The Relationship Between Age and 30-Day Outcomes Following Unicompartmental Versus Total Knee Arthroplasty

Background: Understanding the short-term complication profile following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA) can improve surgical decision-making and patient outcomes. This study aimed to determine if the difference in risk of 30-day morbidity and mortality between UKA and TKA varied based on patient age. Methods: This retrospective study of a national quality improvement database using data from 2014 to 2020 included 403,342 patients undergoing UKA (n = 12,324) or TKA (n = 391,018). A generalized additive model evaluated nonlinear relationships between primary outcome and predictors (age, procedure, and procedure x age interaction) using a 1:5 UKA to TKA matched sample. Probabilities and odds ratios (95% confidence interval [CI]) estimated the relative risk of complications by age. Results: In the generalized additive model, TKA patients relative to UKA had 1.30 odds (95% CI 1.19 to 1.43, P < 0.001) of 30-day morbidity and mortality. There was a significant nonlinear relationship between age and primary outcome (P = 0.02), such that the odds were lowest at younger ages. They increased slowly until the age of 65 years, when the slope became steeper. The interaction terms for age and procedure were not significant (P = 0.30). The 30-day probability for short-term complications of a 65-, 75-, and 85-year-olds undergoing UKA was 2.1% (95% CI 1.8 to 2.3), 2.4% (95% CI 2.0 to 2.8), and 3.2% (95% CI 2.3 to 4.1), respectively. The probability of a 65-, 75-, and 85-year-old undergoing TKA was 2.9% (95% CI 2.7 to 3.0), 3.6% (95% CI 3.3 to 3.8), and 5.5% (95% CI 4.7 to 6.3), respectively. Conclusions: Patients undergoing UKA had a quantifiable lower likelihood of morbidity or mortality than TKA at all ages. These data can provide individualized risk for UKA and TKA across the age spectrum and could be helpful in counseling patients regarding their perioperative risk. Level of evidence: III (retrospective comparative study).