The efficacy and safety of opening-wedge high tibial osteotomy in treating unicompartmental knee osteoarthritis

Huang, Sicong; Chen, Yu‐Fang; Liu, Xuedong; Han, Yongtao; Li, Yiqun

doi:10.1097/md.0000000000014927

Cited by 3 publications

(2 citation statements)

References 14 publications

(14 reference statements)

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“…12 High tibial osteotomy (HTO) is a common jointpreserving surgery performed in the treatment of OA. 8,14,26 It unloads the affected compartment and aims to relieve pain and slow the progression of unicompartmental knee OA to avoid or postpone knee arthroplasty in patients with unicompartmental OA. During the surgery, degenerative cartilage is often observed in the involved compartment, triggering the use of various surgical techniques to attempt to promote cartilage regeneration, with the hopes of delaying the progress of osteoarthritis.…”

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confidence: 99%

Outcomes of High Tibial Osteotomy With Versus Without Mesenchymal Stem Cell Augmentation: A Systematic Review and Meta-analysis

Tan

Kwan

Neo

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The outcomes after high tibial osteotomy (HTO) with augmentation of intra-articular mesenchymal stem cell (MSCs) for medial tibiofemoral osteoarthritis remain controversial. Purpose: To pool existing studies to compare the outcomes of HTO with versus without intra-articular MSC augmentation when performed for medial tibiofemoral osteoarthritis. Study Design: Systematic review; Level of evidence, 3. Methods: The systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were clinical studies that compared the outcomes of HTO with intra-articular MSC augmentation (MSC group) versus without (control group). Pre- and postoperative outcomes were compared between groups from measures including the Lysholm score, International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score, Hospital for Special Surgery Knee Rating Scale, Tegner score, visual analog scale for pain, arthroscopic and histological grading scales, femorotibial angle, weightbearing line, and posterior tibial slope. Results: We reviewed 4 studies with a total of 224 patients. The MSC group demonstrated significantly greater improvement versus controls in the pooled Lysholm score (weighted mean difference [WMD], 6.64; 95% CI, 0.90 to 12.39) and pooled IKDC score (WMD, 9.21; 95% CI, 4.06 to 14.36), which were within or close to the minimal clinically important difference. Radiological outcomes were similar in both groups, including the femorotibial angle (WMD, –0.01; 95% CI, –1.10 to 1.09), weightbearing line, and posterior tibial slope. The studies were homogeneous, and no publication bias was noted. Conclusion: Intra-articular MSC augmentation for HTO may modestly improve functional outcomes as compared with HTO alone. However, adequate data are lacking to make definitive conclusions regarding the effect of MSC augmentation on pain or arthroscopic and histologic grading.

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confidence: 99%

Outcomes of High Tibial Osteotomy With Versus Without Mesenchymal Stem Cell Augmentation: A Systematic Review and Meta-analysis

Tan

Kwan

Neo

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The procedure aims to ameliorate the stress acting on the mechanical axis of the lower limb and to relieve the forces acting on the medial compartment of the knee joint. HTO can stop or delay the progression of medial compartment KOA while improving knee joint pain and patient mobility 20 . However, the surgery is complex and technically demanding for young doctors 21 .…”

Section: Discussionmentioning

confidence: 99%

High fibular osteotomy ameliorates medial compartment knee osteoarthritis in a rabbit model

Yan

Zhao

Duan

et al. 2021

Journal of Biomechanics

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Purpose Knee osteoarthritis (KOA) is a common and severe disease characterized by articular cartilage degeneration, subchondral bone remodeling and in ammation. This study aimed to investigate the therapeutic effects of high bular osteotomy (HFO) in a KOA rabbit model and to examine the molecular mechanisms involved in medial compartment KOA protective effects.Methods A rabbit model of destabilization of the medial meniscus was used to induce post-traumatic KOA. The effectiveness of HFO on protection against KOA was tested. Hematoxylin and eosin staining, Safranin O/Fast green staining and micro-CT analysis were performed to evaluate structural and morphological changes. The expression of metalloproteinase (MMP)-1, MMP-3, MMP-13, collagen type II (Col2), a disintegrin and metalloproteinase domain with thrombospondin motifs (ADAMTS)-5, aggrecan, interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α was assessed by real time PCR, western blotting and enzyme-linked immunosorbent assay. Additionally, western blotting was performed to test the expression of NFκB p65, phospho-IκBα and IκBα.Results HFO delayed the progression of articular cartilage damage and suppressed subchondral bone remodeling. HFO also decreased MMP-1, MMP-3, MMP-13 and ADAMTS-5 expression, and increased Col2 and aggrecan expression. In parallel, HFO attenuated the expression of IL-1β, IL-6 and TNF-α. Furthermore, the molecular mechanism underlying the protective effect of HFO in medial compartment KOA was related to the NFκB signaling pathway.Conclusion HFO may be a novel therapeutic approach to treating medial compartment KOA.

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Surgery for osteoarthritis

Choong

Dowsey

2023

Osteoarthritis Health Professional Training Manual

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The efficacy and safety of opening-wedge high tibial osteotomy in treating unicompartmental knee osteoarthritis

Cited by 3 publications

References 14 publications

Outcomes of High Tibial Osteotomy With Versus Without Mesenchymal Stem Cell Augmentation: A Systematic Review and Meta-analysis

Outcomes of High Tibial Osteotomy With Versus Without Mesenchymal Stem Cell Augmentation: A Systematic Review and Meta-analysis

High fibular osteotomy ameliorates medial compartment knee osteoarthritis in a rabbit model

Surgery for osteoarthritis

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