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Age-dependent effect found for patient satisfaction with UKA vs TKA
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GENEVA — Younger patients who underwent unicompartmental knee arthroplasty reported better satisfaction scores and were more likely to have their expectations met for pain and other measures compared with patients of the same age who had total knee arthroplasty, according to recently presented data.
Investigators found these differences became less significant in older patient groups.
“There is controversy regarding the best treatment options for patients undergoing unicompartmental knee arthroplasty vs. total knee arthroplasty,”
“The literature suggests that the long-term survival rate of unicompartmental knee arthroplasty is not comparable with total knee arthroplasty in low-volume hospitals. Studies have previously just looked at the failure rate and loosening rate,” he said. “Not many of them have looked into patient satisfaction, although they have increased attention to that in the past few years.”
Minimum 3-year follow-up
von Keudell and his colleagues comprehensively compared subjective and functional outcomes of patients who underwent either unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) at a minimum of 3 years postoperatively. They categorized patients into three age groups: younger than 55 years, 55 to 64 years and older than 65 years.
Researchers enrolled 735 patients between 2002 and 2006. After excluding for bilateral surgeries, as well as revisions and secondary procedures, the researchers had a total group of 386 patients, including 245 who underwent primary TKA and 141 who underwent UKA.
Patients provided a satisfaction rate and rated on a scale of one to 10 whether their expectations had been met for pain, range of motion, daily living function, return to recreational activity and ability to kneel.
Ninety-six percent of all patients who underwent UKA and were aged younger than 55 years were satisfied compared with 81% of those who underwent TKA in this same age group, von Keudell reported. With increasing age, “the percentage rate goes up in the total knee arthroplasty group, especially in the age group over 65 years and slightly goes down in the unicompartmental knee arthroplasty group,” he said. Given the lower mortality and morbidity associated with UKA, it remains unclear whether older patients should receive more generously a TKA given the higher satisfaction, he noted.
Motion, return to sport
Patients’ reports of whether their expectations had been met for the various parameters were only significant for range of motion and return to sport, von Keudell said.
“However, when you look closer at the numbers, you can see there was a consistently higher percentage [among the UKA group] where their expectations were met in all different parameter scores in comparison to the total knee arthroplasty group,” he said. “This was underscored by the evidence of the range of motion.”
Within both groups, researchers observed no difference between the preoperative and postoperative range of motion. However, a comparison between the groups revealed a significantly greater postoperative range of motion among patients who underwent UKA compared with those who underwent TKA.
“It might be because we had a high preoperative range of motion in the unicompartmental knee arthroplasty group,” von Keudell said. – by Tina DiMarcantonio
References:
von Keudell AG. Primary total and unicompartmental knee arthroplasty: An age-dependent analysis of patient satisfaction. Presented at the 15th European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress 2012. May 2-5. Geneva.
For more information:
Arvind G. von Keudell, MD, can be reached at the Department of Orthopedic Surgery, Brigham and Women’s Hospital, Cartilage Repair Center, 75 Francis Street, Boston 02446; email: avonkeudell@partners.org.