Efficacy and safety of staged versus simultaneous unicompartmental knee arthroplasty: a meta-analysis#br#
2021, 25 (24):
OBJECTIVE: Patients with bilateral knee osteoarthritis who meet the indications for bilateral unicompartmental knee arthroplasty can have treatment options that can be divided into two methods: staged versus simultaneous unicompartmental knee arthroplasty. Thus, meta-analysis was used to compare the efficacy and safety of simultaneous and staged unicompartmental knee arthroplasty.
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METHODS: Cochrane Library, PubMed, Web of Science, CNKI, and Wanfang were searched for studies. Retrieval words included “one staged, simultaneous bilateral, two staged, staged bilateral, unicompartmental knee arthroplasty, unicompartmental knee replacement and UKA” in English and Chinese. Literature was case control study, cohort study or randomized controlled trial that included simultaneous and staged unicompartmental knee arthroplasty. RevMan 5.3 software was used for meta-analysis.
RESULTS: (1) Totally 24 studies were included, among which 7 were prospective cohort studies and 17 were historical cohort studies. Nine items of study quality assessment were of high quality, 13 were of medium quality and 2 were of low quality. (2) The meta-analysis showed that the clinical outcomes of staged bilateral unicompartmental knee arthroplasty in blood transfusion rate (odds ratio (OR)=2.93, 95% confidence interval (CI):2.55-3.37, P < 0.000 01), deep vein thrombosis (OR=1.35, 95%CI:1.25-1.46, P < 0.000 01), pulmonary complications (OR=1.49, 95%CI:1.33-1.67, P < 0.000 01), cardiac complications (OR=1.09, 95%CI:1.04-1.15, P=0.000 9), gastrointestinal complications (OR=1.52, 95%CI:1.44-1.60, P < 0.000 01), urinary complications (OR=1.18, 95%CI:1.11-1.25, P < 0.000 01), readmission (OR=1.25, 95%CI:1.06-1.47, P=0.008) and death (OR=1.63, 95%CI:1.42-1.87, P < 0.000 01) were significantly lower than those of simultaneous bilateral unicompartmental knee arthroplasty. (3) Simultaneous bilateral unicompartmental knee arthroplasty went down in ASA class (weighted mean difference (WMD)=-0.08, 95%CI:-0.10 to -0.06, P < 0.000 01), hematoma (OR=0.53, 95%CI:0.49-0.57, P < 0.000 01), infection (OR=0.73, 95%CI:0.66-0.80, P < 0.000 01), craniocerebral complications (OR=0.87, 95%CI:0.77-1.00, P=0.05) and hospital cost (standard mean difference (SMD)=-5.43, 95%CI:-7.13 to -3.73, P < 0.000 01).
CONCLUSION: Staged bilateral unicompartmental knee arthroplasty can more effectively reduce the perioperative risk, and have a lower blood transfusion rate and mortality rate, while simultaneous bilateral unicompartmental knee arthroplasty can effectively reduce hematoma and infection risk. To further compare and evaluate the safety and efficacy of staged and simultaneous bilateral unicompartmental knee arthroplasty, larger sample, and high-quality randomized controlled trials need to be included to provide evidence for verification.