Abstract
Partial knee arthroplasty is making a resurgence as many patients and surgeons are realising that there are good options for preserving normally functioning knee tissues when facing end-stage knee OA without having to automatically proceed to TKA. What are potential advantages of this type of reasoning and could “less be more”? TKA is not a benign treatment for isolated unicompartmental knee disease. A multicentre study examining 2,919 TKA's and UKA's found lower rates of overall complications at 11% for TKA's and 4.3% for UKA's. Significant variables for TKA included longer length of stay, more patients sent to an ECF, higher manipulation rate, higher readmission, ICU admission, and transfusion rates. Bolognesi, et al examining 68,790 TKA and UKA, reproduced these results with lower DVT/PE, deep infection rates and lower death rates. The 1 year and 5 year revision rates were higher for UKA's and have been hypothesised to be lower thresholds for revision of dissatisfied UKA vs. a TKA with well-fixed implants.
Hospital costs continue to rise for arthroplasty procedures. Outpatient procedures may decrease cost, improve patient satisfaction, and improve physician efficiency. Our outpatient UKA program includes pre-op medical assessment and education, regional and pre-emptive anesthesia, post-op home care prn, and coordination with family and therapy providers. We utilise risk stratification mobile foot pumps, IV heparin, and oral ECASA for DVT prophylaxis. Patient satisfaction is very high in the outpatient setting.
We have performed 60 inpatient UKAs and 82 outpatient UKAs this year. To date we have had no acute hospital admissions. This program has worked well in our hands but may not be generalisable to all centres and all patients.
Functional improvements may be better for UKA vs. TKA further substantiating the evidence that “less is more” for the surgical treatment of isolated compartmental disease of the knee.
