High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis with Kissing Lesions in Relatively Young Patients

Abstract

PurposeThe purpose of this study is to compare the clinical and radiographic outcomes of high tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) in advanced medial compartment arthritis accompanied by kissing lesions in relatively young patients.Materials and MethodsForty-five patients were divided into the HTO (n=23) and UKA (n=22) groups. Clinically, we evaluated the Lysholm knee scoring scale, visual analogue scale, Hospital for Special Surgery, and Western Ontario and McMaster Universities Osteoarthritis index scores preoperatively, 6 and 12 months postoperatively, and at the final follow-up. Radiographically, we measured the femoral-tibial angle and mechanical axis deviation preoperatively and at the final follow-up.ResultsAll clinical outcomes gradually improved in both groups from the postoperative period to the final follow-up. At the final follow-up, all clinical outcomes were slightly better in the UKA group than in the HTO group; however, differences were not statistically significant.ConclusionsHTO is comparable to UKA in terms of clinical outcomes. Thus, the results of this study suggest that HTO might be a good alternative treatment to UKA for medial unicompartmental arthritis accompanied by kissing lesions in relatively young patients.

Preliminary results of high fibular osteotomy (HFO) and cartilage regeneration procedure for medial compartment osteoarthritis of knee with varus deformity

“…Even though HFO improved varus deformity of osteoarthritic knee, the correction for deformity was limited and the precise correction angle cannot be estimated. Therefore, for better clinical result, the pathology of medial compartment warranted arthroscopic intervention, to treat the biological and mechanical aspects of osteoarthritis [14], [15], [16], [17], [18], [19], [20].…”

“…Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA) [2]. As arthroplasty is associated with serious postoperative challenges, joint preserving procedures have become popular and appropriate for young and active patients [3], [18]. Therefore the ideal candidate for an HTO is a young patient (<60 years of age), with isolated medial osteoarthritis, with good range of motion and without ligamentous instability [4].…”

Mid-term results of high tibial osteotomy for medial compartment arthritis using hemicallostasis by dynamic external fixator

“…Our study aims to prove effectiveness of high tibial osteotomy in improving clinical outcomes (as measured by Oxford knee score) in varus arthritic knee by changing knee alignment using hemicallostasis produced by dynamic external fixator. Proponents of high tibial osteotomy emphasize newer cartilage regeneration in arthritic knee after overcorrecting varus deformity in medial compartment as demonstrated by Koshino et al [9] Also as compared to surface replacement of arthritic surface as in Unicondylar Knee arthroplasty or total knee arthroplasty, HTO is highly cost effective and requires less stringent instrumentation and techniques [10,11,13,14] . Although results of UKA and HTO are almost comparable, many recent long-term studies have proved 10-15 year survivorship of HTO if done by precise techniques.…”

Can medial stability be preserved after open wedge high tibial osteotomy?

“…High tibial osteotomy (HTO) is a useful surgical option for medial osteoarthritis combined with varus deformity in young active patients [ 1 , 2 ]. Several surgical options for HTO exist, including the lateral closed wedge and medial open wedge osteotomy [ 3 , 4 ].…”