Clinical Outcomes of Unicompartmental Knee Arthroplasty in Patients with Full-versus Partial-Thickness Cartilage Loss: A Systematic Review and Meta-Analysis

Abstract

Objective The objective of the study was to compare postoperative patient-reported outcomes and reoperation rates following unicompartmental knee arthroplasty (UKA) between patients with full-thickness cartilage loss (FTCL) and partial-thickness cartilage loss (PTCL). Design Multiple databases, including PubMed, Embase, Cochrane Library, and CNKI, were searched until October 2019 for studies comparing the Oxford Knee Score (OKS), American Knee Society (AKS) score, and reoperation rates between patients with FTCL and PTCL following UKA. Data analysis was performed using Review Manager software. Results A total of 613 UKA cases from 5 retrospective cohort studies were included. The mean difference in postoperative OKSs was significantly higher by 2.92 in FTCL group than in PTCL group (95% confidence interval [CI] = −5.29 to −0.55; P = 0.02). Improvement in OKS was significantly higher by 2.69 in FTCL group than in PTCL group (95% CI = −4.79 to −0.60; P = 0.01). However, the differences in OKSs were not clinically significant. The mean difference in AKS knee scores was similar between the 2 groups (95% CI = −9.14 to −3.34; P = 0.36), whereas the pooled mean difference in AKS function scores was higher by 5.63 in FTCL group than in PTCL group (95% CI = −9.27 to −1.98; P = 0.002), which was clinically relevant. The reoperation rates were statistically higher in PTCL group than in FTCL group (odds ratio = 2.24; 95% CI = 1.15 to 4.38; P = 0.02). Conclusions Patients with FTCL achieved superior postoperative patient-reported outcomes and lower reoperation rates following UKA compared with those with PTCL. Thus, we believe this procedure should only be applied to end-stage medial osteoarthritis of the knee joint.