Therapeutic Effects Comparison and Revision Case Analysis of Unicompartmental Knee Arthroplasty and Open Wedge High Tibial Osteotomy in Treating Medial Knee Osteoarthritis in Patients Under 60 years: A 2–6‐year Follow‐up Study

Abstract

Objective To evaluate the therapeutic effects and revision cases of unicompartmental knee arthroplasty (UKA) and open wedge high tibial osteotomy (OWHTO) in treating medial knee osteoarthritis (MKOA) in patients under 60 years. Methods The present retrospective study included a total of 192 patients who were diagnosed with MKOA and treated by UKA or OWHTO in the Second Affiliated hospital of Xi'an Jiaotong University and Xi'an Honghui Hospital between December 2012 and December 2016. Among these patients, 83 were treated by UKA (17 men and 66 women, aged 53.7 ± 5.2 years) and 109 were treated by OWHTO (23 men and 86 women, aged 51.8 ± 6.9 years). Patients were followed up at 1, 3, 6, and 12 months for the first year postoperation, and every 6 months from the second year postoperation. Basic data, perioperative data, hospital for special surgery (HSS) score, visual analogue pain score (VAS), low‐impact recovery, and revision cases of the patients were evaluated. Results The average follow‐up periods of the UKA group and the OWHTO group were 39.3 ± 11.2 months and 40.2 ± 13.5 months, respectively. No significant difference was found in the basic data of the two groups (P ≥ 0.05). The operative time, incision length, and dominant blood loss of the UKA group was less than those of OWHTO group by 19.6%, 10.7%, and 35.1%, respectively, and the differences were significant (P < 0.05), while no significant difference was found in postoperative in‐bed time (P ≥ 0.05). The HSS scores of the UKA group at 1 and 3 months postoperation were higher than those of the OWHTO group by 5.1% and 3.9% (P < 0.05), while no differences were found from 6 months postoperation (P ≥ 0.05). The VAS score of the UKA group 1 month postoperation was lower than that of the OWHTO group by 12.2% (P < 0.05), while no differences were found from 3 months postoperation (P ≥ 0.05). One year after the operation, most patients in both groups could not achieve ideal recovery in low‐impact sports, and no significant differences were found (P < 0.05). The sport in which most patients could not achieve ideal recovery was mountain climbing. No revision cases occurred in the OWHTO group, while two revisions occurred in the UKA group. Conclusion Candidates for UKA should be chosen carefully and the current indications and contraindications raised by Goodfellow should be modified.

Unicompartmental knee arthroplasty versus high tibial osteotomy for medial knee osteoarthritis: A systematic review and meta-analysis

“…Among them, there were variation in the selection of outcome indicators and assessment system, and the results were inconsistent. Comparing with previous studies, half of the selected articles were from China (19 from 38 studies) [27][28][29][30][31][32][33][34][35][36] and half of them were updated publications in 2019 and 2020 (19 from 38 studies), [27][28][29][32][33][34][35][36] which were not at all or unfrequently discussed in other systemically quantitative analyses, resulting in obviously different comparison results. In contrast with the meta-analyses by Cao et al 15 Santoso et al 16 and Han et al 17 which observed no significant difference on knee function scores, in this study, higher WOMAC score was found after UKA compared with HTO indicating UKA may produce better functional outcome.…”

Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis

“…Fourteen studies with 1965 patients reported 176 subjects who underwent revision to TKA. [9,10,14,19,20,25,28,29,31,32,[37][38][39]41] The pooled data showed that the OR for the revision rate was 1.70 (95% CI: 0.74-3.91, I 2 = 73%, P = .21; Fig. 4), and there was no significant difference between the 2 groups.…”

“…[13,14,18,19,[21][22][23]26,30,32,33,35,41] Different assessment systems have been used to assess pain. Based on the available data, 7 studies [18,19,21,23,26,35,41] included information on postoperative pain, which was assessed by the visual analogue scale (VAS). [42] The present analysis showed no statistically significant difference between the 2 groups (MD, 0.39, 95% CI: −0.01 to 0.79, I 2 = 91%, P = .06; Fig.…”

A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea

“…Most patients with knee osteoarthritis(OA) have lesions limited to the medial compartment, and high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for this condition [ 1 – 3 ]. HTO and UKA, which are often performed as primary surgeries in medial knee OA, report good results as the ultimate treatment for OA with an added advantage of delaying conversion to total knee arthroplasty (TKA) [ 4 , 5 ].…”

“…However, to date, considering which of the two surgical methods to choose remains controversial, comparing long-term survival rates and surgical outcomes [ 6 – 8 ] In particular, when selecting a surgical method for patients in their 50 s and 60 s, there are many considerations. [ 3 , 9 – 11 ]. Both HTO and UKA have the advantage of saving native joint spaces, but there are some differences in surgical techniques and indications.…”