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)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
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
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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?
Quels sont les résultats importants ?
- 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
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
