ARTHROPLASTY
Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):22 Knee. 2012 Mar;19(2):103-6. Epub 2011 Feb 22.56 patients suffering from unicompartmental osteoarthritis were randomized to either undergo unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) to compare clinical and functional results. At an average of 52 month follow-up, UKA provided similar functional outcomes to TKA, while requiring less surgical time and fewer blood transfusions.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomização
3/4
Medições dos resultados
4/4
Inclusão / Exclusão
2/4
Descrição da terapia
4/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Total knee arthroplasty, the current standard for treatment of knee osteoarthritis requiring replacement, may be an excessive treatment for patients suffering from only medial compartment osteoarthritis. Unicompartmental knee arthroplasty (UKA) provides theoretical advantages when compared to TKA, which include: a smaller incision size, reduced muscular dissection, less postoperative pain, less blood loss, shorter operative times,and quicker rehabilitation. These possible advantages merit an investigation comparing the results of TKA and UKA for patients with unicompartmental osteoarthritis.
¿Cuál era la pregunta principal de la investigación?
Does mobile bearing unicompartmental knee arthroplasty provide similar functional results when compared to fixed bearing total knee arthroplasty for patients with unicompartmental knee osteoarthritis, while incurring fewer related costs and risks, as evaluated over 52 months?
¿Cuáles fueron los hallazgos importantes?
- Significantly less blood was lost during the UKA procedure, inferred by the change in hemoglobin (1.6g/dl (SD 0.7; Range: 0.4 to 3.0) compared to TKA 2.7g/dl (SD 1.6; Range: 0.9 to 5.8 (p=0.007)). Total postoperative drainage was significantly lesser in UKA 436 ml (SD 14; range 100 to 380) compared to 512 (SD 11; range 60 to 910) in TKA (p<0.01).
- Average operation time was 68.8 min (range: 50 to 102) in UKA compared to 81.5 min in TKA (range: 56 to 115) (p<0.01).
- Deep vein thrombosis following the operation was more prevalent in the TKA group with 7 of 56 compared to 3 of 56 (p<0.01)
- There were no differences between Knee Society scores of the two groups (80.58 (Range: 70 to 100) UKA and 78.9 (Range: 70 to 87) TKA), indicating similar functional recovery (p>0.05). There were also no differences in ROM between the two groups (UKA: 115 (SD 4) vs. TKA: 117 (SD 7); p=0.18).
- 7 UKA patients underwent conversion to TKA
¿Qué es lo que más debo recordar?
Unicompartmental knee arthroplasty provides similar clinical results compared to total knee arthroplasty for patients suffering from unicompartmental knee osteoarthritis. However, UKA was associated with significantly lower blood loss and operation time.
¿Cómo afectará esto al cuidado de mis pacientes?
The authors suggest that UKA should be considered as the primary treatment for unicompartmental knee osteoarthritis once surgeons are competent. However, this opinion is based on the assumption of reduced cost and risk, which needs to be conclusively supported using high quality RCTs.
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