![]() 8, used propensity-matched UKA and TKA patients in the National Joint Registry for England and Wales from 2003-2012 and included 25,334 UKA and 75,996 TKA. 21, examined 605 UKA and 22,235 TKA in an institutional database with a trend toward less VTE related to UKA. Additionally, Beard et al.7, conducted a multicenter RCT of 528 patients with 2 VTE events in both cohorts, Schmidt-Braekling et al.17, added a RCT of 112 patents to the literature, and Brown et al. Wilson et al., identified two RCT including 614 patients and four large cohort studies including 574 patients that were underpowered to compare VTE incidence in UKA and TKA 6. In that review and meta-analysis the UKA/TKA VTE RR was 0.39 (0.27 – 0.57, p < 0.001) derived from the British Registry 8, and four American national databases 10,13,16,20, that include 32,711 UKA and 228,499 TKA patients. Wilson et al., used a systemic review of RCT of more than 50 patients, nationwide databases, joint registries, and large cohort studies to compare UKA to TKA 6. Systemic review methodologies with meta-analysis remain underpowered to measure these events. There are no randomized controlled trials (RCT) powered to examine uncommon sentinel events such as VTE and mortality following UKA compared to TKA, but every study has reported similar or improved complication rates, VTE incidence, and mortality in UKA patients compared to TKA patients. Conversely, Koh et al., reported a consecutive series of 70 patients without VTE symptoms following UKA, but 26% had a VTE lesion identified with multidetector row computer tomography (CT), and all resolved without thromboprophylaxis nor thrombotic treatment 19. Several large consecutive series report an absence of symptomatic VTE 17, or asymptomatic VTE following UKA 18. VTE related to UKA is reported less frequently and symptomatic VTE occurs in 0.41-1.6% 14,15 of patients including symptomatic DVT in 0.28 – 1.6% 14–17, and PE in 0.13% 14. Rationale: UKA is an alternative option to TKA for the surgical management of symptomatic osteoarthritis and accounted for 2.7% of all primary TKA reported in the American Joint Replacement Register 1, 5.6% of the Australian Register 2, 8% of the Swedish Register 3, and 9.1% of the British Register 4.Ī vast body of literature has reported comparable or better clinical UKA outcomes compared to TKA 5–7, fewer early postoperative complications 6,8–12, fewer early reoperations 8,10–12, and decreased mortality 6,8,13 but a greater revision rate compared to TKA 1,2,4,8,13. There is a paucity of data on patellofemoral joint arthroplasty (PFJA) and VTE risk. Most studies had a trend of decreased VTE risk following UKA compared to TKA but were underpowered, only registry studies were sufficiently powered and showed a VTE risk ratio (RR) of 0.39 (0.27-0.57). Response/Recommendation: The incidence of symptomatic venous thromboembolism (VTE) is low in both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) patients, deep venous thrombosis (DVT) and pulmonary embolism (PE) occur in up to 1.6% and 0.13% of UKA patients. Tad Gerlinger, Ivan Bohacek, David Campbell.
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