Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation

T W Hamilton, H G Pandit, A V Lombardi, J B Adams, C R Oosthuizen, A Clavé, C A F Dodd, K R Berend, D W Murray, T W Hamilton, H G Pandit, A V Lombardi, J B Adams, C R Oosthuizen, A Clavé, C A F Dodd, K R Berend, D W Murray

Abstract

Aims: An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre.

Patients and methods: Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature.

Results: The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100).

Conclusion: The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):3-10.

Keywords: Functional outcome; Implant survival; Indications; Patient selection; Total knee arthroplasty; Unicompartmental knee arthroplasty.

©2016 Murray et al.

Figures

Fig. 1
Fig. 1
Flowchart of study patients (UKA, unicompartmental knee arthroplasty; TKA, total knee arthroplasty; AP, anteroposterior; SONK, spontaneous osteonecrosis of the knee; MCL, medial collateral ligament; ACL, anterior cruciate ligament).

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