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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2023

28-06-2022 | Osteoarthrosis | KNEE

Unicompartmental knee arthroplasty in patients under the age of 60 years provides excellent clinical outcomes and 10-year implant survival: a systematic review

A study performed by the Early Osteoarthritis group of ESSKA-European Knee Associates section

Authors: Theofylaktos Kyriakidis, Vipin Asopa, Mike Baums, René Verdonk, Trifon Totlis

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

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Abstract

Purpose

The purpose of the present study was to systematically review the clinical and functional outcomes following medial unicompartmental knee arthroplasty (UKA) in patients under the age of 60 years old.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies between 2012 and April 2022, on patients 18–60 years old who have had a unicompartmental knee replacement evaluating patient-reported outcomes measures (PROMs), were included. The Knee Society Scores (KSS) clinical score was considered the primary outcome. Pre- and post-operative range of motion (ROM), PROMs, complications and survival were recorded. Paired sample t testing was performed to compare the pre-operative with post-operative KSS.

Results

Seventeen articles comprising 2083 unicompartmental arthroplasties were included. The follow-up range was between 1 and 15 years. In eligible studies, all reported outcomes were improved following UKA. The mean KSS clinical was significantly improved from 45.5 (SD: 9.6) pre-operatively to 89.4 (SD: 4.4) post-operatively (p = 0.0001). Mean implant survival ranged 86–96.5% at 10 years follow-up. There was no significant difference between mobile and fixed bearing in terms of ROM and KSS clinical. In total, 92 revisions and 7 re-operations with implant retention were reported.

Conclusion

Unicompartmental knee arthroplasty for medial osteoarthritis is a safe, reliable and effective treatment option for patients of 60 years or younger. It provides pain relief, satisfactory activity level, excellent clinical outcomes, and up to 96.5% implant survival at 10-year follow-up.

