Download PDF
J Knee Surg 2021; 34(10): 1138-1141
DOI: 10.1055/s-0040-1702189
Original Article

Trends in Utilization of Total and Unicompartmental Knee Arthroplasty in the United States

Cynthia A. Kahlenberg 
1   Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
,
Shawn S. Richardson
1   Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
,
Jordan A. Gruskay
1   Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
,
Michael B. Cross
1   Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Total knee replacement (TKR) and unicompartmental knee replacement (UKR) are successful procedures for patients with knee arthritis. While strict criteria were proposed early on for UKR, some surgeons have expanded these indications to include younger and heavier patients. The purpose of this study is to analyze trends in usage of TKR and UKR in the United States. This retrospective study analyzed an insurance administrative dataset. Patients who underwent primary TKR and UKR were identified via current procedural terminology codes. Information on incidence, obesity, use of computer navigation, and surgical setting were collected. We analyzed 7,194 UKRs and 128,849 TKRs performed from 2007 to 2016. Prevalence of obesity in both groups increased over the study period. Utilization of computer navigation increased for UKR but declined for TKR. The rate of outpatient procedures significantly increased for UKR but remained constant for TKR. Both TKR and UKR are being performed at increasing rates and on heavier patients. The use of computer navigation and outpatient surgical setting is increasing for UKR but not for TKR. Knowledge of these trends is important for surgeons and policy-makers to help inform surgical indications and resource allocation.

Keywords

total knee arthroplasty - unicompartmental knee arthroplasty - trends - utilization

Note

This investigation was performed at the Hospital for Special Surgery.




Publication History

Received: 04 October 2018

Accepted: 07 January 2020

Article published online:
04 March 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB. et al. Cost-effectiveness of total knee replacement: a prospective cohort study. Arthritis Care Res (Hoboken) 2014; 66 (04) 592-599
    CrossrefPubMedGoogle Scholar
  • 2 Dakin H, Gray A, Fitzpatrick R, Maclennan G, Murray D. , KAT Trial Group. Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set. BMJ Open 2012; 2 (01) e000332
    CrossrefPubMedGoogle Scholar
  • 3 Losina E, Walensky RP, Kessler CL. et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009; 169 (12) 1113-1121 , discussion 1121–1122
    CrossrefPubMedGoogle Scholar
  • 4 Soohoo NF, Sharifi H, Kominski G, Lieberman JR. Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am 2006; 88 (09) 1975-1982
    PubMedGoogle Scholar
  • 5 Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989; 71 (01) 145-150
    CrossrefPubMedGoogle Scholar
  • 6 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
    CrossrefPubMedGoogle Scholar
  • 7 Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315 (21) 2284-2291
    CrossrefPubMedGoogle Scholar
  • 8 Pearle AD, van der List JP, Lee L, Coon TM, Borus TA, Roche MW. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up. Knee 2017; 24 (02) 419-428
    CrossrefPubMedGoogle Scholar
  • 9 van der List JP, Zuiderbaan HA, Pearle AD. Why do medial unicompartmental knee arthroplasties fail today?. J Arthroplasty 2016; 31 (05) 1016-1021
    CrossrefPubMedGoogle Scholar
  • 10 Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 2004; (423) 161-165
    CrossrefPubMedGoogle Scholar
  • 11 Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 2010; 468 (01) 141-146
    CrossrefPubMedGoogle Scholar
  • 12 Ollivier M, Parratte S, Lino L, Flecher X, Pesenti S, Argenson JN. No benefit of computer-assisted TKA: 10-year results of a prospective randomized study. Clin Orthop Relat Res 2018; 476 (01) 126-134
    CrossrefPubMedGoogle Scholar
  • 13 Ajwani SH, Jones M, Jarratt JW, Shepard GJ, Ryan WG. Computer assisted versus conventional total knee replacement: a comparison of tourniquet time, blood loss and length of stay. Knee 2012; 19 (05) 606-610
    CrossrefPubMedGoogle Scholar
  • 14 Peersman G, Jak W, Vandenlangenbergh T, Jans C, Cartier P, Fennema P. Cost-effectiveness of unicondylar versus total knee arthroplasty: a Markov model analysis. Knee 2014; 21 (Suppl. 01) S37-S42
    CrossrefPubMedGoogle Scholar
  • 15 Liddle AD, Judge A, Pandit H, Murray DW. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 2014; 384 (9952): 1437-1445
    CrossrefPubMedGoogle Scholar
  • 16 Cody JP, Pfefferle KJ, Ammeen DJ, Fricka KB. Is outpatient unicompartmental knee arthroplasty safe to perform at an ambulatory surgery center? A comparative study of early post-operative complications. J Arthroplasty 2018; 33 (03) 673-676
    CrossrefPubMedGoogle Scholar
  • 17 Bovonratwet P, Ondeck NT, Tyagi V, Nelson SJ, Rubin LE, Grauer JN. Outpatient and inpatient unicompartmental knee arthroplasty procedures have similar short-term complication profiles. J Arthroplasty 2017; 32 (10) 2935-2940
    CrossrefPubMedGoogle Scholar