scholarly journals Unicompartmental knee arthroplasty: A PearlDiver study evaluating complications rates, opioid use and utilization in the Medicare population

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Brandon L. Morris ◽  
Jack M. Ayres ◽  
Daniel Reinhardt ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Complication Rates ◽  
Opioid Use ◽  
Level Of Evidence ◽  
Medicare Population ◽  
Unicompartmental Knee ◽  
Lower Complication ◽  
Icd 10 ◽  
Outcome Differences

Abstract Purpose Despite increased utilization of unicompartmental knee arthroplasty (UKA) for unicompartmental knee osteoarthritis, outcomes in Medicare patients are not well-reported. The purpose of this study is to analyze practice patterns and outcome differences between UKA and TKA in the Medicare population. It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to TKA. Methods Using PearlDiver, the Humana Claims dataset and the Medicare Standard Analytic File (SAF) were analyzed. Patients who underwent UKA and TKA were identified by CPT codes. Postoperative complications were identified by ICD-9/ICD-10 codes. Opioid use was analyzed by the number of days patients were prescribed opioids postoperatively. Survivorship was defined as conversion to TKA. Results In the Humana dataset, 7,808 UKA and 150,680 TKA patients were identified. 8-year survivorship was 87.7% (95% CI [0.861,0.894]). Postoperative opioid use was significantly higher after TKA (186.1 days) compared to UKA (144.7 days) (p < 0.01, Δ = 41.1, 95% CI = [30.41, 52.39]). In the SAF dataset, 20,592 UKA patients and 110,562 TKA patients were identified. Survivorship was highest in patients > 80 years old and lowest in patients < 70 years old. In both datasets, postoperative complication rates were higher in TKA patients compared to UKA patients in nearly all categories. Conclusions UKA represents an increasingly utilized treatment for osteoarthritis in the Medicare population and may be comparatively advantageous to TKA due to reduced opioid use and complication rates after surgery. Level of evidence Level III

Reduced opioid requirements following unicompartmental knee arthroplasty compared with total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 22-27 ◽  
Author(s):  
I. L. Kalbian ◽  
T. L. Tan ◽  
A. J. Rondon ◽  
V. A. Bonaddio ◽  
M. R. Klement ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Multivariate Analysis ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Unicompartmental Knee ◽  
The Usa ◽  
Total Knee ◽  
Continued Use

Aims Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. Patients and Methods We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use. Results Patients undergoing UKA had a second opioid prescription filled 50.2% of the time, compared with 60.5% for TKA (p = 0.006). After controlling for potential confounders, patients undergoing UKA were still less likely to require a second prescription than those undergoing TKA (adjusted odds ratio (OR) 0.58, 95% confidence interval (CI) 0.42 to 0.81; p = 0.001). Continued opioid use requiring more than five prescriptions occurred in 13.7% of those undergoing TKA and 5.8% for those undergoing UKA (p = 0.001), and was also reduced in UKA patients compared with TKA patients (adjusted OR 0.33, 95% CI 0.16 to 0.67; p = 0.022) in multivariate analysis. The continued use of opioids after six months was 11.8% in those undergoing TKA and 8.3% in those undergoing UKA (p = 0.149). The multivariate models for second prescriptions, continued use with more than five, and continued use beyond six months yielded concordance scores of 0.70, 0.86, and 0.83, respectively. Conclusion Compared with TKA, patients undergoing UKA are less likely to require a second opioid prescription and use significantly fewer opioid prescriptions. Thus, orthopaedic surgeons should adjust their patterns of prescription and educate patients about the reduced expected analgesic requirements after UKA compared with TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):22–27

Simultaneous bilateral unicompartmental knee arthroplasty surgery has benefits in low complication rate and cost-effectiveness: a systematic review

2020 ◽  
Vol 5 (4) ◽  
pp. 218-223
Author(s):  
Nicolas Pujol ◽  
Yoshiki Okazaki ◽  
Takayuki Furumatsu
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cost Savings ◽  
Level Of Evidence ◽  
Patient Profile ◽  
One Stage ◽  
Unicompartmental Knee

