Unicompartmental knee replacement provides excellent results at 15 years .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(4):6 J Bone Joint Surg Br. 2009 Jan;91(1):52-7To compare the two surgical procedures, 102 knees requiring knee replacement were randomized to receive either unicompartmental knee replacement (UKR) or total knee replacement (TKR). A previous assessment established that UKR had superior results at 5 year follow-up. The continued 15 year follow-up demonstrated that results were maintained with 71.4% of patients having excellent outcomes in terms of Bristol knee score and prosthesis survivorship.
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.
2/4
Aleatorización
3/4
Medición de resultados
3/4
Inclusión / exclusión
4/4
Descripción de la terapia
3/4
Estadísticas
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?
Unicompartmental knee replacement (UKR) has increased in popularity over the last few years; however, there is still an existent belief that a TKR is preferable for patients over the age of 60, as is regarded to have a better success rate. The data in this study has previously established the superiority of UKR with a follow up of 5 years. For a longer term follow up of 15 years, this study was conducted to validate the findings.
¿Cuál era la pregunta principal de la investigación?
Does the use of the St Georg Sled unicompartmental knee replacement provide superior outcomes when compared to total knee replacement at 15 years?
- Surgeries in 4 patients in the UKR group were unsuccessful (either revision surgery or a Bristol knee score < 60), whereas in 6 patients in the TKR group were considered unsuccessful (p=0.51) .
- 71.4% of patients had an excellent outcome in the UKR group compared to 52.6 % in the TKR.
- Average Bristol knee scores were 92 and 87.5 in the UKR and TKR groups, respectively (p=0.99), with the median pain scores being 40 and 35 (15-90), respectively.
- The survivorship of the implant (either revision surgery or a Bristol knee score < 60) was 89.8% (95% CI 74.3 to 100) in the UKR group and 78.7% (95% Ci 56.2 to 100) in the TKR group. There was no difference in survival between the two groups (p=0.51).
- 78% patients in the UKR group had > 120° of flexion compared to 38% in the TKR group (p=0.08).
¿Qué es lo que más debo recordar?
Unicompartmental knee replacement maintained the excellent early results at 15 years, demonstrating excellent Bristol knee scores and implant survivorship.
¿Cómo afectará esto al cuidado de mis pacientes?
The use of UKR can provide excellent results for elderly patients requiring knee replacement. Further research is needed with larger simple sizes.
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