJ,Tabor O B,Bernard M,et al.Unicompartmental knee arthroplasty:long-term success in middle-age and obese patients.J Surg Orthop Adv,2005,14(2):59-63.
10.	Steele RG,Hutabarat S,Evans RL,et al.Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years.J Bone Joint Surg Br,2006,88(9):1164-1168.
11.	Laurencin CT,Zelicof SB,Scott RD,et al.Unicompartmental versus total knee arthroplasty in the same patient.A comparative study.Clin Orthop Relat Res,1991(273):151-156.
12.	Kozinn SC,Scott R.Unicondylar knee arthroplasty.J Bone Joint Surg Am,1989,71(1):145-150.
13.	Price A J,Webb J,Topf H,et al.Rapid recovery after oxford unicompartmental arthroplasty through a short incision.J Arthroplasty,2001,16(8):970-976.
14.	Gioe TJ,Novak C,Sinner P,et al.Knee arthroplasty in the young patient:survival in a community registry.Clin Orthop Relat Res,2007,464(34):83-87.
15.	曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具.中国循证心血管医学杂志,2012,(4):297-299.
16.	Weale AE,Murray DW,Newman JH,et al.The length of the patellar tendon after unicompartmental and total knee replacement.The Journal of bone and joint surgery.British volume,1999,81(5):790-795.
17.	Newman J,Pydisetty RV,Ackroyd C.Unicompartmental or total knee replacement:the 15-year results of a prospective randomised controlled trial.J Bone Joint Surg Br,2009,91(1):52-57.
18.	White SH,Ludkowski PF,Goodfellow JW.Anteromedial osteoarthritis of the knee.J Bone Joint Surg Br,1991,73(4):582-586.
19.	Newman JH,Ackroyd CE,Shah NA.Unicompartmental or total knee replacement? Five-year results of a prospective,randomised trial of 102 osteoarthritic knees with unicompartmental arthritis.J Bone Joint Surg Br,1998,80(5):862-865.
20.	Cameron HU,Jung YB.A comparison of unicompartmental knee replacement with total knee replacement.Orthop Rev,1988,17(10):983-988.
21.	Beard DJ,Holt MD,Mullins MM,et al.Decision making for knee replacement:variation in treatment choice for late stage medial compartment osteoarthritis.Knee,2012,19(6):886-889.
22.	Weale AE,Murray DW,Baines J,et al.Radiological changes five years after unicompartmental knee replacement.J Bone Joint Surg Br,2000,82(7):996-1000.
23.	Khan OH,Davies H,Newman JH,et al.Radiological changes ten years after St.Georg Sled unicompartmental knee replacement.Knee,2004,11(5):403-407.
24.	Pearse AJ,Hooper GJ,Rothwell A,et al.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,2010,92(4):508-512.
25.	Baker PN,Petheram T,Jameson SS,et al.Comparison of patient-reported outcome measures following total and unicondylar knee replacement.J Bone Joint Surg Br,2012,94(7):919-927.
26.	Banks SA,Fregly BJ,Boniforti F,et al.Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements.Knee Surg Sports Traumatol Arthrosc,2005,13(7):551-556.
27.	徐建平,徐卫东,林国兵,等.双膝骨关节炎患者行小切口单髁置换术与全膝关节置换术临床疗效对比分析.中华外科杂志,2013,51(2):157-160.
28.	Sun PF,Jia YH.Mobile bearing UKA compared to fixed bearing TKA:a randomized prospective study.Knee,2012,19(2):103-106.
29.	Newman JH.Is the St.Georg Sled better than total knee replacement?.Orthopade,2000,29(Suppl 1):S9-S10.
30.	陈竞青,高石军,李彤,等.微创小切口技术在膝关节内侧胫股间室骨关节炎治疗中的应用.中华医学杂志,2012,92(1):36-39.
31.	Costa CR,Johnson AJ,Mont MA,et al.Unicompartmental and total knee arthroplasty in the same patient.J Knee Surg,2011,24(4):273-278.
32.	Dalury DF,Fisher DA,Adams MJ,et al.Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient.Orthopedics,2009,32(4):325-327.
33.	Manzotti A,Confalonieri N,Pullen C.Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis:a matched paired study.International Orthopaedics,2007,31(3):315-319.
34.	Yang KY,Wang MC,Yeo SJ,et al.Minimally invasive unicondylar versus total condylar knee arthroplasty--early results of a matched-pair comparison.Singapore Med J,2003,44(11):559-562.
35.	Lombardi AV,Berend KR,Walter CA,et al.Is Recovery Faster for Mobile-bearing Unicompartmental than Total Knee Arthroplasty?.Clinical Orthopaedics and Related Research,2009,467(6):1450-1457.

