Comparable functional outcomes and longer operative time for bicompartmental vs total knee arthroplasty: A meta-analysis with fragility index analysis

Bicompartmental knee arthroplasty (BKA) is an alternative to total knee arthroplasty (TKA) for isolated medial and patellofemoral osteoarthritis. Comparative efficacy remains unclear, and fragility of outcomes is unknown. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing BKA to TKA was performed. Continuous outcomes (Oxford Knee Score, range of motion, operative time, Knee Society Score) and revision rates were analyzed. Fragility index (FI) and reverse FI (rFI) were used to assess statistical robustness. Seven RCTs (290 knees) were included. Functional scores were comparable ( P > .05). Operative time was significantly longer for BKA ( P = .01). Revision risk trended higher with BKA (RR = 2.34). Median FI and rFI were 2.0 and 0.5. In 71.4% of studies, loss to follow-up exceeded FI/rFI. BKA yields similar short-term functional outcomes to TKA but is associated with longer operative time and a trend towards higher revision rates. Fragility analysis revealed low statistical robustness, suggesting routine BKA should not be performed until larger, long-term trials are completed. I CRD420251081005