Management of young patients with degenerative joint disease (DJD) of the knee is challenging. The spectrum of surgical options include joint preservation and arthroplasty. Direct clinical comparison of these procedures would be useful. We sought to compare the “treatment effect” of various surgical interventions in young patients with knee DJD.
Our institution’s registry identified 283 patients age 30-50 who underwent surgery for DJD of the knee by a single surgeon: 68 TKA, 60 UKA, 96 osteochondral allograft (OCA) transplantation, 35 distal femoral osteotomy (DFO), and 24 high tibial osteotomy (HTO) were included. Knee injury and Osteoarthritis Outcome Scores (KOOS) were captured preoperatively and postoperatively. KOOS subscales include symptoms, pain, activities of daily living, sports and recreation, and quality of life.
Mean follow-up was 5.2 years (range, 2-14 years). Mean age was 42 years. Clinically significant improvements were seen on every KOOS subscale for all treatments (p<0.001) (Table 1.) Largest improvement in symptoms was for UKA (30 points). OCA had the lowest improvement (17 points), but pre and postoperative mean scores were highest. Best pain score improvement was for TKA and UKA (both 29 points). Lowest pain score improvement was for OCA (19 points). ADL scores improved most for TKA (31 points) and least for OCA (18 points). Improvement in sports and recreation was similar for TKA, UKA, OCA, and DFO (34, 33, 35, and 39 respectively and lowest for HTO (17 points). Quality of life improved most for TKA (42 points), followed by HTO (37 points) and UKA (36 points).
Arthroplasty had the largest treatment effects for symptoms, pain, and activities of daily living. Osteotomy had the largest treatment effects for sports and recreation (DFO) and quality of life (HTO). OCA had the lowest treatment effects but highest mean KOOS scores.