Bicompartmental knee arthroplasty (BKA) provides an alternate option to total knee arthroplasty (TKA) for medio-patellofemoral osteoarthritis with the advantage of better joint kinematics and bone preservation.
Aims: We aimed to locate, appraise and synthesize the available literature to assess the functional outcome of modular BKA in comparison to TKA in patients with medio-patellofemoral osteoarthritis.
Materials And Methods
After an extensive literature search based on electronic databases such as MEDLINE, EMBASE, CINAHL, and PubMed, and grey literature, nine papers satisfied our selection criteria which included one randomized controlled trial, one prospective cohort, three retrospective cohort, and four case series. Narrative synthesis was performed due to clinical, methodological and statistical heterogeneity among the included studies.
There were 331 participants (341 knees) in this systematic review. BKA group included 229 patients (239 knees) and TKA group included 102 patients (102 knees). The quality of included studies was variable ranging from moderate to very low as per GRADE score with low to high risk of bias. Most of the studies showed similar or better functional outcome in BKA compared to TKA such as Knee society score, Knee osteoarthritis and outcome score, and Short form-36 score in short to mid-term follow up. BKA patients achieved better range of movement and forgotten knee status than TKA patients. It resulted in longer operative time, but less intraoperative blood loss. Long-term series showed 95.1% survivorship of BKA at 5 years and 58% at 17 years. None of the study mentioned significant difference in complications between the two groups.
Current evidence suggests good outcome after modular BKA in comparison to TKA in terms of pain, ROM, clinical and functional score, health related quality of life scores, and revision surgery in short to mid-term follow up, however, with poor long-term survivorship.