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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
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.
Qual era la domanda di ricerca principale?
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).
Che cosa devo ricordare di più?
Unicompartmental knee replacement maintained the excellent early results at 15 years, demonstrating excellent Bristol knee scores and implant survivorship.
Come influenzerà l'assistenza ai miei pazienti?
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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