Early comparative outcomes of unicompartmental and total knee arthroplasty in severely obese patients

Background

Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA.

Methods

Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI > 35 kg/m² (mean 41 kg/m²) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared.

Results

UKA patients had higher preoperative ROM, and Knee Society pain (KSP), functional (KSF), and clinical (KSC) scores (p < 0.001, p = 0.0008, p = 0.0003, p = 0.051 respectively). Mean tourniquet times, operative times, and lengths of stay were lower after UKA. Four TKA patients required transfusion. Mean follow-up was 2.3 years. The frequency of manipulation under anesthesia was higher in TKA patients (p < 0.001), while the rate of component revision was similar between the two groups (1.2% vs. 1.7%, p = 0.328). Frequency of deep infection was lower in the UKA group (p = 0.016). Postoperative KSF, change in KSF, and ROM were higher (p < 0.0001) after UKA, but KSP and KSC were equivalent.

Conclusions

Severely obese patients who underwent medial UKA demonstrated equal survivorship with substantially fewer reoperations, reduced deep infection, and less perioperative complications at short term follow-up. Severely obese patients had improved KSF scores and maintenance of ROM after UKA compared with TKA.