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

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 PRISMA 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 1 April 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 randomized controlled trials and 10 cohort studies involving 671 patients, were included in this analysis. The Knee Society (KSS) total score (MD = 2.57; 95% 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-From-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.