Download PDF
J Knee Surg 2023; 36(07): 716-724
DOI: 10.1055/s-0041-1741389
Original Article

An ACS-NSQIP Analysis of Unicompartmental Knee Arthroplasty Trends from 2013 to 2018

Niall Cochrane
1   Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
,
Elshaday Belay
1   Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
,
Mark Wu
1   Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
,
Jeffrey O'Donnell
1   Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
,
Billy Kim
1   Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
,
Thorsten Seyler
1   Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Unicompartmental knee arthroplasty (UKA) volume has increased with advances in implant design, perioperative protocols, and patient selection. This study analyzed national trends of UKA from 2013 to 2018 and the relationship between patient demographics and postoperative outcomes. Data on UKA (CPT 27446) from 2013 to 2018 was collected from the National Surgical Quality Improvement Program (NSQIP). Variables collected included patient demographics, American Society of Anesthesiology classification, functional status, NSQIP morbidity probability, operative time, length of stay, 30-day reoperation, and readmission rates. There was an increase in outpatient UKAs performed (920 in 2013; 11,080 in 2018) (p < 0.0001). Analysis of variance from 2013 to 2018 revealed significant decrease in patient body mass index (BMI) (32.5 in 2013; 31.5 in 2018) (p < 0.01) and NSQIP morbidity probability (0.014 in 2013; 0.011 in 2018) (p < 0.0001). Operative time increased (79.1 minutes in 2013; 84.4 minutes in 2018) (p < 0.01), but length of stay decreased (0.9 days in 2013; 0.5 days in 2018) (p < 0.0001). The number of all-cause and related readmissions decreased significantly (p < 0.045; p < 0.01). Age, male gender, BMI >40 and chronic obstructive pulmonary disease (COPD) were significant predictors for 30-day readmission. BMI >40 was a significant predictor for discharge destination. UKA has seen a rise in incidence from 2013 to 2018 with an increasing number of outpatient UKAs. Operative times and 30-day readmissions have both decreased in this time. BMI > 40 is predictive for discharge destination after UKA, while age, male gender, BMI >40, and COPD are independent risk factors for 30-day readmission.

Keywords

orthopedics - arthroplasty - unicompartmental total knee

Note

This study was performed at Duke University Medical Center.




Publication History

Received: 12 February 2021

Accepted: 16 November 2021

Article published online:
06 January 2022

© 2022. Thieme. All rights reserved.

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

 

