Total Knee Arthroplasty Has Higher Postoperative Morbidity Than Unicompartmental Knee Arthroplasty: A Multicenter Analysis

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Abstract

A total of 2235 primary total knee arthroplasties (TKAs) and 605 unicompartmental knee arthroplasties performed at 3 institutions over 5 years were reviewed to compare the incidence of postoperative complications between these groups. The overall risk of complications for patients undergoing TKA was 11.0%, compared with 4.3% for patients undergoing unicompartmental knee arthroplasty (P < .0001). Total knee arthroplasty was associated with increased rates of manipulation (odds ratio [OR], 13.0; P < .0001), transfusion (OR, 8.5; P = .036), intensive care unit admission (OR, 7.4; P = .049), discharge to a rehabilitation facility (OR, 5.2; P < .0001) and had longer hospital stays (mean, 3.3 vs 2.0 days; P < .0001). There was a trend toward an increased risk of deep infection (0.8% vs 0.2%, P = .13), readmission (4.2% vs 2.7%, P = .0795), thromboembolic events (1.0% vs 0.64%, P = .398), and any reoperation (1.4% vs 0.6%; P = .064). The increased risk of perioperative complications after TKA should be considered when counseling patients if they are an appropriate candidate for either procedure.

Section snippets

Methods

A total of 2235 consecutive primary TKA and 605 consecutive primary UKA procedures were performed at 3 institutions between 2004 and 2009 by 6 surgeons (AVL, CDV, KRB, MEB, PMF, RAM). These cases were retrospectively reviewed for postoperative complications that occurred within 90 days after surgery. All patients included in the study had a minimum 90 days of follow-up; 82 knees in 82 patients were excluded for inadequate follow-up. This study was approved by the institutional review board of

Results

The overall risk of complications for patients undergoing TKA was 11.0%, compared with 4.3% for patients undergoing UKA (P < .0001; Table 3). Because the patients undergoing TKA were somewhat older (mean difference 1.2 years), more likely to be female (67.0% vs 55.3%), and had a higher mean Charlson comorbidity index (0.58 vs 0.43) and a higher mean BMI (34.5 vs 31.1 kg/m2), the association between procedure and complications was assessed in our regression analysis, and TKA was still found to

Discussion

The choice between UKA and TKA for appropriately selected patients remains controversial. Both physicians and patients tend to be complication averse, and if a patient were deemed to be appropriate for either procedure, the risk of perioperative complications would be an important factor to consider when counseling patients on this decision. In this retrospective, multicenter study of more than 2800 patients, we found that TKA was associated with greater perioperative morbidity than UKA.

Acknowledgments

The authors thank Philip M Faris, MD, and Robert A Malinzak, MD, for contributing cases to this series.

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    The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2012.03.022.

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