Xia Kuanyu, Min Lang, Xie Wenqing, Yang Guang, Yon Dong Keon, Lee Seung Won, Koyanagi Ai, Jacob Louis, Smith Lee, Shin Jae Il, Rahmati Masoud, Xiao Wenfeng, Li Yusheng
Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China.
Chin Med J (Engl). 2024 Jul 11. doi: 10.1097/CM9.0000000000003193.
The choice of unicompartmental knee arthroplasty (UKA) vs. total knee arthroplasty (TKA) in the surgical treatment of knee osteoarthritis (KOA) remains controversial. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the clinical results of UKA and TKA for treating unicompartmental KOA.
PubMed, Embase, and the Cochrane Library were systematically searched for articles published up to January 2, 2023. The literature was rigorously screened to include only RCTs comparing UKA and TKA for unicompartmental KOA. A systematic review and meta-analysis were performed to calculate the mean difference (MD), relative risk (RR), and 95% confidence interval (CI) according to the Cochrane standards.
Thirteen publications involving 683 UKAs and 683 TKAs were analyzed. Except for one study with a follow-up period of 15 years, all outcome measures reported were within 5 years of follow-up. Meta-analysis showed better knee recovery (MD: 1.23; 95% CI: 1.01-1.45; P <0.00001), greater knee function (MD: 1.78; 95% CI: 0.34-3.22; P = 0.02), less pain (MD: 0.75; 95% CI: 0.43-1.06; P <0.00001), and better health status (MD: 3.75; 95% CI: 0.81-6.69; P = 0.01) after UKA than TKA. However, considering the minimal clinically important difference values for these variables, the findings were not clinically relevant. Moreover, UKA patients had fewer complications (RR: 0.59; 95% CI: 0.45-0.78; P = 0.0002) and shorter hospital stays (MD: -0.89; 95% CI: -1.57 to -0.22; P = 0.009) than did TKA patients. There were no statistically significant differences in terms of postoperative range of movement, revision, failure, operation time, and patient satisfaction.
In terms of clinical efficacy, there was no obvious advantage of UKA over TKA in the surgical treatment of knee OA when considering the minimal clinically important difference. The main advantage of UKA over TKA is that it leads to fewer complications and a shorter length of hospital stay. It is ideal to perform prospective studies with longer follow-up periods to fully evaluate the long-term efficacy and safety of the two procedures in the future.
在膝关节骨关节炎（KOA）的外科治疗中，单髁膝关节置换术（UKA）与全膝关节置换术（TKA）的选择仍存在争议。本研究旨在对随机对照试验（RCT）进行系统评价和荟萃分析，以比较UKA和TKA治疗单髁KOA的临床结果。
系统检索了截至2023年1月2日在PubMed、Embase和Cochrane图书馆发表的文章。对文献进行严格筛选，仅纳入比较UKA和TKA治疗单髁KOA的RCT。根据Cochrane标准进行系统评价和荟萃分析，计算平均差（MD）、相对风险（RR）和95%置信区间（CI）。
分析了13篇涉及683例UKA和683例TKA的文献。除一项随访期为15年的研究外，所有报告的结局指标均在随访5年内。荟萃分析显示，UKA术后膝关节恢复情况更好（MD：1.2；95%CI：1.01-1.45；P<0.00001）、膝关节功能更佳（MD：1.78；95%CI：0.34-3.22；P=0.02）、疼痛更少（MD：0.75；95%CI：0.43-1.06；P<0.00001）、健康状况更好（MD：3.75；95%CI：0.81-6.69；P=0.01）。然而，考虑到这些变量的最小临床重要差异值，这些结果在临床上并不相关。此外，UKA患者的并发症少于TKA患者（RR：0.59；95%CI：0.45-0.78；P=0.0002），住院时间更短（MD：-0.89；95%CI：-1.57至-0.22；P=0.009）。术后活动范围、翻修、失败、手术时间和患者满意度方面无统计学显著差异。
在临床疗效方面，考虑到最小临床重要差异，UKA在膝关节OA的外科治疗中并不比TKA有明显优势。UKA相对于TKA的主要优势在于其并发症更少、住院时间更短。未来进行更长随访期的前瞻性研究以全面评估这两种手术的长期疗效和安全性是理想的。
