Insufficient evidence to confirm benefits of custom partial knee arthroplasty: a systematic review

Abstract

Purpose: The purpose of this systematic review was to synthesise the available literature and critically appraise current evidence on the functional and radiographic outcomes as well as reoperation and revision rates of custom partial knee arthroplasty, i.e., unicompartmental knee arthroplasty (UKA), bicompartmental knee arthroplasty (BKA), and patellofemoral arthroplasty (PFA).

Material and methods: This systematic review was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and a protocol was registered with Prospero. On 25 May 2021, two authors independently searched and screened Level I-IV studies that reported on outcomes of custom partial knee arthroplasty using the databases of MEDLINE^®, EMBASE^®, and the Cochrane Library without restriction on date of publication. Findings from eligible articles were synthesised and tabulated, and quality assessments were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists.

Results: Fifteen articles were eligible for data extraction, of which two comparative and four case series were on custom UKA (follow-up, 0-9 months), one comparative and five case series on custom BKA (follow-up, 0.25-72 months), and three case series on custom PFA (follow-up, 2-119 months). Three studies on custom UKA reported mean Knee Society Score (KSS) Knee of 86-94 and mean KSS Function of 94-95, and two studies on custom BKA reported mean KSS Knee of 90-94 and KSS function of 81, whereas one study on custom PFA reported KSS Knee of 91 and KSS Function of 89. Custom implants tended to have less bone-implant mismatch compared to off the shelf (OTS) implants. Revision rates were 3-25% for custom UKA (at 0-109 months), 3-5% for custom BKA (at 12-72 months), and 0-14% for custom PFA (at 2-119 months).

Conclusion: Due to the small number of comparative studies and lack of consistency in reported outcomes, it remains difficult to ascertain the benefits of custom partial knee arthroplasty. Anecdotal evidence suggests that, compared to OTS implants, custom implants result in less bone-implant mismatch and that 78-91% of patients are either satisfied or very satisfied after custom partial knee arthroplasty.

Level of evidence: IV.

Keywords: Arthroplasty, replacement, knee; Knee; Knee prosthesis; Partial knee arthroplasty; Patient outcome assessment; Patient reported outcome measures.