Partial knee replacements (PKR) found to be equally effective as total knee replacements (TKR), and more cost effective, according to the new research from a randomised clinical trial published in The Lancet, funded by the National Institute for Health Research (NIHR). Results from the TOPKAT study (Total or Partial Knee Arthroplasty Trial), led by researchers at the University of Oxford, suggest that over five years PKR has similar, if not a slightly better clinical outcome than TKR. More importantly, the economic benefit of using PKR is substantial and could save the NHS about £30 million per annum based on an increase of 31% usage. At present only 9% of joint replacements are PKR yet it is thought that around 40% of patients could be suitable candidates.
‘Patients with knee problems could benefit from PKR, which replaces only the diseased area and retains more soft tissue besides being cost-effective.’
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Chief investigator Professor David Beard, Rosetrees/Royal College of Surgeons Director of the Surgical Interventional Research Unit at the University of Oxford, said: "Despite many previous studies and considerable data, we have never had a sufficiently large randomised clinical trial to answer this important question. TOPKAT has now definitively shown us that both operations provide benefit and are worthwhile but, given the option, PKR is probably the implant of choice - providing sufficient expertise exists to implant it." Read More..
He adds: "An important caveat is that the surgeries in the trial were performed by well trained, experienced surgeons in both groups. If any recommendation to increase the use of PKR is made it will have to be accompanied by provision of adequate training and expertise for surgeons undertaking the technically more demanding PKR procedure."
Over 300,000 knee replacements are performed in the UK each year, mainly for osteoarthritis. Surgeons and patients face a choice of which type of operation to perform or undergo for medial compartment (one area in the joint) arthritis.
TKR replaces all parts of the joint whereas a PKR replaces only the diseased area and retains as much soft tissue as possible. TKR is fully established and used most often whereas PKR is less common and has been in widespread use for a shorter period.
The multidisciplinary team from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, and the Health Services Research Unit at the University of Aberdeen, with the support of the British Association of Knee Surgeons (BASK), found the failure or revision rate for PKR to be identical to that of TKP (both with revision rates of 4%). These findings contrast with previous research based on national registries, which showed PKR to have higher revision date.
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Professor Beard says: "The trial is a testament to everyone's hard work and will help patients in the future, adding to our increasing body of quality evidence for surgical procedures."
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Source-Eurekalert