Interestingly in this paper it was strongly recommended that PKR should be reserved for patients with bone-on-bone disease severe enough to warrant consideration for total knee arthroplasty radiographically and clinically. Thirty years later a recent consensus has been made to redefine the concept of PKR with a new and updated list of indications and contraindications for medial PKR ( 12). Indeed, there has been considerable debate over the years regarding the ideal indications and contraindications of PKR since the classic 1989 article by Kozinn and Scott with strict indications ( 11). ( 10) refers to the indications of respective procedures. The first point raised by the paper by Beard et al. The authors concluded that PKR should be considered the first choice for patients with advanced OA of medial knee compartment based on their clinical results and in light of reduced costs and better cost effectiveness with PKR during their study period. This was linked to slightly better outcomes, reduced costs of surgery, and follow-up health-care costs which were lower with PKR than TKR.

They also made a health economics analysis including the length of hospital stay and data on cost-effectiveness, and found that PKR was more effective and less expensive than TKR during the 5 years of follow-up. At the 5-year follow-up, the authors found that both TKR and PKR were effective, the clinical outcomes were similar with no significant difference in Oxford Knee score, and the rate of re-operations and complications was identical. They included 528 patients, of whom 264 were assigned to the PKR group and 264 were assigned to the TKR group, through a multicentre study involving 27 sites in the UK. ( 10) evaluated the clinical results and cost-effectiveness of TKR versus PKR in patients with medial compartment OA of the medial compartment of the knee through a randomized controlled comparative study. In contrast higher frequencies of revision and reoperations with PKR have been identified using observational, registry-based study ( 9). In systematic review and meta-analysis evaluation it was clear that more patients did return to physical and sportive activities after PKR than after TKR, but again confounding factors were inadequately taken into account ( 8). While these studies have reported good clinical results after both PKR and TKR, there is a tendency tend to have marginally better function for PKR patients but sources of heterogeneity in type of patients might be a potential source of interference. The number of existing comparative randomized studies is limited ( 1, 5- 7) with often reduced number of cases. TKR has for many years been considered the standard of surgical treatment for knee OA due to demonstrated reproducibility and effectiveness for relieving pain and restoring function ( 3), however PKR has increased in popularity over the last 20 years as shown in national orthopedic registries ( 4). The debate of which option between TKR and PKR offers better clinical advantages for symptomatic OA of one compartment of the knee has generated frequent controversy in the orthopedic community ( 1, 2). He can either decide to replace the three compartments of the knee while realizing a total knee replacement (TKR), or he can replace only the affected medial femorotibial compartment while realizing a partial knee replacement (PKR). In case of bone on bone osteoarthritis (OA) limited to the medial compartment of the knee and after failure of non-operative treatments, the orthopedic surgeon has two options. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Ziming Chen (Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia).Ĭomment on: Beard DJ, Davies LJ, Cook JA, et al. Email: and Peer Review: This article was commissioned and reviewed by the Academic Editor Dr. Institute for Locomotion, Hospital Sainte-Marguerite, Department of Orthopedic Surgery, 270 Boulevard Sainte-Marguerite, 13009 Marseille, France.

Knee compartments