Unicompartmental knee arthroplasty versus High tibial osteotomy in treatment of isolated medial compartment Osteoarthritis of knee: A Systematic Review and MetaAnalysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim Mostafa El-Ganzoury ◽  
Zeiad Mohamed Zakaria ◽  
Ahmed Elsayed ◽  
Abd Ellah Elwarwary
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Meta Analysis ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Medial Compartment Osteoarthritis ◽  
Total Knee

Abstract Background Several surgical procedures have been mentioned to treat medial compartment osteoarthritis (OA), as total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO). Objectives The aim of the study is a systematic review & meta analysis conducted to compare the outcomes between UKA & HTO in different types of patients diagnosed as an isolated medial compartment OA who treated with UKA or HTO and statistically compare between their results of pain, range of motion, complications, and i ncidence of revision to TKA using studies published between 2009 to 2019 from any country. Patients and Methods The review will be restricted to Randomized controlled trials (RCTs), clinical trials, and comparative studies, either prospective or retrospective, which studied the outcome of HTO versus UKA of isolated medial compartment osteoarthritis patients, articles published in English &published during 2009 to 2019. Results About 150 articles were found using search keywords. By filtration and screening of the title and exclusion of unrelated articles, about 60 articles were found. By applications of all inclusion and exclusion criteria, only 12 articles were fit to undergo this meta-analysis. Conclusion In conclusion, there were no significant differences in the pain score, knee score, complication rate and revision rate to TKA between HTO and UKA, while the HTO group manifested superior ROM compared to the UKA group. So, HTO may be convenient for patients with high activity requirements. Over time, both groups exhibited increased revision rates with the deteriorated clinical outcomes. Therefore when deciding on a therapeutic plan, the ability to revise these failed choices of treatment to a total knee arthroplasty should be a major consideration. This may assist surgeons in their choice. Based on the findings of current meta-analysis, it appears that the two groups have the same efficiency and safety in the treatment of medial knee OA.

Similar Outcome, but Different Surgical Requirement in Conversion Total Knee Arthroplasty following High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Meta-Analysis

2018 ◽  
Vol 32 (07) ◽  
pp. 686-700 ◽  
Author(s):  
Yong Seuk Lee ◽  
Hyun Jung Kim ◽  
Su Jung Mok ◽  
O-Sung Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Meta Analysis ◽  
Quality Data ◽  
Tibial Osteotomy ◽  
Unicompartmental Knee ◽  
Surgical Data ◽  
Total Knee

AbstractThe present systematic review and meta-analysis were conducted to find out how effective any subsequent conversion total knee arthroplasty (TKA) would be after unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) and which is better in outcomes. A rigorous and systematic approach was used. Each of the selected studies was evaluated for methodological quality. Data were extracted by the following standardized protocol: study design, level of evidence, cases enrolled, age, sex ratio, follow-up, kind of index surgery, type of index surgery, average time to failure, mode of failure, surgical data, preclinical score, post-clinical score, and major related complications. Nineteen articles were included in the final analysis. In conversion TKA following UKA, revision components (metal augment, bone graft, and stem) were frequently used, and thicker polyethylene was used comparing to the primary TKA. In the conversion TKA following HTO, only stem was more common (relative risk of revision component UKA:HTO = 0.57:0.07). The estimated range of motions (ROM) of conversion TKA following HTO and UKA was 107.75° (101.93–113.58°) and 111.84° (108.41–115.26°), respectively (p > 0.05). The knee scores of conversion TKA following HTO and UKA were 89.10 (86.45, 91.75) and 85.48 (79.82, 91.14), respectively (p > 0.05). The function scores were 78.60 (72.44, 84.76) and 75.60 (69.85, 81.35), respectively (p > 0.05). Clinical outcome was similar between conversion TKA following HTO and UKA. However, conversion TKA after UKA required more revision components and thicker polyethylene, while conversion TKA after HTO sometimes required a stem to bypass the osteotomy gap.

Cost-Effectiveness Analysis of Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Treatment of Medial Compartmental Osteoarthritis

2011 ◽  
Vol 1 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Christopher A Brown ◽  
Tyler S Watters ◽  
Richard C Mather ◽  
Lori A Orlando
Keyword(s):  
Cost Effectiveness ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Decision Model ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Medial Compartment Osteoarthritis ◽  
Markov Decision ◽  
Markov Decision Model

ABSTRACT Background Interest in unicompartmental knee arthroplasty (UKA) has recently increased in the United States concomitantly with an increase in the prevalence of physiologically active patients presenting with medial compartment osteoarthritis. This study examined the cost-effectiveness of UKA compared with high tibial osteotomy (HTO) in patients with medial compartment osteoarthritis. Methods A Markov decision model was constructed with review of literature to conduct a cost-utility analysis of UKA as compared to HTO in a patient population aged 40 years at the time of surgical intervention. Utility values were assigned to health states annually based on the commonly accepted reference values of 1 being “full health” and 0 being “death”. These values are used to estimate quality-adjusted life years (QALYs). The Markov decision model was used to evaluate the total accumulated costs and effectiveness, measured in QALYs. Results The average cost of the UKA was cheaper by $842 and resulted in a significant incremental effectiveness gain compared to HTO (+ 0.96 QALY). UKA gained 20.05 QALY at a cost-effectiveness (C/E) ratio of $1048/QALY, whereas HTO gained 19.09 QALY at a C/E ratio of $1145/QALY. Conclusion Both UKA and HTO are cost-effective procedures but patients treated with UKA may experience an increased net health benefit over their lifetime. Level of evidence Economic and decision analysis level II.

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