A matched comparison of long term outcomes of total and unicompartmental knee replacements in different ages based on national databases: Analysis of data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Hasan R Mohammad*, Alexander Liddle, Andrew Judge, David Murray

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background
The 2 main treatment options for end-stage single compartment knee arthritis are unicompartmental (UKR) or total knee replacement (TKR). We compared the long-term outcomes in different age groups.
Methods
In total, 54,215 UKRs and 54,215 TKRs from the National Joint Registry and Hospital Episode Statistics database were propensity score matched and Kaplan-Meier and regression analysis used to compare revision, reoperation, mortality, and 3-month complications.
Results
UKR had higher 10-year revision rates (12% vs 5%, hazard ratio [HR] 2.31, P < .001) and 10-year reoperation rates (25% vs 21%, HR 1.12, P < .001). UKR had lower 10-year mortality rates (13.6% vs 15.5%, HR 0.86, P < .001). UKR had lower rates of medical (P < .001) and procedure related (P < .001) complications and deaths (HR 0.61, P = .02). If 100 patients had a UKR instead of a TKR then over 10 years, if they were <55 years old there would be 7 more reoperations and 1 less death; if they were 55-64 years old there would be 6 more reoperations and 2 more deaths; if they were 65-74 years old there would be 4 more reoperations and 2 less deaths; and if they were ≥75 years old there would be 3 more reoperations and 4 less deaths.
Conclusion
UKR has higher revision and slightly higher reoperation rates but lower mortality rates than matched TKR. The decision to do a UKR should, in part, be based on the balance of these risks, which are influenced by patient age. In the elderly group (>75 years) the data suggests that UKR compared to TKR has a greater absolute reduction in mortality than the increase in reoperation rate.
Levels of evidence
III.
Original languageEnglish
JournalJournal of Arthroplasty
DOIs
Publication statusPublished - 4 Oct 2021

Bibliographical note

Funding Information:
We thank the patients and staff of all the hospitals in England, Wales, Northern Ireland, and Isle of Man who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Sub-committee, and staff at the NJR Center for facilitating this work. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Healthcare Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented. During the conduct of the study H.R.M. was supported by the Henni Mester scholarship from the University of Oxford, Goodfellow research fellowship and Royal College of Surgeons of England Research Fellowship.

Publisher Copyright:
© 2021 Elsevier Inc.

Keywords

  • age
  • revision
  • reoperation
  • total knee replacement
  • unicompartmental knee replacement

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