ImportanceBilateral knee osteoarthritis is frequent and the best choice of treatment remains questionable, especially when the surgeon has to consider simultaneous or staged bilateral unicompartmental knee arthroplasty (UKA).ObjectiveThe purpose of this systematic review was to conduct a systematic review assessing the clinical outcomes associated with simultaneous bilateral and staged bilateral UKA.Evidence reviewA literature search was conducted in June 2019 in Medline, PubMed and Embase. A full-text review of eligible studies was conducted by two investigators.FindingsA total of 10 retrospective studies were identified. These studies described the results of simultaneous bilateral UKA compared either to staged bilateral UKA or unilateral UKA. Results showed that the prevalence of mortality at a minimum of 30 days postoperatively, deep vein thrombosis, the rate of blood transfusion and reintervention were not higher in patients undergoing a one-stage bilateral UKA. The cost-effectiveness is in favour of doing a one-stage procedure due to the shortness of total hospital stay.Conclusions and relevanceOne-stage simultaneous bilateral UKA can be performed with preventing the postoperative complication, and result in cost savings for patients with symptomatic medial bilateral unicompartmental knee osteoarthritis. Further comparative studies are necessary to determine the best patient profile for such a surgery, and the technical considerations during surgery (consecutive surgery or simultaneous surgery with two operative teams).Level of evidenceIV.

scholarly journals Robotic-assisted Unicompartmental knee Arthroplasty optimizes joint line restitution better than conventional surgery

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Roberto Negrín ◽  
Jaime Duboy ◽  
Nicolás O. Reyes ◽  
Maximiliano Barahona ◽  
Magaly Iñiguez ◽  
...  
Keyword(s):  
Femoral Component ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Slope ◽  
Conventional Technique ◽  
Joint Line ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Tibial Resection ◽  
Unicompartmental Knee

Abstract Purpose To compare joint line restoration after unicompartmental knee arthroplasty (UKA) between conventional and robotic-assisted surgery. Previous studies have shown that joint line distalization can lead to higher failure rates. The hypothesis was that robotic-assisted UKA is associated with less femoral component distalization and a precise tibial cut, which allows a more anatomical restitution of the knee joint line. Methods Retrospective cohort study of patients undergoing medial or lateral UKA between May 2018 and March 2020. Preoperative and postoperative radiologic assessment of the joint line was performed by two observers, using three different methods, one for tibial slope and one for tibial resection. Robotic assisted UKA and conventional UKA groups were compared. Results Sixty UKA were included, of which 48 (77.42%) were medial. Robotic-assisted UKA were 40 (64.52%) and 22(35.48%) were conventional The distalization of the femoral component was higher in the conventional group despite the method of measurement used In both Weber methods, the difference was statistically different: Conventional 2.3 (0.9 to 5.6) v/s Robotic 1.5 (− 1.1 to 4.1) (p =0.0025*). A higher proportion of patients achieved a femoral component position ≤ two millimeters from the joint line using robotic-assisted UKA compared to the conventional technique . No statistical difference between robotic-assisted and conventional UKA was found in tibial resection and slope. Conclusion Robotic-assisted UKA shows a better rate of joint line restoration due to less femoral component distalization than conventional UKA. No difference was found in the amount of tibial resection between groups in this study. Level of evidence III

scholarly journals Radiological outcomes following manual and robotic-assisted unicompartmental knee arthroplasty

2021 ◽  
Vol 2 (3) ◽  
pp. 191-197
Author(s):  
Gregory S. Kazarian ◽  
Robert L. Barrack ◽  
Toby N. Barrack ◽  
Charles M. Lawrie ◽  
Ryan M. Nunley
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Robotic System ◽  
Target Range ◽  
Implant Survival ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Unicompartmental Knee ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Survival Level