  • References

  • 1 Riff AJ, Sah AP, Della Valle CJ. Outcomes and complications of unicondylar arthroplasty. Clin Sports Med 2014; 33 (01) 149-160
    CrossrefPubMedGoogle Scholar
  • 2 MacIntosh DL, Hunter GA. The use of the hemiarthroplasty prosthesis for advanced osteoarthritis and rheumatoid arthritis of the knee. J Bone Joint Surg Br 1972; 54 (02) 244-255
    CrossrefPubMedGoogle Scholar
  • 3 Emerson Jr RH, Potter T. The use of the McKeever metallic hemiarthroplasty for unicompartmental arthritis. J Bone Joint Surg Am 1985; 67 (02) 208-212
    CrossrefPubMedGoogle Scholar
  • 4 Scott RD, Joyce MJ, Ewald FC, Thomas WH. McKeever metallic hemiarthroplasty of the knee in unicompartmental degenerative arthritis. Long-term clinical follow-up and current indications. J Bone Joint Surg Am 1985; 67 (02) 203-207
    CrossrefPubMedGoogle Scholar
  • 5 Springer BD, Scott RD, Sah AP, Carrington R. McKeever hemiarthroplasty of the knee in patients less than sixty years old. J Bone Joint Surg Am 2006; 88 (02) 366-371
    CrossrefPubMedGoogle Scholar
  • 6 Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am 1980; 62 (08) 1329-1337
    CrossrefPubMedGoogle Scholar
  • 7 Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am 1978; 60 (02) 182-185
    CrossrefPubMedGoogle Scholar
  • 8 Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am 1989; 71 (01) 145-150
    CrossrefPubMedGoogle Scholar
  • 9 Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplasty 2008; 23 (03) 408-412
    CrossrefPubMedGoogle Scholar
  • 10 Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP. Medial unicompartmental arthroplasty of the knee. J Am Acad Orthop Surg 2019; 27 (05) 166-176
    CrossrefPubMedGoogle Scholar
  • 11 Lim JW, Cousins GR, Clift BA, Ridley D, Johnston LR. Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis. J Arthroplasty 2014; 29 (09) 1779-1783
    CrossrefPubMedGoogle Scholar
  • 12 Lombardi Jr AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty?. Clin Orthop Relat Res 2009; 467 (06) 1450-1457
    CrossrefPubMedGoogle Scholar
  • 13 Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW. Unicompartmental versus total knee arthroplasty database analysis: is there a winner?. Clin Orthop Relat Res 2012; 470 (01) 84-90
    CrossrefPubMedGoogle Scholar
  • 14 Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S. J Bone Joint Surg Am 2015; 97 (05) 396-402
    CrossrefPubMedGoogle Scholar
  • 15 Hamilton TW, Pandit HG, Jenkins C, Mellon SJ, Dodd CAF, Murray DW. Evidence-based indications for mobile bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty 2017; 32 (06) 1779-1785
    CrossrefPubMedGoogle Scholar
  • 16 Pandit H, Jenkins C, Gill HS. et al. Unnecessary contraindications for mobile-bearing unicompartmental knee replacement. J Bone Joint Surg Br 2011; 93 (05) 622-628
    CrossrefPubMedGoogle Scholar
  • 17 Mohammad HR, Matharu GS, Judge A, Murray DW. Comparison of the 10-year outcomes of cemented and cementless unicompartmental knee replacements: data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Acta Orthop 2020; 91 (01) 76-81
    CrossrefPubMedGoogle Scholar
  • 18 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
  • 19 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).. Hip, Knee & Shoulder Arthroplasty: 2019 Annual Report. Adelaide: AOA; 2019
    Google Scholar
  • 20 The New Zealand Joint Registry Ten Year Report. New Zealand Orthopedic Association, 2009. https://www.nzoa.org.nz/sites/default/files/NJR%2010%20Year%20Report.pdf. Accessed November 4, 2021
    PubMedGoogle Scholar
  • 21 Willis-Owen CA, Brust K, Alsop H, Miraldo M, Cobb JP. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee 2009; 16 (06) 473-478
    CrossrefPubMedGoogle Scholar
  • 22 Liddle AD, Pandit H, Judge A, Murray DW. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am 2016; 98 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 23 Bovonratwet P, Ondeck NT, Nelson SJ, Cui JJ, Webb ML, Grauer JN. Comparison of outpatient vs inpatient total knee arthroplasty: an ACS-NSQIP analysis. J Arthroplasty 2017; 32 (06) 1773-1778
    CrossrefPubMedGoogle Scholar
  • 24 Courtney PM, Boniello AJ, Berger RA. Complications following outpatient total joint arthroplasty: an analysis of a national database. J Arthroplasty 2017; 32 (05) 1426-1430
    CrossrefPubMedGoogle Scholar
  • 25 American College of Surgeons. ACS National Surgical Quality Improvement Program (ACS-NSQIP). http://site.acsnsqip.org/participants/ Accessed December 4, 2021
    PubMedGoogle Scholar
  • 26 Cram P, Hawker G, Matelski J. et al. Disparities in knee and hip arthroplasty outcomes: an observational analysis of the ACS-NSQIP clinical registry. J Racial Ethn Health Disparities 2018; 5 (01) 151-161
    CrossrefPubMedGoogle Scholar
  • 27 Eamer G, Al-Amoodi MJH, Holroyd-Leduc J, Rolfson DB, Warkentin LM, Khadaroo RG. Review of risk assessment tools to predict morbidity and mortality in elderly surgical patients. Am J Surg 2018; 216 (03) 585-594
    CrossrefPubMedGoogle Scholar
  • 28 American College of Surgeons User Guide for the 2018 ACS NSQIP Participant Use Data File. https://www.facs.org/-/media/files/quality-programs/nsqip/nsqip_puf_userguide_2018.ashx Accessed December 4, 2021
    PubMedGoogle Scholar
  • 29 Stern SH, Becker MW, Insall JN. Unicondylar knee arthroplasty. An evaluation of selection criteria. Clin Orthop Relat Res 1993; (286) 143-148
    PubMedGoogle Scholar
  • 30 van der List JP, Chawla H, Zuiderbaan HA, Pearle AD. The role of preoperative patient characteristics on outcomes of unicompartmental knee arthroplasty: a meta-analysis critique. J Arthroplasty 2016; 31 (11) 2617-2627
    CrossrefPubMedGoogle Scholar
  • 31 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
  • 32 Richter DL, Diduch DR. Cost comparison of outpatient versus inpatient unicompartmental knee arthroplasty. Orthop J Sports Med 2017; 5 (03) 2325967117694352 DOI: 10.1177/2325967117694352.
    CrossrefPubMedGoogle Scholar
  • 33 Hoorntje A, Koenraadt KLM, Boevé MG, van Geenen RCI. Outpatient unicompartmental knee arthroplasty: who is afraid of outpatient surgery?. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 759-766
    CrossrefPubMedGoogle Scholar
  • 34 Gruskay J, Richardson S, Schairer W. et al. Incidence and safety profile of outpatient unicompartmental knee arthroplasty. Knee 2019; 26 (03) 708-713
    CrossrefPubMedGoogle Scholar
  • 35 Molloy J, Kennedy J, Jenkins C, Mellon S, Dodd C, Murray D. Obesity should not be considered a contraindication to medial Oxford UKA: long-term patient-reported outcomes and implant survival in 1000 knees. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2259-2265
    CrossrefPubMedGoogle Scholar
  • 36 Plate JF, Augart MA, Seyler TM. et al. Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 645-651
    CrossrefPubMedGoogle Scholar
  • 37 Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995; 273 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 38 Gupta PK, Franck C, Miller WJ, Gupta H, Forse RA. Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset. J Am Coll Surg 2011; 212 (03) 301-309
    CrossrefPubMedGoogle Scholar
  • 39 Kelly KJ, Greenblatt DY, Wan Y. et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg 2011; 15 (02) 250-259 , discussion 259–261
    CrossrefPubMedGoogle Scholar
  • 40 Sellers MM, Merkow RP, Halverson A. et al. Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013; 216 (03) 420-427
    CrossrefPubMedGoogle Scholar