Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2017

Open Access 01-12-2017 | Research article

Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review

Authors: Marcel Budhi Santoso, Lidong Wu

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2017

Login to get access

Abstract

Background

Debate remains whether high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA) is more beneficial for the treatment of unicompartmental knee osteoarthritis. The purpose of this study was to compare the functional results, knee scores, activity levels, and complications between the two procedures.

Methods

We performed a systematic review of published literature from August 1982 through January 2017. Fifteen papers reporting three prospective randomized trials were subjected to a meta-analysis.

Results

No significant difference between the two groups was noted with respect to free walking (velocity), knee score, deterioration of the contralateral or patellofemoral knee, or revision rate and total knee arthroplasty. However, UKA produced better outcomes compared to HTO in terms of the functional results, pain assessment, and complications, although patients who underwent HTO tended to have slightly better range of motion.

Conclusions

Valgus HTO provides better physical activity for younger patients whereas UKA is more suitable for older patients due to shorter rehabilitation time and faster functional recovery. Although UKA patients tended to have improved overall long-term outcomes, which may be due to accurate indications and patient selection, both treatment options yielded pleasing results. Therefore, we are unable to conclude that either method is superior.
Literature
1.
go back to reference Jackson JP. Osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br). 1958;40:826. Jackson JP. Osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br). 1958;40:826.
2.
go back to reference Gaasbeek R, Welsing R, Marink M, Verdonschot N, van Kampen A. The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2007;5:978–84.CrossRef Gaasbeek R, Welsing R, Marink M, Verdonschot N, van Kampen A. The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2007;5:978–84.CrossRef
3.
go back to reference Hohmann E, Bryant A. Closing or opening wedge high tibial osteotomy: watch out for the slope. Orth Tech Orthop. 2007;17:38–45.CrossRef Hohmann E, Bryant A. Closing or opening wedge high tibial osteotomy: watch out for the slope. Orth Tech Orthop. 2007;17:38–45.CrossRef
4.
go back to reference Insall J, Aglietti P. A 5- to 7-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am. 1980;62:1329.CrossRefPubMed Insall J, Aglietti P. A 5- to 7-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am. 1980;62:1329.CrossRefPubMed
5.
go back to reference Ivarsson I, Gillquist J. Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty: a comparative study. Clin Orthop Relat Res. 1991;266:139. Ivarsson I, Gillquist J. Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty: a comparative study. Clin Orthop Relat Res. 1991;266:139.
7.
go back to reference Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719.PubMed Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719.PubMed
8.
go back to reference Karpman RR, Volz RG. Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee. Orthopedics. 1982;5(8):989.PubMed Karpman RR, Volz RG. Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee. Orthopedics. 1982;5(8):989.PubMed
9.
go back to reference Broughton NS, Newman JH, Baily RA. Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5–10 years’ follow-up. J Bone Joint Surg (Br). 1986;68(3):447. Broughton NS, Newman JH, Baily RA. Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5–10 years’ follow-up. J Bone Joint Surg (Br). 1986;68(3):447.
10.
go back to reference Jefferson RJ, Whittle MW. Biomechanical assessment of unicompartmental knee arthroplasty, total condylar arthroplasty and tibial osteotomy. Clin Biomech. 1989;4(4):232.CrossRef Jefferson RJ, Whittle MW. Biomechanical assessment of unicompartmental knee arthroplasty, total condylar arthroplasty and tibial osteotomy. Clin Biomech. 1989;4(4):232.CrossRef
11.
go back to reference Weale AE, Newman JH. Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. Clin Orthop Relat Res. 1994;302:134. Weale AE, Newman JH. Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. Clin Orthop Relat Res. 1994;302:134.
12.
go back to reference Stukenbor C, Wirth CJ, Lazovic D, et al. High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 710-year follow-up prospective randomised study. Knee. 2001;8:187.CrossRef Stukenbor C, Wirth CJ, Lazovic D, et al. High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 710-year follow-up prospective randomised study. Knee. 2001;8:187.CrossRef
14.
go back to reference Dettoni F, Maistrelli GL, Rossi P, et al. UKA versus HTO: clinical results at short term follow up. 75th AAOS Annual Meeting. 2008. San Francisco, CA; 2008. Dettoni F, Maistrelli GL, Rossi P, et al. UKA versus HTO: clinical results at short term follow up. 75th AAOS Annual Meeting. 2008. San Francisco, CA; 2008.