Level of evidence

IV.
Literature
1.
go back to reference Argenson JN, Boisgard S, Parratte S, Descamps S, Bercovy M, Bonnevialle P et al (2013) Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: a multicenter French nationwide study including 846 cases. Orthop Traumatol Surg Res 99:385–390CrossRefPubMed Argenson JN, Boisgard S, Parratte S, Descamps S, Bercovy M, Bonnevialle P et al (2013) Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: a multicenter French nationwide study including 846 cases. Orthop Traumatol Surg Res 99:385–390CrossRefPubMed
2.
go back to reference Bhattacharya R, Scott CE, Morris HE, Wade F, Nutton RW (2012) Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Knee 19:348–351CrossRefPubMed Bhattacharya R, Scott CE, Morris HE, Wade F, Nutton RW (2012) Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Knee 19:348–351CrossRefPubMed
3.
go back to reference Biswas D, Van Thiel GS, Wetters NG, Pack BJ, Berger RA, Della Valle CJ (2014) Medial unicompartmental knee arthroplasty in patients less than 55 years old: minimum of two years of follow-up. J Arthroplast 29:101–105CrossRef Biswas D, Van Thiel GS, Wetters NG, Pack BJ, Berger RA, Della Valle CJ (2014) Medial unicompartmental knee arthroplasty in patients less than 55 years old: minimum of two years of follow-up. J Arthroplast 29:101–105CrossRef
4.
go back to reference Calkins TE, Hannon CP, Fillingham YA, Culvern CC, Berger RA, Della Valle CJ (2021) Fixed-bearing medial unicompartmental knee arthroplasty in patients younger than 55 years of age at 4–19 years of follow-up: a concise follow-up of a previous report. J Arthroplast 36:917–921CrossRef Calkins TE, Hannon CP, Fillingham YA, Culvern CC, Berger RA, Della Valle CJ (2021) Fixed-bearing medial unicompartmental knee arthroplasty in patients younger than 55 years of age at 4–19 years of follow-up: a concise follow-up of a previous report. J Arthroplast 36:917–921CrossRef
5.
go back to reference Cao Z, Mai X, Wang J, Feng E, Huang Y (2018) Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: a systematic review and meta-analysis. J Arthroplast 33:952–959CrossRef Cao Z, Mai X, Wang J, Feng E, Huang Y (2018) Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: a systematic review and meta-analysis. J Arthroplast 33:952–959CrossRef
6.
go back to reference Faour Martin O, Valverde Garcia JA, Martin Ferrero MA, Vega Castrillo A, Zuil Acosta P, Suarez De Puga CC (2015) The young patient and the medial unicompartmental knee replacement. Acta Orthop Belg 81:283–288PubMed Faour Martin O, Valverde Garcia JA, Martin Ferrero MA, Vega Castrillo A, Zuil Acosta P, Suarez De Puga CC (2015) The young patient and the medial unicompartmental knee replacement. Acta Orthop Belg 81:283–288PubMed
7.
go back to reference Fu D, Li G, Chen K, Zhao Y, Hua Y, Cai Z (2013) Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplast 28:759–765CrossRef Fu D, Li G, Chen K, Zhao Y, Hua Y, Cai Z (2013) Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplast 28:759–765CrossRef
8.
go back to reference Gill JR, Corbett JA, Wastnedge E, Nicolai P (2021) Forgotten joint score: comparison between total and unicondylar knee arthroplasty. Knee 29:26–32CrossRefPubMed Gill JR, Corbett JA, Wastnedge E, Nicolai P (2021) Forgotten joint score: comparison between total and unicondylar knee arthroplasty. Knee 29:26–32CrossRefPubMed
9.
go back to reference Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN, Yeo SJ (2018) Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplast 33:355–361CrossRef Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN, Yeo SJ (2018) Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplast 33:355–361CrossRef
10.
go back to reference Goshima K, Sawaguchi T, Sakagoshi D, Shigemoto K, Hatsuchi Y, Akahane M (2017) Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:918–923CrossRefPubMed Goshima K, Sawaguchi T, Sakagoshi D, Shigemoto K, Hatsuchi Y, Akahane M (2017) Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:918–923CrossRefPubMed
11.
go back to reference Greco NJ, Lombardi AV Jr, Price AJ, Berend ME, Berend KR (2018) Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years. J Arthroplast 33:2435–2439CrossRef Greco NJ, Lombardi AV Jr, Price AJ, Berend ME, Berend KR (2018) Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years. J Arthroplast 33:2435–2439CrossRef
12.
go back to reference Gulati Y, Raina P, Nimkar GA, Bahl V (2020) Oxford partial knee replacement: early follow up results in young verses elderly age group patients. J Arthrosc Jt Surg 7:64–68CrossRef Gulati Y, Raina P, Nimkar GA, Bahl V (2020) Oxford partial knee replacement: early follow up results in young verses elderly age group patients. J Arthrosc Jt Surg 7:64–68CrossRef
13.
go back to reference Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF, Murray DW (2017) Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplast 32:1779–1785CrossRef Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF, Murray DW (2017) Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplast 32:1779–1785CrossRef
14.
go back to reference Jacquet C, Gulagaci F, Schmidt A, Pendse A, Parratte S, Argenson JN et al (2020) Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports. Knee Surg Sports Traumatol Arthrosc 28:3849–3857CrossRefPubMed Jacquet C, Gulagaci F, Schmidt A, Pendse A, Parratte S, Argenson JN et al (2020) Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports. Knee Surg Sports Traumatol Arthrosc 28:3849–3857CrossRefPubMed
