Beard and colleagues compared partial with total knee replacement for medial compartment knee osteoarthritis, measuring both clinical outcome and cost‑effectiveness.
Pragmatic multicenter randomized trial of 528 patients at 27 NHS hospitals (68 surgeons), with the primary outcome at 5 years.
The 5‑year mean Oxford Knee Score did not differ significantly between partial and total replacement (difference 1.04, 95% CI −0.42 to 2.50).
Both procedures improved the Oxford Knee Score by more than 18 points on average.
Reoperation, including revision, was similar by treatment received, at 22 of 245 after partial vs 28 of 269 after total replacement.
Revision by 5 years occurred in 10 of 245 partial and 8 of 269 total replacements.
Patient‑rated improvement (95% vs 90%) and willingness to repeat the operation (91% vs 84%) were significantly higher after partial replacement, but the lack of blinding may have biased both.
Over 5 years, partial replacement yielded 0.240 more QALYs (95% CI 0.046 to 0.434) and cost £910 less (95% CI £317 to £1503) than total replacement.
Board pearl
TOPKAT found no excess reoperation after partial replacement, which contrasts with mainly non‑randomized data, although its partial‑replacement surgeons were relatively experienced.
Authors' conclusion
Both total knee replacement and partial knee replacement are effective, offer similar clinical outcomes and have similar reoperation and complication rates. Some patient-reported measures of treatment approval were significantly higher for partial knee replacement than for total knee replacement. Partial knee replacement was more cost-effective (more effective and cost saving) than total knee replacement at 5 years.
Beard and colleagues compared partial with total knee replacement for medial compartment knee osteoarthritis, measuring both clinical outcome and cost‑effectiveness.
Pragmatic multicenter randomized trial of 528 patients at 27 NHS hospitals (68 surgeons), with the primary outcome at 5 years.
The 5‑year mean Oxford Knee Score did not differ significantly between partial and total replacement (difference 1.04, 95% CI −0.42 to 2.50).
Both procedures improved the Oxford Knee Score by more than 18 points on average.
Reoperation, including revision, was similar by treatment received, at 22 of 245 after partial vs 28 of 269 after total replacement.
Revision by 5 years occurred in 10 of 245 partial and 8 of 269 total replacements.
Patient‑rated improvement (95% vs 90%) and willingness to repeat the operation (91% vs 84%) were significantly higher after partial replacement, but the lack of blinding may have biased both.
Over 5 years, partial replacement yielded 0.240 more QALYs (95% CI 0.046 to 0.434) and cost £910 less (95% CI £317 to £1503) than total replacement.
Board pearl
TOPKAT found no excess reoperation after partial replacement, which contrasts with mainly non‑randomized data, although its partial‑replacement surgeons were relatively experienced.
Authors' conclusion
Both total knee replacement and partial knee replacement are effective, offer similar clinical outcomes and have similar reoperation and complication rates. Some patient-reported measures of treatment approval were significantly higher for partial knee replacement than for total knee replacement. Partial knee replacement was more cost-effective (more effective and cost saving) than total knee replacement at 5 years.