Evidence map›Paper›PMID 40448116›Full record

ArticleJournal of orthopaedic surgery and research2025

Cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy for medial compartment knee osteoarthritis in young patients: a Canadian public payer perspective.

Pakpoom Ruangsomboon, Onlak Ruangsomboon, Davis Tam, Bheeshma Ravi, Seper Ekhtiari, Daniel Pincus, Sebastian Tomescu

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In one paragraph

Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Pakpoom RuangsomboonSunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0001-7041-3562
Onlak RuangsomboonFaculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. doctor.mo@yahoo.com.ORCID https://orcid.org/0000-0002-0848-7162
Davis TamSunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0009-0003-3220-1114
Bheeshma RaviSunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0003-1829-6885
Seper EkhtiariDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada.ORCID https://orcid.org/0000-0002-4571-9655
Daniel PincusSunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.ORCID https://orcid.org/0000-0003-3783-8205
Sebastian Tomescu *Sunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.ORCID http://orcid.org/0009-0009-0600-6626

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn medial compartment osteoarthritis (OA) of the knee in young patients who fail conservative treatment, clinical equipoise exists between three surgical strategies: (1) total knee arthroplasty (TKA), (2) unicompartmental knee arthroplasty (UKA), and (3) medial opening wedge high tibial osteotomy (HTO). This study evaluated the cost-effectiveness of three surgical strategies, using a probabilistic Markov model from the Ontario public payer perspective in Canada.

methodsA probabilistic Markov model was developed to perform a cost-utility analysis comparing TKA, UKA, and HTO. The base case simulated a 45-year-old Canadian cohort with unilateral medial knee OA over a lifetime horizon. Outcomes included quality-adjusted life months (QALMs), discounted lifetime costs (1.5% annually), incremental cost-effectiveness ratios (ICERs), and net monetary benefit (NMB), reported in 2023 Canadian dollars (CAD, $). A willingness to pay (WTP) threshold of $4,166.67/QALM was applied. Model uncertainty was assessed via 3,000 iterations of probabilistic sensitivity analysis. Scenario analyses using sex-specific mortality rates were also conducted.

resultsMean costs were $9,157 (TKA), $9,238 (HTO), and $9,419 (UKA). UKA produced the highest QALMs (290.53), followed by TKA (277.02) and HTO (270.88). HTO was absolutely dominated, as it was both more costly and less effective than TKA. Among undominated strategies, UKA yielded an ICER of $19.46/QALM compared to TKA. UKA also had the highest NMB ($1,201,112), outperforming TKA ($1,145,110) and HTO ($1,119,411). UKA was the most cost-effective option in 55.27% of probabilistic simulations, followed by TKA (23.83%) and HTO (20.90%). Scenario analyses with sex-specific mortality showed similar trends.

conclusionsUKA is the most cost-effective surgical strategy from a public payer perspective for young patients with medial knee OA. At a WTP of $4,166.67/QALM, UKA balances long-term durability and economic value better than TKA or HTO. LEVEL OF EVIDENCE: Level III, Model-based economic evaluation.

Indexed as

Arthroplasty, Replacement, KneeCost-Benefit AnalysisOsteoarthritis, KneeOsteotomyTibiaCanadaFemaleHumansMaleMarkov ChainsMiddle AgedQuality-Adjusted Life YearsCanadaCost-effectivenessCost-utility analysisHigh tibial osteotomyMarkov modelMedial knee osteoarthritisTotal knee arthroplastyUnicompartmental knee arthroplasty

Identifiers

PMID40448116
PMCPMC12125944

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.