Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates

Abstract

Background: Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up.

Methods: A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritis considered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship.

Results: UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates.

Conclusion: Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.

Keywords: elderly; isolated medial compartmental osteoarthritis; knee arthroplasty complication; knee arthroplasty revision; total knee arthroplasty; unicompartmental knee arthroplasty.