1. Ledingham J,Regan M,Jones A,et al.Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital.Ann Rheum Dis,1993,52(7):520-526.
2. Amin AK,Patton JT,Cook RE,et al.Unicompartmental or total knee arthroplasty? Results from a matched study.Clinical Orthopaedics and Related Research,2006(451):101-6.
3. Berman AT,Bosacco SJ,Kirshner S,et al.Factors influencing long-term results in high tibial osteotomy.Clin Orthop Relat Res,1991(272):192-198.
4. Barrett WP,Scott RD.Revision of failed unicondylar unicompartmental knee arthroplasty.J Bone Joint Surg Am,1987,69(9):1328-1335.
5. Berger RA,Meneghini RM,Jacobs JJ,et al.Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up.J Bone Joint Surg Am,2005,87(5):999-1006.
6. Griffin T,Rowden N,Morgan D,et al.Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis:a systematic study.ANZ J Surg,2007,77(4):214-221.
7. Luscombe KL,Lim J,Jones PW,et al.Minimally invasive Oxford medial unicompartmental knee arthroplasty.A note of caution!.Int Orthop,2007,31(3):321-324.
8. Argenson JN,Chevrol-Benkeddache Y,Aubaniac JM.Modern unicompartmental knee arthroplasty with cement:a three to ten-year follow-up study.J Bone Joint Surg Am,2002,84-A (12):2235-2239.
9. Tabor OJ,Tabor O B,Bernard M,et al.Unicompartmental knee arthroplasty:long-term success in middle-age and obese patients.J Surg Orthop Adv,2005,14(2):59-63.
10. Steele RG,Hutabarat S,Evans RL,et al.Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years.J Bone Joint Surg Br,2006,88(9):1164-1168.
11. Laurencin CT,Zelicof SB,Scott RD,et al.Unicompartmental versus total knee arthroplasty in the same patient.A comparative study.Clin Orthop Relat Res,1991(273):151-156.
12. Kozinn SC,Scott R.Unicondylar knee arthroplasty.J Bone Joint Surg Am,1989,71(1):145-150.
13. Price A J,Webb J,Topf H,et al.Rapid recovery after oxford unicompartmental arthroplasty through a short incision.J Arthroplasty,2001,16(8):970-976.
14. Gioe TJ,Novak C,Sinner P,et al.Knee arthroplasty in the young patient:survival in a community registry.Clin Orthop Relat Res,2007,464(34):83-87.
15. 曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具.中国循证心血管医学杂志,2012,(4):297-299.
16. Weale AE,Murray DW,Newman JH,et al.The length of the patellar tendon after unicompartmental and total knee replacement.The Journal of bone and joint surgery.British volume,1999,81(5):790-795.
17. Newman J,Pydisetty RV,Ackroyd C.Unicompartmental or total knee replacement:the 15-year results of a prospective randomised controlled trial.J Bone Joint Surg Br,2009,91(1):52-57.
18. White SH,Ludkowski PF,Goodfellow JW.Anteromedial osteoarthritis of the knee.J Bone Joint Surg Br,1991,73(4):582-586.
19. Newman JH,Ackroyd CE,Shah NA.Unicompartmental or total knee replacement? Five-year results of a prospective,randomised trial of 102 osteoarthritic knees with unicompartmental arthritis.J Bone Joint Surg Br,1998,80(5):862-865.
20. Cameron HU,Jung YB.A comparison of unicompartmental knee replacement with total knee replacement.Orthop Rev,1988,17(10):983-988.
21. Beard DJ,Holt MD,Mullins MM,et al.Decision making for knee replacement:variation in treatment choice for late stage medial compartment osteoarthritis.Knee,2012,19(6):886-889.
22. Weale AE,Murray DW,Baines J,et al.Radiological changes five years after unicompartmental knee replacement.J Bone Joint Surg Br,2000,82(7):996-1000.
23. Khan OH,Davies H,Newman JH,et al.Radiological changes ten years after St.Georg Sled unicompartmental knee replacement.Knee,2004,11(5):403-407.
24. Pearse AJ,Hooper GJ,Rothwell A,et al.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,2010,92(4):508-512.
25. Baker PN,Petheram T,Jameson SS,et al.Comparison of patient-reported outcome measures following total and unicondylar knee replacement.J Bone Joint Surg Br,2012,94(7):919-927.
26. Banks SA,Fregly BJ,Boniforti F,et al.Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements.Knee Surg Sports Traumatol Arthrosc,2005,13(7):551-556.
27. 徐建平,徐卫东,林国兵,等.双膝骨关节炎患者行小切口单髁置换术与全膝关节置换术临床疗效对比分析.中华外科杂志,2013,51(2):157-160.
28. Sun PF,Jia YH.Mobile bearing UKA compared to fixed bearing TKA:a randomized prospective study.Knee,2012,19(2):103-106.
29. Newman JH.Is the St.Georg Sled better than total knee replacement?.Orthopade,2000,29(Suppl 1):S9-S10.
30. 陈竞青,高石军,李彤,等.微创小切口技术在膝关节内侧胫股间室骨关节炎治疗中的应用.中华医学杂志,2012,92(1):36-39.
31. Costa CR,Johnson AJ,Mont MA,et al.Unicompartmental and total knee arthroplasty in the same patient.J Knee Surg,2011,24(4):273-278.
32. Dalury DF,Fisher DA,Adams MJ,et al.Unicompartmental knee arthroplasty compares favorably to total knee arthroplasty in the same patient.Orthopedics,2009,32(4):325-327.
33. Manzotti A,Confalonieri N,Pullen C.Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis:a matched paired study.International Orthopaedics,2007,31(3):315-319.
34. Yang KY,Wang MC,Yeo SJ,et al.Minimally invasive unicondylar versus total condylar knee arthroplasty--early results of a matched-pair comparison.Singapore Med J,2003,44(11):559-562.
35. Lombardi AV,Berend KR,Walter CA,et al.Is Recovery Faster for Mobile-bearing Unicompartmental than Total Knee Arthroplasty?.Clinical Orthopaedics and Related Research,2009,467(6):1450-1457.

Chinese Journal of Evidence-Based Medicine

Effects of Unicompartmental Keen Arthroplasty versus Total Keen Arthroplasty for Unicompartmental Osteoarthritis: A Meta-analysis

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