Bearing Dislocation and Progression of Osteoarthritis After Mobile-bearing Unicompartmental Knee Arthroplasty Vary Between Asian and Western Patients: A Meta-analysis

• Published in: Clinical orthopaedics and related research 2018-05, Vol.476 (5), p.946-960
• Main Authors: Ro, Kyung-Han, Heo, Jae-Won, Lee, Dae-Hee
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - instrumentation; Asian Continental Ancestry Group; Biomechanical Phenomena; Clinical Research; Disease Progression; European Continental Ancestry Group; Female; Humans; Knee Joint - physiopathology; Knee Joint - surgery; Knee Prosthesis; Male; Middle Aged; Osteoarthritis, Knee - diagnosis; Osteoarthritis, Knee - ethnology; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - surgery; Prosthesis Design; Prosthesis Failure; Range of Motion, Articular; Reoperation; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 0009-921X; 1528-1132; 0009-921X
• DOI: 10.1007/s11999.0000000000000205

Implant survivorship is reported to be lower and complications, particularly bearing dislocation, are reported to be more frequent in Asian than in Western patients with medial knee osteoarthritis (OA) undergoing Oxford® Phase III unicompartmental knee arthroplasty (UKA). To date, however, these complications have not been compared between these groups of patients. The purpose of this study was to perform a meta-analysis comparing the standardized incidence rates of (1) all-cause reoperation; (2) reoperation related to bearing dislocation; and (3) reoperation related to progression of lateral compartment arthritis in Asian and Western patients with medial knee OA who underwent Oxford Phase III UKA. We searched MEDLINE® (January 1, 1976, to May 31, 2017), EMBASE® (January 1, 1985, to May 31, 2017), and the Cochrane Library (January 1, 1987, to May 31, 2017) for studies that reported complications of Oxford Phase III UKAs. Studies were included if they reported reoperation rates attributable to bearing dislocation and/or progression of lateral knee OA after surgery with this implant. Twenty-seven studies were included in this systematic review and 16 studies with followups > 5 years were included in the meta-analysis. These rates were converted to standardized incidence rate (that is, reoperations per 100 observed component years) based on mean followup and number of involved knees in each study. After applying prespecified inclusion and exclusion criteria, the studies were categorized into two groups, Asian and Western, based on hospital location. Twenty-five studies, containing 3152 Asian patients and 5455 Western patients, were evaluated. Study quality was assessed by the modified Coleman Methodology score (MCMS). Although all studies were Level IV, their mean MCMS score was 66.92 (SD, 8.7; 95% confidence interval [CI], 63.5-70.3), indicating fair quality. Because the heterogeneity of all subgroup meta-analyses was high, a random-effects model was used with estimations using the restricted maximum likelihood method. There was no difference in the proportion of Asian patients versus Western patients undergoing reoperation for any cause calculated as 100 component observed years (1.022 of 3152 Asian patients; 95% CI, 0.810-1.235 versus 1.300 of 5455 Western patients; 95% CI, 1.067-1.534; odds ratio, 0.7839; 95% CI, 0.5323-1.1545; p = 0.178). The mean reoperation rate attributable to bearing dislocation per 100 observed years was higher in Asian than in West