Improving Estimates of Annual Survival Rates for Medial Unicompartmental Knee Arthroplasty, a Meta-Analysis

Abstract

Background: Medial unicompartmental knee arthroplasty (mUKA) is an increasingly popular treatment option for medial compartment knee osteoarthritis. Published mUKA survival rates have varied. The purpose of this meta-analysis was to provide pooled estimates of mUKA survival 5 and 10 years postoperatively.

Methods: We included studies in English within the last 15 years with a clear description of mUKA failure. Random-effects models were used to pool complementary log-log transformed implant survival estimates at 5 and 10 years postoperatively. Between-study variance was estimated using the restricted maximum likelihood method. Between-study heterogeneity was tested using the χ2 test and quantified using the I² statistic. I² values <25%, 25%-75%, and >75% were considered low, moderate, and high, respectively. Multivariable meta-regression was used to assess the potential association of mean patient age and study start year with survival estimates at 5 and 10 years. All analyses were performed using the metafor and meta packages implemented in R software version 3.3.4 (R Foundation for Statistical Computing, Vienna, Austria).

Results: Twenty-six studies met inclusion criteria, representing 42,791 knees. Study-level and pooled 5- and 10-year mUKA survival estimates were 95.3% (95% confidence interval, 93.6-96.6) and 91.3% (88.9-93.3), respectively. Between-study heterogeneity was high (>88%) for all years. Mean patient age and study start year explained only 12.3% and 30.7% of between-study heterogeneity at 5 and 10 years, respectively.

Conclusion: Five- and 10-year pooled mUKA survival estimates were 95.3% and 91.3%, respectively. These data establish better estimates of mUKA survivorship and can help when counseling patients considering mUKA.

Keywords: UKA; failure; knee arthroplasty; survival rate; unicompartmental knee arthroplasty.