Travmatologiâ i Ortopediâ Rossii (Oct 2021)
Whether the Partial Knee Arthroplasty is Worthwhile: Estimation of Orthopedic Surgeons from Large Arthroplasty Center
Abstract
Background. Despite several proven advantages of the partial knee arthroplasty (PKA) over the total knee arthroplasty (TKA) in selected patients with osteoarthritis (OA) or osteonecrosis (ON), there is still no consensus regarding the feasibility of this procedure among practitioners all over the world. The purpose of the study to perform comprehensive analysis of the preferences of knee surgeons, regarding the feasibility of partial arthroplasty for modern orthopedic practice. Materials and Methods. A special questionnaire was developed that includes 4 sections devoted to personal surgical experience, understanding of indications/contraindications to PKA, attitude to potential advantages and disadvantages, as well as the reasons limiting the use of this technology in the daily practice. Using the institutional register of knee arthroplasty there were identified 37 orthopedic surgeons who perform more than 20 knee replacements annually. All of them agreed to participate in the survey. All surgeons were men with average age 43.1 years (min 31, max 64, moda 41, SD = 8.9). The total number of knee arthroplasties performed by all respondents during the last year was 3094 . Results. The surgeons divided into two groups: 17 (46%) performed PKA but majority did not (20 (54%)). The average age of the surgeons of the 1st group was less than in the 2nd one (41.8 and 44.1 years (p0.05)). The surgeons from group 1 significantly often respond in a positive way regarding the advantages of PKA compared to TKA (p0.01). The significant differences among surgical estimations regarding PKA noted in the questions related to the speed of rehabilitation (p0.05), the achievement of the forgotten knee phenomenon (p0.01) and the frequency of postoperative complications (p0.01). There was a trend that the more often a surgeon utilized PKA, the more he believes in its advantages over TKA. Only 1 respondent consider PKA fully unreliable, and 6 surgeons reported that they are unfamiliar with surgical technique. Interestingly that all surgeons, except one in the second group, met right candidates for PKA in their daily practice. There was no correlation between the studied parameters and surgeons age, experience, as well as annual caseload. Conclusions. Every second surgeon (54%) who regularly performs knee replacement ignores PKA as a method of choice for selected patients with OA or ON despite evidence-based literature data even in a large orthopedic center. For PKA users among the most significant advantages of this approach there are the faster rehabilitation (p0.05), ability to reach the forgotten knee (p0.01), as well as lower incidence and severity of postoperative complications (p0.01).
Keywords
