Nav: Home

Increased use of partial knee replacement could save the NHS £30 million per year

July 17, 2019

New research from a randomised clinical trial published today in The Lancet and funded by the National Institute for Health Research (NIHR) shows that partial knee replacements (PKR) are as good as total knee replacements (TKR), whilst being more cost effective.

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.

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."

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.

The study was started in 2010 and 528 patients from 27 hospital sites were followed up at five years with the help of Trial Manager, Dr Lottie Davies. They were asked questions about pain, function, activity levels and satisfaction. Most of the clinical measures were very similar between the two types although more patients having a PKR reported they would have the operation again compared to those having a TKR. The cost effectiveness findings (patient improvement in relation to cost) were the most persuasive to show that PKR should probably be offered to more patients.

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."

Professor Marion Campbell, co-investigator from the University of Aberdeen said, "The results have been sent to NICE and NHS commissioning bodies will now consider the findings to see how they might adjust or change the delivery of knee replacement in the UK."
-end-
The full paper 'The clinical and cost e ectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised trial' can be read in The Lancet. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31281-4/fulltext

For further information, please contact: Jo Silva, NDORMS Communications Manager at jo.silva@ndorms.ox.ac.uk or on +44 (0) 7857306287

University of Oxford

Related Knee Replacement Articles:

Knee replacement timing is all wrong for most patients
The timing of knee replacement surgery is critical to optimize its benefit.
Study: 'Pre-habilitation' by peer coaches before knee replacement may improve outcomes
HSS researchers launched a study to see if a 'pre-habilitation'' program - counseling by a peer coach who has already had knee replacement - could empower and inform patients scheduled for the surgery and lead to better outcomes.
Study finds racial variation in post-op care after knee replacement surgery
A large study analyzing 107,000 knee replacement surgeries found that African Americans were significantly more likely than white patients to be discharged to an inpatient rehabilitation or skilled nursing facility rather than home care after the procedure.
Race and poverty not risk factors for total knee replacement revision or failure
In a new study published in Arthritis Care & Research, HSS investigators found race and poverty are not risk factors for total knee replacement revision or failure at a high-volume orthopedic hospital.
Increased use of partial knee replacement could save the NHS £30 million per year
New research from a randomised clinical trial published today in The Lancet and funded by the National Institute for Health Research (NIHR) shows that partial knee replacements (PKR) are as good as total knee replacements (TKR), whilst being more cost effective.
Low income is a risk factor for 'catastrophic' amputation after knee joint replacement
Above-knee amputation (AKA) is a rare but severe complication of deep infection after knee replacement surgery.
Study reveals hip and knee replacement performance in England and Wales
The performance of different prosthetic implant combinations used in patients undergoing hip and knee replacements in England and Wales over the last 14 years have, for the first time, been directly compared in two new studies.
Smart, self-powered knee implants could reduce number of knee replacement surgeries
Smart knee implants may soon be a reality thanks to research conducted by a team including faculty at Binghamton University, State University of New York.
CU researchers: Home care for knee replacement patients aids in recovery
A team of physical therapy researchers from the University of Colorado School of Medicine have conducted one of the first full-scale studies to assess the effectiveness of in-home physical therapy care for patients who have had knee replacement surgery.
Study examines care for knee replacement patients at physical therapy facilities
In an analysis of 112 records from 30 physical therapy (PT) sites regarding care for patients who had undergone total knee replacement (TKR) surgery, investigators found that the content and amount of specific exercises varied widely.
More Knee Replacement News and Knee Replacement Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Our Relationship With Water
We need water to live. But with rising seas and so many lacking clean water – water is in crisis and so are we. This hour, TED speakers explore ideas around restoring our relationship with water. Guests on the show include legal scholar Kelsey Leonard, artist LaToya Ruby Frazier, and community organizer Colette Pichon Battle.
Now Playing: Science for the People

#569 Facing Fear
What do you fear? I mean really fear? Well, ok, maybe right now that's tough. We're living in a new age and definition of fear. But what do we do about it? Eva Holland has faced her fears, including trauma and phobia. She lived to tell the tale and write a book: "Nerve: Adventures in the Science of Fear".
Now Playing: Radiolab

Uncounted
First things first: our very own Latif Nasser has an exciting new show on Netflix. He talks to Jad about the hidden forces of the world that connect us all. Then, with an eye on the upcoming election, we take a look back: at two pieces from More Perfect Season 3 about Constitutional amendments that determine who gets to vote. Former Radiolab producer Julia Longoria takes us to Washington, D.C. The capital is at the heart of our democracy, but it's not a state, and it wasn't until the 23rd Amendment that its people got the right to vote for president. But that still left DC without full representation in Congress; D.C. sends a "non-voting delegate" to the House. Julia profiles that delegate, Congresswoman Eleanor Holmes Norton, and her unique approach to fighting for power in a virtually powerless role. Second, Radiolab producer Sarah Qari looks at a current fight to lower the US voting age to 16 that harkens back to the fight for the 26th Amendment in the 1960s. Eighteen-year-olds at the time argued that if they were old enough to be drafted to fight in the War, they were old enough to have a voice in our democracy. But what about today, when even younger Americans are finding themselves at the center of national political debates? Does it mean we should lower the voting age even further? This episode was reported and produced by Julia Longoria and Sarah Qari. Check out Latif Nasser's new Netflix show Connected here. Support Radiolab today at Radiolab.org/donate.