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Assessing the non-inferiority of prosthesis constructs used in total and unicondylar knee replacements using data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man: a benchmarking study
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    Response to Assessing the non-inferiority of prosthesis constructs used in total and unicondylar knee replacements
    • David W Murray, Orthopaedic Surgeon Nuffield Orthopaedic Centre, Oxford
    • Other Contributors:
      • James A Kennedy, Clinical Research Fellow
      • Hasan R Mohammad, Clinical Research Fellow
      • Thomas W Hamilton, Orthopaedic Specialist Registrar

    We read with interest your paper about benchmarking knee replacements based on NJR data and were surprised that you considered the most striking finding was that the revision rate of UKR was more than 100% higher than TKR. Anyone familiar with registry data would have expected this as one of the few things all registries agree on is that the overall revision rate of UKR is about three times higher than that of TKR. You then mention the numerous advantages of UKR compared to TKR that often outweigh the disadvantage of the higher revision. Surely the sensible way to decide what implant to use is for the surgeon and patient to discuss the pro and cons of UKR and TKR and decide which is most appropriate. If the decision is to do a UKR then the next step is to consider which implant to use, in part based on their relative revision rates. Therefore benchmarking UKR against UKR, which we believe ODEP are doing, would be useful. In contrast benchmarking UKR against TKR, which is what you have done, is unhelpful.

    One of the main advantages of UKR, particularly in the elderly, is that it is much safer than TKR, with the risk of major medical complications being half or less. As a result the death rate is lower following UKR, not just early but also in the midterm. Had you done a similar non-adjusted analysis with death being the outcome rather than revision the most striking finding would have been that the death rate following TKR would be higher than that of UKR. UKR have...

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    Conflict of Interest:
    One of the authors is a designer of the Oxford UKR and receives benefits for personal or professional use from Zimmer Biomet in the form of royalties and consultancy payments. In addition institutional funding related to knee replacement has been received from Zimmer Biomet.