| Title: |
Assessing clinical and cost effectiveness of total versus partial knee replacement (TOPKAT): 10-year follow-up of a multicentre, randomised controlled trial |
| Authors: |
Beard, D; Davies, LJ; Cook, JA; MacLennan, G; Hudson, J; Price, A; Carr, A; Little, M; Leal, J; Fitzpatrick, R; Murray, DW; Campbell, MK |
| Contributors: |
Group, TOPKAT Study |
| Publisher Information: |
Elsevier |
| Publication Year: |
2025 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
BackgroundThe Total or Partial Knee Arthroplasty Trial (TOPKAT) aimed to evaluate the difference between total knee replacement (TKR) and partial (unicompartmental) replacement (PKR) for treatment of late-stage medial compartment knee osteoarthritis. As longevity is a key issue for joint replacement, extended follow-up periods are required to fully evaluate the long-term efficacy. In this analysis, we report the 10-year follow-up of the TOPKAT trial.MethodsTOPKAT was a multicentre, randomised, pragmatic comparative effectiveness trial including an expertise component. Patients with medial compartment knee osteoarthritis were enrolled from 27 UK National Health Service (NHS) hospitals and randomly assigned (1:1) to receive PKR or TKR by surgeons who were either expert in and willing to perform both surgeries or by a surgeon with particular expertise in the allocated procedure. Neither surgeons, patients, nor follow-up assessors were masked to allocation, but the implant type was not highlighted at any stage. The primary long-term endpoint was the Oxford Knee Score (OKS) in the intention-to-treat population at 10 years. Cost effectiveness was also assessed. Individuals with relevant lived experience were involved in the study design. This trial is registered with ISRCTN03013488 and ClinicalTrials.gov, NCT01352247, and is complete.FindingsBetween Jan 18, 2010, and Sept 30, 2013, of 962 patients assessed for eligibility, 528 patients (306 [58%] male, 222 [42%] female, mean age 65 years [SD 8·7]) were randomly assigned (PKR n=264; TKR n=264). Follow-up primary outcome response rate for eligible patients (excluding those who had died or withdrew) at 10 years was 326 (73%) of 444. Both operations provided good outcome. The between-group estimates ruled out any individually clinically meaningful differences in mean OKS scores (mean difference 0·27, 95% CI −1·59 to 2·13) or cumulatively over 10 years in the area under the curve analysis (mean difference 0·45, 95% CI −0·98 to 1·88). At 10 years, by treatment received, ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1016/S2665-9913(25)00250-4 |
| Availability: |
https://doi.org/10.1016/S2665-9913(25)00250-4; https://ora.ox.ac.uk/objects/uuid:fa986c2c-eae0-4b9f-8e73-bcb866f8682b |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.F2883398 |
| Database: |
BASE |