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Scientific Articles   |    
Unicompartmental Knee Arthroplasty and Total Knee Arthroplasty Among Medicare Beneficiaries, 2000 to 2009
Michael P. Bolognesi, MD1; Melissa A. Greiner, MS2; David E. Attarian, MD1; Tyler Steven Watters, MD1; Samuel S. Wellman, MD1; Lesley H. Curtis, PhD2; Keith R. Berend, MD3; Soko Setoguchi, MD, DrPH2
1 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710
2 Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail address for S. Setoguchi: soko.setoguchi@duke.edu
3 Joint Implant Surgeons, Inc., 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054
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Investigation performed at the Duke Clinical Research Institute, Durham, North Carolina



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 20;95(22):e174 1-9. doi: 10.2106/JBJS.L.00652
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Abstract

Background: 

Unicompartmental knee arthroplasty is a less-invasive alternative to total knee arthroplasty for patients with arthritis affecting only the medial or lateral compartment. However, little is known about recent trends in the use of these procedures and the associated outcomes among older patients.

Methods: 

With use of a nationally representative 5% sample of Medicare beneficiaries who were sixty-five years of age or older and who had undergone either unilateral unicompartmental knee arthroplasty or unilateral total knee arthroplasty from 2000 to 2009, we assessed trends in the use of unicompartmental and total knee arthroplasty, associated durations of hospital stay, and postoperative outcomes. The outcome measures were the rates of implant revision or removal within five years and the rates of periprosthetic infection, thromboembolic events, myocardial infarction, and all-cause mortality within one year. We conducted Kaplan-Meier analyses to assess the cumulative incidence of unadjusted outcomes and used Cox proportional-hazards regression to understand the relative risks of the outcomes for each procedure.

Results: 

A total of 68,603 patients underwent unilateral total knee arthroplasty (n = 65,505) or unilateral unicompartmental knee arthroplasty (n = 3098) from 2000 to 2009. The mean age was seventy-five years; 34% of the patients were men, and 92% were white. The procedure rate was twenty-one times higher for total knee arthroplasty (597 per 100,000 person-years) than unicompartmental knee arthroplasty (twenty-nine per 100,000 person-years). The use of total knee arthroplasty increased 1.7-fold, and the use of unicompartmental knee arthroplasty increased 6.2-fold. The mean length of stay (and standard deviation [SD]) was 3.9 ± 2.1 days for total knee arthroplasty and 2.4 ± 1.7 days for unicompartmental knee arthroplasty. The five-year revision rate was 3.7% for total knee arthroplasty and 8.0% for unicompartmental knee arthroplasty. After multivariable adjustment, the risk of revision remained 2.4 times higher for unicompartmental knee arthroplasty than for total knee arthroplasty (95% confidence interval [CI] = 2.03 to 2.83). After multivariable adjustment, patients who underwent unicompartmental knee arthroplasty had no significant differential one-year risk of infection (adjusted hazard ratio [HR] = 0.74; 95% CI = 0.55 to 1.01), thromboembolic events (adjusted HR =0.86; 95% CI = 0.57 to 1.29), or mortality (adjusted HR = 0.75; 95% CI = 0.50 to 1.11).

Conclusions: 

Although unicompartmental knee arthroplasty accounted for only 4.5% of the unilateral knee replacements among Medicare beneficiaries, the use of this procedure has increased dramatically. Compared with those who had total knee arthroplasty, patients who underwent unicompartmental knee arthroplasty had higher revision rates but shorter durations of stay and tended to have lower rates of perioperative complications. These findings need to be confirmed by studies that incorporate detailed clinical information.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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