Efficacy and safety of bicompartmental versus total knee arthroplasty for treating medial tibiofemoral compartment combined with patellofemoral compartment osteoarthritis: a systematic review and META-analysis
Bibliographic record
Abstract
BACKGROUND: Both bicompartmental knee arthroplasty (BKA) and total knee arthroplasty (TKA) are viable treatment options for patients with osteoarthritis affecting the medial tibiofemoral and patellofemoral compartments. The efficacy and safety of both surgical procedures were assessed through a systematic review and meta-analysis. METHODS: This review was registered in the PROSPERO database and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, as well as the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive systematic literature search was conducted across the PubMed, Embase, Web of Science, and Cochrane Library databases, with a cut-off date of April 1, 2025, to identify relevant studies. We included randomized controlled trials (RCTs) and cohort studies comparing BKA with TKA for treating patients with osteoarthritis in the medial tibiofemoral and patellofemoral compartments. Studies from all countries and in any language were considered. Eligible studies were assessed for quality, data extracted, and meta-analyzed using Review Manager 5.4 software. RESULTS: Based on strict inclusion and exclusion criteria, 14 studies, including 4 RCTs and 10 cohort studies involving 671 patients, were included in this analysis. The Knee Society (KSS) total score (mean difference [MD] = 2.57; 95% confidence interval [CI]: 0.55, 4.60; P = 0.01) and the University of California at Los Angeles score (MD = 0.56; 95% CI: 0.23, 0.89; P = 0.0009) were significantly better in the BKA group than in the TKA group; no significant differences in KSS function score were observed between the two groups at 6 and 12 months (6 months: MD = -0.61; 95% CI: -5.35, 4.13; P = 0.80; 12 months: MD = 4.72; 95% CI: -1.50, 10.94; P = 0.14), but the BKA group had higher score than the TKA group at more than 24 months (MD = 4.04; 95% CI: -0.26, 8.34; P = 0.07). Patients in the BKA group demonstrated greater joint mobility than those in the TKA group at 6 months, 12-24 months, and more than 24 months (6 months: MD = 8.00; 95% CI: 4.68, 11.31; P < 0.00001; 12-24 months: MD = 13.92; 95% CI: 9.80, 18.04; P < 0.00001; >24 months: MD = 4.63; 95% CI: 1.34, 7.91; P = 0.006). The Western Ontario and McMaster Universities Osteoarthritis Index physical function score (MD = 7.30; 95% CI: 4.34, 10.26; P < 0.00001) was higher than the TKA group in the early period. The hip-knee-ankle angle was greater in the TKA group than in the BKA group (MD = -2.94; 95% CI: -3.50, -2.32; P < 0.00001). Additionally, surgical blood loss (MD = -1.23; 95% CI: -1.58, -0.88; P < 0.00001) and hospital stay were lower in the BKA group than in the TKA group ( P < 0.05). No significant differences were found between the two groups in KSS joint score at three-time points (6 months: MD = 2.32; 95% CI: -2.31, 6.94; P = 0.33; 12 months: MD = -3.85; 95% CI: -8.79, 1.08; P = 0.13; >24 months: MD = 0.28; 95% CI: -3.26, 4.23; P = 0.80), Oxford Knee score (MD = 1.56; 95% CI: -2.40, 5.51; P = 0.44), the Short-Form-36 Health Survey (Mental Component Summary: MD = 0.10; 95% CI: -3.05, 3.25; P = 0.95; MD = -1.40; 95% CI: -3.84, 1.04; P = 0.26), timed up and go (MD = -0.28; 95% CI: -0.65, 0.10; P = 0.15), revision rate (MD = 1.92; 95% CI: 0.74, 4.98; P = 0.18), or postoperative complications (MD = 2.03; 95% CI: 0.45, 9.17; P = 0.36). CONCLUSION: Our results suggest that BKA may be an alternative surgical option for patients with medial-patellofemoral osteoarthritis compared to TKA, but further studies are needed to confirm this conclusion and evaluate long-term outcomes and cost-effectiveness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.030 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.040 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".