Research Article: Fixed-bearing unicompartmental vs. total knee arthroplasty in elderly patients with medial osteoarthritis and anterior cruciate ligament deficiency: a retrospective comparative study
Abstract:
To compare fixed-bearing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in elderly patients with medial compartment osteoarthritis and anterior cruciate ligament (ACL) deficiency.
A retrospective case-control study with 1:1 propensity score matching was performed, enrolling 85 UKA and 85 TKA patients. Baseline covariates were well balanced (all standardized mean differences <0.1). Perioperative data, knee range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Tegner scores, patient satisfaction, and complications were analyzed over 5-year follow-up.
UKA was associated with significantly lower postoperative pain (VAS: 3.65?±?1.11 vs. 5.03?±?0.78; MD ?1.38, 95% CI ?1.67 to ?1.09; P <?0.0001), hemoglobin loss (8.15?±?4.32 vs. 10.29?±?5.88?g/L; MD ?2.14, 95% CI ?3.69 to ?0.59; P =?0.0076), and tramadol consumption (774.10?±?139.90 vs. 1,114.00?±?308.70?mg; MD ?339.90, 95% CI ?412.0 to ?267.8; P <?0.0001), with similar complication rates (2.35% vs. 4.71%; P =?0.6819). Postoperative ROM was greater in the UKA group at all time points (1 year: 125.30?±?9.30° vs. 119.00?±?10.85°; MD 6.30°, 95% CI 3.26–9.34; P <?0.0001). WOMAC scores were lower at 1 year (29.61?±?12.88 vs. 34.74?±?12.56; MD ?5.13, 95% CI ?8.95 to ?1.31; P =?0.0094) but comparable from 2 to 5 years. At 5 years, instability rates were similar (1.18% vs. 3.53%; P =?0.6205), while UKA achieved higher Tegner (4.46?±?1.14 vs. 3.99?±?0.78; MD 0.47, 95% CI 0.18–0.76; P =?0.0020) and satisfaction scores (7.74?±?1.10 vs. 6.94?±?1.44; MD 0.80, 95% CI 0.41–1.19; P <?0.0001).
Fixed-bearing UKA may represent a suitable alternative in carefully selected elderly patients with ACL-deficient medial osteoarthritis, yielding favorable perioperative recovery and comparable 5-year safety to TKA. Prospective multicenter studies are required to validate these findings.
Introduction:
To compare fixed-bearing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in elderly patients with medial compartment osteoarthritis and anterior cruciate ligament (ACL) deficiency.
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