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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
2/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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