We recently published a paper comparing the incidence of adverse outcomes after unicompartmental and total knee arthroplasty (UKA and TKA). The conclusion of this study, which was in favour of UKA, was dismissed as “biased” in a review in Bone & Joint 360. Although this study is one of the least biased comparisons of UKA and TKA, this episode highlights the biases that exist both for and against UKA. In this review, we explore the different types of bias, particularly selection, reporting and measurement. We conclude that comparisons between UKA and TKA are open to bias. These biases can be so marked, particularly in comparisons based just on national registry data, that the conclusions can be misleading. For a fair comparison, data from randomised studies or well-matched, prospective observational cohort studies, which include registry data, are required, and multiple outcome measures should be used. The data of this type that already exist suggest that if UKA is used appropriately, compared with TKA, its advantages outweigh its disadvantages.
Cite this article: Bone Joint J 2017;99-B:12–15.
D. Murray: Conceived original idea and wrote the manuscript.
A. D. Liddle: Contributed to the drafting, critical revision and final approval of the manuscript.
H. Pandit: Contributed significantly to the drafting, critical revision and final approval of the manuscript.
A. Judge: Contributed significantly to the conception and design of the study, revised and approved the manuscript.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non- profit organisation with which one or more of the authors are associated.
This article was primary edited by D. Johnstone and first proof edited by G. Scott.
- Received May 31, 2016.
- Accepted September 8, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery