Hamilton, TW, Rizkalla, JM, Kontochristos, L et al. (5 more authors) (2017) The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: A meta-analysis. Journal of Arthroplasty, 32 (10). 3228-3237.e2. ISSN 0883-5403
Abstract
Background: Outcomes following UKA are variable and influenced by surgical caseload (UKA/year) and usage (percentage of primary knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors. Methods: MEDLINE (Ovid), Embase (Ovid) and the Web of Science (ISI) were searched for consecutive series of minimally invasive cemented Phase 3 Oxford medial UKA. The primary outcome measure was revision-rate/100 observed component years (%pa). Series were divided into groups according to caseload and usage. Results 46studies, including 12,520 knees, were identified. The annual revision-rate varied from 0%pa to 4.35%pa, mean 1.21%pa (95%CI 0.97-1.47). In series with mean follow-up of ten-years or more the revision-rate was 0.63%pa (95%CI 0.46-0.83), which equates to a ten-year survival of 94% (95%CI 92%-95%). Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patello-femoral problems and polyethylene wear exceedingly rare (<0.1%). Both increasing caseload (p=0.02) and usage (p<0.001) were associated with decreasing revision-rate. The lowest revision-rates were achieved with a caseload >24 UKA/year (0.88%pa, 95%CI 0.63-1.61) and usage >30% (0.69%pa, 95%CI 0.50-0.90). Usage was more important than caseload: with high-usage (≥20%) the revision-rate was low, whether the caseload was high (>12UKA/year) or low (≤12UKA/year), (0.94%pa (95%CI 0.69-1.23) and 0.85%pa (95%CI 0.65-1.08) respectively); whereas with low-usage (<20%) the revision-rate was high, whether the caseload was high or low (1.58%pa, 95%CI 0.57- 3.05 and 1.76%pa, 95%CI 1.21-2.41). Conclusion: To achieve optimum results with mobile-bearing UKA surgeons, whether high or low-caseload, should adhere to the recommended indications such that ≥20%, or ideally >30% of their knee replacements are UKA. If they do this then they can expect to achieve results similar to those of the long-term series, which all had high-usage (>20%) and an average ten-year survival of 94%.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 Elsevier Inc. This is an author produced version of a paper published in The Journal of Arthroplasty. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | unicompartmental knee arthroplasty,implant survival, meta-analysis, surgical caseload, surgical usage |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 15 May 2017 15:10 |
Last Modified: | 11 May 2018 00:38 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.arth.2017.04.063 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:116527 |