Joint awareness is a key determinant of patient satisfaction after knee arthroplasty, yet the comparative impact of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) remains unclear. This study evaluates joint awareness differences between UKA and TKA using the Forgotten Joint Score (FJS-12) to provide updated evidence for clinical decision-making.

A systematic search of PubMed, EMBASE, Web of Science, and Cochrane databases was conducted on January 28, 2026, identifying cohort studies or RCTs comparing UKA and TKA. The primary outcome was FJS-12, categorized by follow-up duration into short-term (<2 year), mid-term (2–3 years), and long-term (>3 years). Study quality was evaluated using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Meta-analysis was performed with the Inverse Variance method, including sensitivity analyses.

This study included 25 studies with a total of 5445 participants, comprising 11 short-term, 9 mid-term, and 7 long-term follow-up studies. Meta-analysis results indicated that UKA outperformed TKA in FJS-12 scores across short-term (mean difference (MD): 12.89; 95% confidence interval (CI): 5.60–20.17; P = 0.0005), mid-term (MD: 6.01; 95% CI: 3.29–8.74; P < 0.001), and long-term (MD: 12.42; 95% CI: 8.88–15.96; P < 0.001) follow-up.

This updated analysis incorporates a larger number of high-quality studies, demonstrating that UKA offers superior joint awareness compared to TKA during long-term follow-up, further validating and reinforcing the advantages of UKA in joint awareness recovery reported in previous research.

I; Systematic Review and Meta-Analysis.