Impact of age on unicompartmental knee arthroplasty outcomes: a systematic review and meta-analysis

Purpose: Unicompartmental knee arthroplasty (UKA) is an effective treatment for late knee osteoarthritis (OA). Young age (< 60 years) has been associated with worse outcomes. The goal of this systematic review and meta-analysis is to study the effect of age on UKA outcomes.

Methods: The primary objective was to compare the UKA revision rate in young patients with that of old patients, using the age thresholds of 60 and 55 years. Secondary objectives were patient-reported outcome measures (PROMs) and implant design. Five databases were searched in December 2021 for original comparative studies with a minimum of 1-year follow-up. No restrictions were placed on the type of UKA prosthesis.

Results: A total of 11 observational studies with 6130 knees were included. A mean MINORS score of 19 was assigned to the review. The mean age of patients was 64 years, with average follow-up of 7.5 ± 2.98 years. There was no significant difference in revision rate, incident or PROMs between young and old patients in the analysis for each age threshold. Further sub-analysis adjusting for implant type in mobile- and fixed-bearing prostheses also showed similar results between those above and under 60 and 55 years.

Conclusion: Young age was not associated with a higher revision rate or lower functional scores. Thus, this review provides evidence that age alone is not a contraindication to UKA, but the surgical choice must be based on several elements, and this finding should be applied in context, given the binary division and heterogeneity of patients.

Level of evidence: III.