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

A D Liddle, H Pandit, A Judge, D W Murray

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

140 Citations (Scopus)

Abstract

Whether to use total or unicompartmental knee replacement (TKA/UKA) for end-stage knee osteoarthritis remains controversial. Although UKA results in a faster recovery, lower rates of morbidity and mortality and fewer complications, the long-term revision rate is substantially higher than that for TKA. The effect of each intervention on patient-reported outcome remains unclear. The aim of this study was to determine whether six-month patient-reported outcome measures (PROMs) are better in patients after TKA or UKA, using data from a large national joint registry (NJR). We carried out a propensity score-matched cohort study which compared six-month PROMs after TKA and UKA in patients enrolled in the NJR for England and Wales, and the English national PROM collection programme. A total of 3519 UKA patients were matched to 10 557 TKAs. The mean six-month PROMs favoured UKA: the Oxford Knee Score was 37.7 (95% confidence interval (CI) 37.4 to 38.0) for UKA and 36.1 (95% CI 35.9 to 36.3) for TKA; the mean EuroQol EQ-5D index was 0.772 (95% CI 0.764 to 0.780) for UKA and 0.751 (95% CI 0.747 to 0.756) for TKA. UKA patients were more likely to achieve excellent results (odds ratio (OR) 1.59, 95% CI 1.47 to 1.72, p < 0.001) and to be highly satisfied (OR 1.27, 95% CI 1.17 to 1.39, p < 0.001), and were less likely to report complications than those who had undergone TKA. UKA gives better early patient-reported outcomes than TKA; these differences are most marked for the very best outcomes. Complications and readmission are more likely after TKA. Although the data presented reflect the short-term outcome, they suggest that the high revision rate for UKA may not be because of poorer clinical outcomes. These factors should inform decision-making in patients eligible for either procedure.

Original languageEnglish
Pages (from-to)793-801
Number of pages9
JournalBone and Joint Journal
Volume97-B
Issue number6
DOIs
Publication statusPublished - Jun 2015

Keywords

  • Aged
  • Arthroplasty, Replacement, Knee
  • England
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Knee
  • Patient Satisfaction
  • Propensity Score
  • Quality of Life
  • Registries
  • Treatment Outcome
  • Wales
  • Comparative Study
  • Journal Article
  • Research Support, Non-U.S. Gov't

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