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Facts & Figures

Check your knowledge on PKR indications (Narrow age range)

Based on the available clinical evidence, many of the historic beliefs about PKR contraindications can be called into question. In this series we examine some of the most common misconceptions. This week: Narrow age range  

Do you know of patients that have been excluded from partial knee replacement because they were too young or too old for it? Clinical papers have reported the positive outcomes of Oxford PKR in patients of all ages; from the under 50s to the over 75s. These data suggest that when it comes to partial knees, age really is just a number. 1, 2, 3

Narrow Age Range – Young patients

Kennedy et al. 2 found no difference in 10-year Oxford implant survivorship between patients in four age groups (<55, 55 to <65, 65 to <75, and ≥75). The cumulative 10-year UKA survival rate for those younger than 55 was 97.2%. While Price et al. 1 found that the ten-year all-cause survival of the Oxford PKR in patients of < 60 years was 91%. According to the authors, The Swedish Knee Arthroplasty Register (SKAR) reported a ten-year cumulative survival rate of about 90% for TKRs performed for OA on patients < 65 years of age (SKAR 2004)4

PKR should only be considered in patients with AMOA (bone on bone in the medial compartment, with a functionally intact ACL, normal LCL and MCL, and full thickness cartilage in the lateral compartment). It is not an option for young patients with less severe arthritis, only young patients with AMOA.

Narrow Age Range – Older patients

The literature suggests that older patients could gain the most from PKR. Siman et al. 20175 concluded that, “due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA while maintaining comparable complications and midterm survivorship.” They recommended that “UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.” While in patients over 75 years, Fabre-Aubrespy (2016)6 showed that PKR provided higher function and better forgotten joint scores with similar survivorship compared to TKR, and Liddle et al. (2014)7 concluded that “older patients (≥ 75), who are least likely to be offered UKR, may derive the greatest benefits.”

1.Price, A. J., et al. “Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age.” The Journal of bone and joint surgery. British volume 87.11 (2005): Find the source here.

2.Kennedy, James A., et al. “Age and outcomes of medial meniscal-bearing unicompartmental knee arthroplasty.” The Journal of arthroplasty 33.10 (2018): Find the source here.

3.Greco, Nicholas J., et al. “Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years.” The Journal of Arthroplasty 33.8 (2018): Find the source here.

4.Swedish Knee Arthroplasty Register. Annual report 2004.

5.Siman, H., et al. “Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older than 75 Years: Comparable Reoperation, Revision and Complication rates.” The Journal of Arthroplasty 32 (2017): Find the source here.

6.Fabre-Aubrespy, M., et al. “ Unicompartmental Knee Arthroplasty in Patients Older than 75 Result in Better Clinical Outcomes and Similar Survivorship Compared to Total Knee Arthroplasty. A Matched Controlled Study.” The Jounal of Arthroplasty 31 (2016): Find the source here.

7.Liddle, A. D., et al. “Determinants of revision and functional outcome following unicompartmental knee replacement.” Osteoarthritis and Cartilage 22 (2014): Find the source here.

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