Aims The purpose of this study was to compare the radiological outcomes of manual versus robotic-assisted medial unicompartmental knee arthroplasty (UKA). Methods Postoperative radiological outcomes from 86 consecutive robotic-assisted UKAs (RAUKA group) from a single academic centre were retrospectively reviewed and compared to 253 manual UKAs (MUKA group) drawn from a prior study at our institution. Femoral coronal and sagittal angles (FCA, FSA), tibial coronal and sagittal angles (TCA, TSA), and implant overhang were radiologically measured to identify outliers. Results When assessing the accuracy of RAUKAs, 91.6% of all alignment measurements and 99.2% of all overhang measurements were within the target range. All alignment and overhang targets were simultaneously met in 68.6% of RAUKAs. When comparing radiological outcomes between the RAUKA and MUKA groups, statistically significant differences were identified for combined outliers in FCA (2.3% vs 12.6%; p = 0.006), FSA (17.4% vs 50.2%; p < 0.001), TCA (5.8% vs 41.5%; p < 0.001), and TSA (8.1% vs 18.6%; p = 0.023), as well as anterior (0.0% vs 4.7%; p = 0.042), posterior (1.2% vs 13.4%; p = 0.001), and medial (1.2% vs 14.2%; p < 0.001) overhang outliers. Conclusion Robotic system navigation decreases alignment and overhang outliers compared to manual UKA. Given the association between component placement errors and revision in UKA, this strong significant improvement in accuracy may improve implant survival. Level of Evidence: III Cite this article: Bone Jt Open 2021;2-3:191–197.

scholarly journals UNICOMPARTIMENTAL KNEE ARTHROPLASTY - 15 YEARS FOLLOW UP

2020 ◽  
Vol 28 (5) ◽  
pp. 233-235
Author(s):  
GILBERTO LUIS CAMANHO
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Case Series ◽  
Level Of Evidence ◽  
Unicompartmental Knee ◽  
Long Term Follow Up ◽  
Lost To Follow Up ◽  
Knee Arthroplasty Surgery ◽  
Arthroplasty Surgery

ABSTRACT Objective: To evaluate clinically and radiologically the long-term follow-up of patients with anteromedial osteoarthritis who underwent unicompartmental knee arthroplasty surgery. Methods: This study included 36 patients who underwent unicompartmental knee arthroplasty surgery for medial compartmental osteoarthritis with a minimum of 15-year post-operative follow-up. All surgeries were performed by a single surgeon (G.L.C) using the Miller-Galante unicompartmental knee implant. Patients were analyzed regarding their clinical functional and implant radiographic conditions. Results: From the 46 patients who could have completed 15 years of follow-up, three required revision surgery with conversion to total knee arthroplasty (6.5%), 36 completed the 15-year follow-up period, and the others were lost to follow-up for reasons not related to unicompartmental arthroplasty. Conclusion: In these 36 patients, the result was satisfactory after follow-up, with complaints and sign of progression of osteoarthritis in some cases. Level of Evidence IV, Case series.

scholarly journals Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e044778
Author(s):  
Yifeng Sun ◽  
Wei Liu ◽  
Jian Hou ◽  
Xiuhua Hu ◽  
Wenqiang Zhang
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Case Control Studies ◽  
Eligibility Criteria ◽  
Robotic Assisted ◽  
Unicompartmental Knee

ObjectiveWe conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA.DesignSystematic review and meta-analysis.Data sourcesThe PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020.Eligibility criteriaCase–control studies comparing robotic-assisted and conventional UKA.Data extraction and synthesisData from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ2 and I2 tests. All analyses were performed using the ‘metafor’ package of R V.3.6.2 software.ResultsA total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis.ConclusionsThis study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required.PROSPERO registration numberCRD42021246927.