15.
go back to reference Takeuchi R, Umemoto Y, Aratake M, et al. A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee. J Orthop Surg Res. 2010;5:65.CrossRefPubMedPubMedCentral Takeuchi R, Umemoto Y, Aratake M, et al. A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee. J Orthop Surg Res. 2010;5:65.CrossRefPubMedPubMedCentral
17.
go back to reference Yim JH, Song EK, Seo HY, et al. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum follow-up of 3 years. J Arthroplasty. 2013;28(2):243.CrossRefPubMed Yim JH, Song EK, Seo HY, et al. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum follow-up of 3 years. J Arthroplasty. 2013;28(2):243.CrossRefPubMed
18.
go back to reference Karamitev S, Stavrev VP, Chifligarov AG. Comparative analysis of the result obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis. Folia Med. 2014;56(1):11–9. doi:10.2478/folmed-2014-0002. Karamitev S, Stavrev VP, Chifligarov AG. Comparative analysis of the result obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis. Folia Med. 2014;56(1):11–9. doi:10.​2478/​folmed-2014-0002.
19.
go back to reference Tuncay I, Bilsel K, Elmadag M, et al. Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis. Acta Orthop Traumatol Turc. 2015;49(3):280–7. doi:10.3944/AOTT.2015.14.0320.PubMed Tuncay I, Bilsel K, Elmadag M, et al. Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis. Acta Orthop Traumatol Turc. 2015;49(3):280–7. doi:10.​3944/​AOTT.​2015.​14.​0320.PubMed
21.
go back to reference Krych AJ, Reardon P, Sousa P, Pagnano M, et al. Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7 years. J Bone Joint Surg Am. 2017;99:113–22. doi:10.2106/JBJS.15.01031.CrossRefPubMed Krych AJ, Reardon P, Sousa P, Pagnano M, et al. Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7 years. J Bone Joint Surg Am. 2017;99:113–22. doi:10.​2106/​JBJS.​15.​01031.CrossRefPubMed
22.
go back to reference Ledingham J, Regan M, Jones A, et al. Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. Ann Rheum Dis. 1993;52:520–6.CrossRefPubMedPubMedCentral Ledingham J, Regan M, Jones A, et al. Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital. Ann Rheum Dis. 1993;52:520–6.CrossRefPubMedPubMedCentral
23.
go back to reference Flecher X, Parratte S, Aubaniac JM, et al. A 12–28-year follow-up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91.CrossRefPubMed Flecher X, Parratte S, Aubaniac JM, et al. A 12–28-year follow-up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91.CrossRefPubMed
24.
go back to reference Gstottner M, Pedross F, Liebensteiner M, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008;128(1):111.PubMed Gstottner M, Pedross F, Liebensteiner M, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008;128(1):111.PubMed
25.
go back to reference Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg (Br). 2008;90(5):592–6.CrossRef Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg (Br). 2008;90(5):592–6.CrossRef
26.
go back to reference Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res. 1990;255:251. Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res. 1990;255:251.
27.
go back to reference Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop. 2010;34(2):155.CrossRefPubMed Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop. 2010;34(2):155.CrossRefPubMed
28.
go back to reference Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J Br. 2014;96(11):1491–7.CrossRef Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J Br. 2014;96(11):1491–7.CrossRef
29.
go back to reference Trieb K, Grohs J, Hanslik-schnabel B, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):149.CrossRefPubMed Trieb K, Grohs J, Hanslik-schnabel B, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):149.CrossRefPubMed
30.
go back to reference Dettoni F, Bonasia DE, Castoldi F, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Owa Orthop J. 2010;30:131. Dettoni F, Bonasia DE, Castoldi F, et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Owa Orthop J. 2010;30:131.
31.
32.
go back to reference Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg. 1978;60-A:182–5.CrossRef Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg. 1978;60-A:182–5.CrossRef
33.
go back to reference Tjörnstrand BA, Egund N, Hagstestedt B. High tibial osteotomy: a seven-year clinical and radiographic follow-up. Clin Orthop. 1981;160:124–36. Tjörnstrand BA, Egund N, Hagstestedt B. High tibial osteotomy: a seven-year clinical and radiographic follow-up. Clin Orthop. 1981;160:124–36.
34.
go back to reference Shoji H, Insall JN. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg. 1973;55-A:963–73.CrossRef Shoji H, Insall JN. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg. 1973;55-A:963–73.CrossRef
35.
go back to reference Kolb W, Guhlmann H, Windisch C, et al. Opening-wedge high tibial osteotomywith a locked low-profile plate. J Bone Joint Surg Am. 2009;91:2581.CrossRefPubMed Kolb W, Guhlmann H, Windisch C, et al. Opening-wedge high tibial osteotomywith a locked low-profile plate. J Bone Joint Surg Am. 2009;91:2581.CrossRefPubMed
36.
