Knee Scores of Patients with Non‐Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed‐Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial

• Published in: Orthopaedic surgery Vol. 14; no. 1; pp. 73 - 87
• Main Authors: Wu, Li‐ping, Mayr, Hermann O, Zhang, Xing, Huang, Yuan‐qiao, Chen, Yuan‐zhuang, Li, Yu‐ming
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.01.2022; John Wiley & Sons, Inc; Wiley
• Subjects: Aged; Arthritis; Arthroplasty, Replacement, Knee - instrumentation; Arthroplasty, Replacement, Knee - methods; Clinical; Consent; Contraindications; Female; Hospitals; Humans; Joint replacement surgery; Joint surgery; Knee; Knee Prosthesis; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Knee - surgery; Patients; Polyethylene; Prospective Studies; Prostheses; Prosthesis Design; Total knee arthroplasty; Transplants & implants; Treatment Outcome; Unicompartmental knee arthroplasty; Knee; Total knee arthroplasty; Osteoarthritis; Unicompartmental knee arthroplasty
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13111

Objective To evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA). Methods From September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared. Results Primarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group. Conclusion UKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA. This study put forward a new concept of non‐lateral compartment knee OA, and reported result of patients with non‐lateral unicompartmental knee OA who were randomly performed MB UKA, FB UKA, and TKA. UKA showed many advantages in comparison with TKA, while there was no significant difference between MB UKA and FB UKA. We believe that our study makes a significant contribution to the literature because this is the first study to compare the clinical outcomes of patients with non‐lateral compartment knee OA, who have randomly received MB UKA, FB UKA, and TKA and show the results of self‐reported knee scores of these patients 3 years postoperatively.