scholarly journals Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty

2018 ◽  
Vol 100-B (1_Supple_A) ◽  
pp. 62-67 ◽  
Author(s):  
N. A. Bedard ◽  
D. E. DeMik ◽  
S. B. Dowdle ◽  
J. J. Callaghan
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Patient Characteristics ◽  
Administrative Claims ◽  
Opioid Use ◽  
Repeat Prescription ◽  
Unicompartmental Knee ◽  
Total Knee ◽  
One Year ◽  
Opioid Users

Aims The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA). Materials and Methods We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA. Results A total of 4205 UKA patients were analysed. Of these, 1362 patients (32.4%) were users of opioids. Pre-operative opioid use was the strongest predictor of prolonged opioid use after UKA. Opioid users were 1.4 (81.6% versus 57.7%), 3.7 (49.5% versus 13.3%) and 5.5 (35.8% versus 6.5%) times more likely to be taking opioids at one, two and three months post-operatively, respectively (p < 0.05 for all). Younger age and specific comorbidities such as anxiety/depression, smoking, back pain and substance abuse were found to significantly increase the rate of repeat prescription for opioids after UKA. Overall, UKA patients required significantly less opioid prescriptions than patients who had undergone THA and TKA. Conclusion One-third of patients who undergo UKA are given opioids in the three months pre-operatively. Pre-operative opioid use is the best predictor of increased repeat prescriptions after UKA. However, other intrinsic patient characteristics are also predictive. Cite this article: Bone Joint J 2018;100-B(1 Supple A):62–7.

scholarly journals Low percentage of surgeons meet the minimum recommended unicompartmental knee arthroplasty usage thresholds: Analysis of 3037 Surgeons from Three National Joint Registries

2021 ◽  
Author(s):  
Antonio Klasan ◽  
David A. Parker ◽  
Peter L. Lewis ◽  
Simon W. Young
Keyword(s):  
New Zealand ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Pooled Analysis ◽  
Registry Study ◽  
Level Of Evidence ◽  
Unicompartmental Knee ◽  
Time Period ◽  
The Uk

Abstract Purpose The reported usage of UKA is around 10% in the UK, Australian and New Zealand joint registries. However, some authors recommend that a higher UKA usage of 20%, or a minimum 12 UKA cases per year, would reduce revision rates. The purpose of this study was to analyze the percentage of surgeons performing the recommended thresholds in these 3 registries. Methods Data from the UK, Australian and New Zealand registry databases was utilized from the time period since their respective introduction until 2017. All primary TKA and UKA performed for the diagnosis of osteoarthritis by surgeons with more than 100 recorded knee arthroplasties in their respective registry were included. The results between the registries were compared and a pooled analysis was performed. The number of surgeons meeting the recommended caseload of > 20% UKA yearly or 12 UKA cases yearly was calculated. Results We identified 3037 knee surgeons performing 1,556,440 knee arthroplasties, of which 131,575 were UKA (8.45%). Over 50% of knee surgeons in each registry had a proportion of less than 5% UKA of their knee replacement procedures. After pooling of data, median surgeon UKA usage was 2.0% (IQR 0–9.1%). The percentage of surgeons meeting the proposed caseload criteria was highest in New Zealand, 16.3%, followed by the UK at 12.4% and Australia 11.3% (p = 0.28). Conclusion More than 50% of knee surgeons in UK, Australian and New Zealand joint registries perform less than 5% of UKA yearly. The majority of experienced knee surgeons are not meeting the recommended minimum thresholds, which might indicate that the recommended thresholds are not feasible for the vast majority of knee surgeons. The reasons behind this require further research. Level of Evidence Level III retrospective registry study.

scholarly journals Evidence-based surgical technique for medial unicompartmental knee arthroplasty

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Tae Kyun Kim ◽  
Anurag Mittal ◽  
Prashant Meshram ◽  
Woo Hyun Kim ◽  
Sang Min Choi
Keyword(s):  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Osteoarthritis Of The Knee ◽  
Evidence Based ◽  
Complication Rates ◽  
Related Factors ◽  
Unicompartmental Knee ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Total Knee

AbstractUnicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.

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