go back to reference Staubli AE, De Simoni C, Babst R, et al. TomoFix: a new LCP concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury. 2003;34 Suppl 2:B55.CrossRefPubMed Staubli AE, De Simoni C, Babst R, et al. TomoFix: a new LCP concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury. 2003;34 Suppl 2:B55.CrossRefPubMed
38.
39.
go back to reference Kozinn SC, Scott RD. Unicondylar knee arthroplasty. J Bone Joint Surg. 1989;71-A:145.CrossRef Kozinn SC, Scott RD. Unicondylar knee arthroplasty. J Bone Joint Surg. 1989;71-A:145.CrossRef
40.
go back to reference Marks R. Reliability and validity of self-paced walking time measures for knee osteoarthrosis. Arthritis Care Res. 1994;7(1):50–3.CrossRefPubMed Marks R. Reliability and validity of self-paced walking time measures for knee osteoarthrosis. Arthritis Care Res. 1994;7(1):50–3.CrossRefPubMed
41.
go back to reference Fransen M, Crosbie J, Edmonds J. Reliability of gait measurements in people with osteoarthritis of the knee. Phys Ther. 1997;77(9):944–53.CrossRefPubMed Fransen M, Crosbie J, Edmonds J. Reliability of gait measurements in people with osteoarthritis of the knee. Phys Ther. 1997;77(9):944–53.CrossRefPubMed
42.
go back to reference Fu D, Li G, Chen K, Zhao Y, Hua Y, Cai Z. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplasty. 2013;28(5):759–65.CrossRefPubMed Fu D, Li G, Chen K, Zhao Y, Hua Y, Cai Z. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplasty. 2013;28(5):759–65.CrossRefPubMed
43.
go back to reference Bohannan RW, Williams Andrews A, Thomas MW. Walking speed: reference values and correlates for older adults. J Orthop Sports Phys Ther. 1996;24(2):86–9.CrossRef Bohannan RW, Williams Andrews A, Thomas MW. Walking speed: reference values and correlates for older adults. J Orthop Sports Phys Ther. 1996;24(2):86–9.CrossRef
44.
go back to reference Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69:332–54.CrossRefPubMed Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69:332–54.CrossRefPubMed
45.
go back to reference Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, et al. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closedwedge technique. J Bone Joint Surg (Br). 2005;87:1227.CrossRef Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, et al. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closedwedge technique. J Bone Joint Surg (Br). 2005;87:1227.CrossRef
46.
go back to reference Stoffel K, Willers C, Korshid O, et al. Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2007;15:1094.CrossRefPubMed Stoffel K, Willers C, Korshid O, et al. Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2007;15:1094.CrossRefPubMed
47.
go back to reference Spahn G, Hofmann GO, Engelhardt LV, et al. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21:96–112. doi:10.1007/s00167-011-1751-2.CrossRefPubMed Spahn G, Hofmann GO, Engelhardt LV, et al. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21:96–112. doi:10.​1007/​s00167-011-1751-2.CrossRefPubMed
48.
go back to reference Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy, a critical long term study of eighty-seven cases. J Bone Joint Surg Am. 1993;75:196–201.CrossRefPubMed Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy, a critical long term study of eighty-seven cases. J Bone Joint Surg Am. 1993;75:196–201.CrossRefPubMed
49.
go back to reference Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg (Br). 2008;90:1548–57.CrossRef Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg (Br). 2008;90:1548–57.CrossRef
50.
go back to reference Barrett WP, Scott RD. Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Joint Surg Am. 1987;69:1328.CrossRefPubMed Barrett WP, Scott RD. Revision of failed unicondylar unicompartmental knee arthroplasty. J Bone Joint Surg Am. 1987;69:1328.CrossRefPubMed
51.
go back to reference Cross MB, Paul YY, Moric M, et al. Revising an HTO or UKA to TKA: is it more like a primary TKA or a revision TKA? J Arthroplasty. 2014;29(2):229–31.CrossRefPubMed Cross MB, Paul YY, Moric M, et al. Revising an HTO or UKA to TKA: is it more like a primary TKA or a revision TKA? J Arthroplasty. 2014;29(2):229–31.CrossRefPubMed
52.
go back to reference Gill T, Schemitsch EH, Brick GW, et al. Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop Relat Res. 1995;321:10. Gill T, Schemitsch EH, Brick GW, et al. Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop Relat Res. 1995;321:10.
53.
go back to reference Robertsson O, Knutson K, Lewold S, Lidgren L. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg (Br). 2001;83(1):45–9.CrossRef Robertsson O, Knutson K, Lewold S, Lidgren L. The routine of surgical management reduces failure after unicompartmental knee arthroplasty. J Bone Joint Surg (Br). 2001;83(1):45–9.CrossRef
Metadata
Title
Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review
Authors
Marcel Budhi Santoso
Lidong Wu
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2017
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-017-0552-9

Other articles of this Issue 1/2017

Journal of Orthopaedic Surgery and Research 1/2017 Go to the issue