15.
go back to reference Jin QH, Lee WG, Song EK, Jin C, Seon JK (2021) Comparison of long-term survival analysis between open-wedge high tibial osteotomy and unicompartmental knee arthroplasty. J Arthroplast 36:1562–1567CrossRef Jin QH, Lee WG, Song EK, Jin C, Seon JK (2021) Comparison of long-term survival analysis between open-wedge high tibial osteotomy and unicompartmental knee arthroplasty. J Arthroplast 36:1562–1567CrossRef
16.
go back to reference Kennedy JA, Mellon SJ, Lombardi AV, Berend KR, Hamilton TW, Murray DW (2020) Candidacy for medial unicompartmental knee replacement declines with age. Orthop Traumatol Surg Res 106:443–447CrossRefPubMed Kennedy JA, Mellon SJ, Lombardi AV, Berend KR, Hamilton TW, Murray DW (2020) Candidacy for medial unicompartmental knee replacement declines with age. Orthop Traumatol Surg Res 106:443–447CrossRefPubMed
17.
go back to reference Kennedy JA, Mohammad HR, Mellon SJ, Dodd CAF, Murray DW (2020) Age stratified, matched comparison of unicompartmental and total knee replacement. Knee 27:1332–1342CrossRefPubMed Kennedy JA, Mohammad HR, Mellon SJ, Dodd CAF, Murray DW (2020) Age stratified, matched comparison of unicompartmental and total knee replacement. Knee 27:1332–1342CrossRefPubMed
18.
go back to reference Khoshbin A, Sheth U, Ogilvie-Harris D, Mahomed N, Jenkinson R, Gandhi R et al (2017) The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc 25:887–894CrossRefPubMed Khoshbin A, Sheth U, Ogilvie-Harris D, Mahomed N, Jenkinson R, Gandhi R et al (2017) The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc 25:887–894CrossRefPubMed
19.
go back to reference Kim MS, Koh IJ, Sohn S, Jeong JH, In Y (2019) Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. Int Orthop 43:2493–2501CrossRefPubMed Kim MS, Koh IJ, Sohn S, Jeong JH, In Y (2019) Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. Int Orthop 43:2493–2501CrossRefPubMed
20.
go back to reference Kim YJ, Kim BH, Yoo SH, Kang SW, Kwack CH, Song MH (2017) Mid-term results of oxford medial unicompartmental knee arthroplasty in young Asian patients less than 60 years of age: a minimum 5-year follow-up. Knee Surg Relat Res 29:122–128CrossRefPubMedPubMedCentral Kim YJ, Kim BH, Yoo SH, Kang SW, Kwack CH, Song MH (2017) Mid-term results of oxford medial unicompartmental knee arthroplasty in young Asian patients less than 60 years of age: a minimum 5-year follow-up. Knee Surg Relat Res 29:122–128CrossRefPubMedPubMedCentral
21.
go back to reference Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Jt Surg Am 71:145–150CrossRef Kozinn SC, Scott R (1989) Unicondylar knee arthroplasty. J Bone Jt Surg Am 71:145–150CrossRef
22.
go back to reference Krych AJ, Reardon P, Sousa P, Pareek A, Stuart M, Pagnano M (2017) Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7 years. J Bone Jt Surg Am 99:113–122CrossRef Krych AJ, Reardon P, Sousa P, Pareek A, Stuart M, Pagnano M (2017) Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7 years. J Bone Jt Surg Am 99:113–122CrossRef
23.
go back to reference Lee M, Chen J, Shi LuC, Lo NN, Yeo SJ (2019) No differences in outcomes scores or survivorship of unicompartmental knee arthroplasty between patients younger or older than 55 years of age at minimum 10-year followup. Clin Orthop Relat Res 477:1434–1446CrossRefPubMedPubMedCentral Lee M, Chen J, Shi LuC, Lo NN, Yeo SJ (2019) No differences in outcomes scores or survivorship of unicompartmental knee arthroplasty between patients younger or older than 55 years of age at minimum 10-year followup. Clin Orthop Relat Res 477:1434–1446CrossRefPubMedPubMedCentral
24.
go back to reference Li Z, Chen Z, Wei J, Zeng X, Sun H, Li Z et al (2021) Excellent outcomes with Oxford uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (</=60 years) at mid-term follow-up. BMC Musculoskelet Disord 22:859CrossRefPubMedPubMedCentral Li Z, Chen Z, Wei J, Zeng X, Sun H, Li Z et al (2021) Excellent outcomes with Oxford uni-compartmental knee arthroplasty in anteromedial osteoarthritis patients (</=60 years) at mid-term follow-up. BMC Musculoskelet Disord 22:859CrossRefPubMedPubMedCentral
25.
go back to reference Mannan A, Pilling RWD, Mason K, Stirling P, Duffy D, London N (2020) Excellent survival and outcomes with fixed-bearing medial UKA in young patients (</= 60 years) at minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 28:3865–3870CrossRefPubMed Mannan A, Pilling RWD, Mason K, Stirling P, Duffy D, London N (2020) Excellent survival and outcomes with fixed-bearing medial UKA in young patients (</= 60 years) at minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 28:3865–3870CrossRefPubMed
26.
go back to reference Migliorini F, Driessen A, Oliva F, Maffulli GD, Tingart M, Maffulli N (2020) Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in patients older than 50 years. J Orthop Surg Res 15:545CrossRefPubMedPubMedCentral Migliorini F, Driessen A, Oliva F, Maffulli GD, Tingart M, Maffulli N (2020) Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in patients older than 50 years. J Orthop Surg Res 15:545CrossRefPubMedPubMedCentral
27.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefPubMedPubMedCentral Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefPubMedPubMedCentral
29.
go back to reference Neufeld ME, Albers A, Greidanus NV, Garbuz DS, Masri BA (2018) A comparison of mobile and fixed-bearing unicompartmental knee arthroplasty at a minimum 10-year follow-up. J Arthroplasty 33:1713–1718CrossRefPubMed Neufeld ME, Albers A, Greidanus NV, Garbuz DS, Masri BA (2018) A comparison of mobile and fixed-bearing unicompartmental knee arthroplasty at a minimum 10-year follow-up. J Arthroplasty 33:1713–1718CrossRefPubMed
30.
go back to reference Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW (2015) The clinical outcome of minimally invasive phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Jt J 97-B:1493–1500CrossRef Pandit H, Hamilton TW, Jenkins C, Mellon SJ, Dodd CA, Murray DW (2015) The clinical outcome of minimally invasive phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs. Bone Jt J 97-B:1493–1500CrossRef
31.
go back to reference Pannell WC, Heidari KS, Mayer EN, Zimmerman K, Heckmann N, McKnight B et al (2019) High tibial osteotomy survivorship: a population-based study. Orthop J Sports Med 7:2325967119890693CrossRefPubMedPubMedCentral Pannell WC, Heidari KS, Mayer EN, Zimmerman K, Heckmann N, McKnight B et al (2019) High tibial osteotomy survivorship: a population-based study. Orthop J Sports Med 7:2325967119890693CrossRefPubMedPubMedCentral
32.
go back to reference Peersman G, Verhaegen J, Favier B (2019) The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study. Int Orthop 43:2739–2745CrossRefPubMed Peersman G, Verhaegen J, Favier B (2019) The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study. Int Orthop 43:2739–2745CrossRefPubMed
33.
go back to reference Schwab PE, Lavand’homme P, Yombi JC, Thienpont E (2015) Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3494–3500CrossRefPubMed Schwab PE, Lavand’homme P, Yombi JC, Thienpont E (2015) Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3494–3500CrossRefPubMed
34.
go back to reference Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:96–112CrossRefPubMed Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:96–112CrossRefPubMed
35.
go back to reference Streit MR, Streit J, Walker T, Bruckner T, Philippe Kretzer J, Ewerbeck V et al (2017) Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients. Knee Surg Sports Traumatol Arthrosc 25:660–668CrossRefPubMed Streit MR, Streit J, Walker T, Bruckner T, Philippe Kretzer J, Ewerbeck V et al (2017) Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients. Knee Surg Sports Traumatol Arthrosc 25:660–668CrossRefPubMed
36.
go back to reference van der List JP, McDonald LS, Pearle AD (2015) Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 22:454–460CrossRefPubMed van der List JP, McDonald LS, Pearle AD (2015) Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee 22:454–460CrossRefPubMed
37.
go back to reference Victor J, Ghijselings S, Tajdar F, Van Damme G, Deprez P, Arnout N et al (2014) Total knee arthroplasty at 15–17 years: does implant design affect outcome? Int Orthop 38:235–241CrossRefPubMed Victor J, Ghijselings S, Tajdar F, Van Damme G, Deprez P, Arnout N et al (2014) Total knee arthroplasty at 15–17 years: does implant design affect outcome? Int Orthop 38:235–241CrossRefPubMed
38.
go back to reference Walker T, Streit J, Gotterbarm T, Bruckner T, Merle C, Streit MR (2015) Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthroplast 30:1911–1916CrossRef Walker T, Streit J, Gotterbarm T, Bruckner T, Merle C, Streit MR (2015) Sports, physical activity and patient-reported outcomes after medial unicompartmental knee arthroplasty in young patients. J Arthroplast 30:1911–1916CrossRef
39.
go back to reference Wang F, Xue H, Ma T, Wen T, Yang T, Xue L et al (2020) Short-term effectiveness of medial unicompartmental knee arthroplasty in young patients aged less than or equal to 60 years. J Orthop Surg (Hong Kong) 28:2309499020945118CrossRefPubMed Wang F, Xue H, Ma T, Wen T, Yang T, Xue L et al (2020) Short-term effectiveness of medial unicompartmental knee arthroplasty in young patients aged less than or equal to 60 years. J Orthop Surg (Hong Kong) 28:2309499020945118CrossRefPubMed
40.
go back to reference Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF et al (2019) Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 364:l352CrossRefPubMedPubMedCentral Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF et al (2019) Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 364:l352CrossRefPubMedPubMedCentral
41.
go back to reference Zhang W, Wang J, Li H, Wang W, George DM, Huang T (2020) Fixed- versus mobile-bearing unicompartmental knee arthroplasty: a meta-analysis. Sci Rep 10:19075CrossRefPubMedPubMedCentral Zhang W, Wang J, Li H, Wang W, George DM, Huang T (2020) Fixed- versus mobile-bearing unicompartmental knee arthroplasty: a meta-analysis. Sci Rep 10:19075CrossRefPubMedPubMedCentral
Metadata
Title
Unicompartmental knee arthroplasty in patients under the age of 60 years provides excellent clinical outcomes and 10-year implant survival: a systematic review
A study performed by the Early Osteoarthritis group of ESSKA-European Knee Associates section
Authors
Theofylaktos Kyriakidis
Vipin Asopa
Mike Baums
René Verdonk
Trifon Totlis
Publication date
28-06-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07029-9

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