Zachary C Lum1, David A Crawford2, Adolph V Lombardi3, Jason M Hurst4, Michael J Morris4, Joanne B Adams5, Keith R Berend3. 1. Doctors Medical Center, Orthopaedic Surgery Department, 1441 Florida Avenue, Modesto, CA 95350, USA. 2. Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA; Mount Carmel Health System, 7333 Smith's Mill Road, New Albany, OH 43054, USA. Electronic address: crawfordda@joint-surgeons.com. 3. Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA; Department of Orthopaedics, The Ohio State University Wexner Medical Center, 376 W 10th Ave, Suite 725, Columbus, OH 43210, USA; Mount Carmel Health System, 7333 Smith's Mill Road, New Albany, OH 43054, USA. 4. Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA; Mount Carmel Health System, 7333 Smith's Mill Road, New Albany, OH 43054, USA. 5. Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
Abstract
BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA. METHODS: Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI >35kg/m2 (mean 41kg/m2) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared. RESULTS: UKA patients had higher preoperative ROM, and Knee Society pain (KSP), functional (KSF), and clinical (KSC) scores (p<0.001, p=0.0008, p=0.0003, p=0.051 respectively). Mean tourniquet times, operative times, and lengths of stay were lower after UKA. Four TKA patients required transfusion. Mean follow-up was 2.3years. The frequency of manipulation under anesthesia was higher in TKA patients (p<0.001), while the rate of component revision was similar between the two groups (1.2% vs. 1.7%, p=0.328). Frequency of deep infection was lower in the UKA group (p=0.016). Postoperative KSF, change in KSF, and ROM were higher (p<0.0001) after UKA, but KSP and KSC were equivalent. CONCLUSIONS: Severely obese patients who underwent medial UKA demonstrated equal survivorship with substantially fewer reoperations, reduced deep infection, and less perioperative complications at short term follow-up. Severely obese patients had improved KSF scores and maintenance of ROM after UKA compared with TKA.
BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obesepatients undergoing medial UKA versus TKA. METHODS: Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI >35kg/m2 (mean 41kg/m2) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared. RESULTS: UKA patients had higher preoperative ROM, and Knee Society pain (KSP), functional (KSF), and clinical (KSC) scores (p<0.001, p=0.0008, p=0.0003, p=0.051 respectively). Mean tourniquet times, operative times, and lengths of stay were lower after UKA. Four TKA patients required transfusion. Mean follow-up was 2.3years. The frequency of manipulation under anesthesia was higher in TKA patients (p<0.001), while the rate of component revision was similar between the two groups (1.2% vs. 1.7%, p=0.328). Frequency of deep infection was lower in the UKA group (p=0.016). Postoperative KSF, change in KSF, and ROM were higher (p<0.0001) after UKA, but KSP and KSC were equivalent. CONCLUSIONS: Severely obesepatients who underwent medial UKA demonstrated equal survivorship with substantially fewer reoperations, reduced deep infection, and less perioperative complications at short term follow-up. Severely obesepatients had improved KSF scores and maintenance of ROM after UKA compared with TKA.
Authors: Kevin F Purcell; Benjamin M Stronach; Marie Gene Almand; Doug Parsell; Trevor Pickering; R Kerk Mehrle; Craig Winkler; Jeff D Almand Journal: Arthroplast Today Date: 2021-06-23