Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty

Abstract

Background: Theoretical considerations suggest that total knee arthroplasty (TKA) is technically more challenging after high tibial osteotomy (HTO), resulting in inferior results compared to primary TKA. However, several studies on this issue have shown contradictory results. The purpose of this meta-analysis to compare survivorship and clinical outcomes between TKA with and without previous HTO. Methods: We reviewed studies that evaluated pain and function scores, range of motion (ROM), operation time, Insall-Salvati (IS) ratio, complications, and survival rates in patients treated with TKA with previous HTO or with primary TKA with short- to midterm (<10 years) or long-term (>10 years) follow-up. Results: Fifteen studies were included in the meta-analysis. There were no significant differences between TKA with and without previous HTO in pain score (95% CI: −0.27 to 0.29; P = .94), function score (95% CI: −0.08 to 0.24; P = .32), operation time (95% CI: −5.43 to 26.85; P = .19), IS ratio (95% CI: −0.03 to 0.08; P = .40), complication rates (TKA with previous HTO, 62/1717; primary TKA, 610/31386; OR 1.31, 95% CI: 0.97–1.77; P = .08), and short- to midterm survival rates (TKA with previous HTO, 1860/2009; primary TKA, 37848/38765; OR 0.55, 95% CI: 0.28–1.10; P = .09). Conversely, ROM (95% CI: −7.40 to −1.26; P = .006) and long-term survival rates (TKA with previous HTO, 1426/1523; primary TKA, 29810/31201; OR 0.71, 95% CI: 0.57–0.89; P = .003) were significantly different between the two groups. In addition, both groups had substantial proportions of knees exhibiting short- to midterm survivorship (92.6% by TKA with previous HTO and 97.6% by primary TKA) and long-term survivorship (93.6% by TKA with previous HTO and 95.5% by primary TKA). Conclusions: This meta-analysis suggests that a previous HTO affected ROM or survival of TKA in the long-term even though both groups have equivalent clinical outcomes and complications. Thus, orthopedic surgeons should offer useful information regarding the advantages and disadvantages of both procedures to patients, and should provide advice on the generally higher risk of revision after TKA with previous HTO at long-term follow-up when counseling patients.

Surgical Treatment of Patients With Knee Pathology and Deformities of the Lower Extremities: А Systematic Review

“…ВТО, которая может предотвратить замену сус тава, является признанным методом лечения остеоартроза, особенно у молодых и активных пациентов. Однако у части пациентов болезнь прогрессирует, и в зависимости от степени остеоартроза, уровня боли и функции сустава эндопротезирование является следующим этапом лечения [32,46]. L. Amendola с соавторами сравнили результаты лечения 29 пациентов после эндопротезирования с предшедствующей ВТО (время, прошедшее от остеотомии до эндопротезирования составило 8,5 лет) и у 29 пациентов, перенесших первичное эндопротезирование коленного сустава со сроком наблюдения 97 мес.…”

Comparison of stemless and conventional stemmed shoulder arthroplasties in shoulder arthropathy

“…I 2 statistics with a value less than 40% represent low heterogeneity, and a value of 75% or more indicates high heterogeneity. [ 18 ] When statistical heterogeneity was substantial, we conducted metaregression to identify potential sources of bias such as study type and sample size. The age of the study subjects was also considered.…”

Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing

“…Combined PFJR and high tibial osteotomy or distal femur osteotomy might be used in patients with a deformity >5° varus or valgus [ 65 ]. However, the authors do not favor combined approaches since increased deformities are often a predictor for progression of the OA in the medial or lateral compartment and the outcome of a later total knee replacement is usually compromised by a prior femoral or tibial osteotomy [ 66 , 67 ].…”