Unicompartmental Knee Osteoarthritis (UKOA): Unicompartmental Knee Arthroplasty (UKA) or High Tibial Osteotomy (HTO)?

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

Abstract

 
Background:
The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis.
 
Methods:
The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic.
Results:
In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years). However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done.
Conclusion:
The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty). However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies are needed in order to answer the question of this article.

Keywords


1. Mont MA, Stuchin SA, Paley D, Sharkey PF, Parvisi J,
Tria AJ Jr, et al. Different surgical options for mono�-
compartmental osteoarthritis of the knee: high tibial
osteotomy versus unicompartmental knee arthroplasty
versus total knee arthroplasty: indications,
techniques, results, and controversies. Instr Course
Lect. 2004; 53(1):265-83.
2. Karpman RR, Volz RG. Osteotomy versus unicompartmental
prosthetic replacement in the treatment
of unicompartmental arthritis of the knee. Orthopedics.
1982; 5(8):989-91.
3. Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer
A. High tibial osteotomy versus unicompartmental
joint replacement in unicompartmental knee joint
osteoarthritis: 7-10-year follow-up prospective randomised
study. Knee. 2001; 8(3):187-94.
4. Zhang QD, Guo WS, Liu ZH, Zhang Q, Cheng LM, Li ZR.
Meta-analysis of unicompartmental knee arthroplasty
versus high tibial osteotomy in the treatment of
unicompartmental knee osteoarthritis. Zhonghua Yi
Xue Za Zhi. 2009; 89(39):2768-72.
5. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna
D, Rossi R. High tibial osteotomy versus unicompartmental
knee arthroplasty for medial compartment
arthrosis of the knee: a review of the literature. Iowa
Orthop J. 2010; 30(1):131-40.
6. Yim JH, Song EK, Seo HY, Kim MS, Seon JK. Comparison
of high tibial osteotomy and unicompartmental
knee arthroplasty at a minimum follow-up of 3 years.
J Arthroplasty. 2013; 28(2):243-7.
7. 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.
8. Nwachukwu BU, McCormick FM, Schairer WW, Frank

RM, Provencher MT, Roche MW. Unicompartmental
knee arthroplasty versus high tibial osteotomy: United
States practice patterns for the surgical treatment
of unicompartmental arthritis. J Arthroplasty. 2014;
29(8):1586-9.
9. Lobenhoffer P, Agneskirchner JD. Osteotomy around
the knee vs. Unicondylar knee replacement. Orthopade.
2014; 43(10):923-9.
10. Brouwer RW, Jakma TS, Bierma-Zeinstra SM, Verhagen
AP, Verhaar J. Osteotomy for treating knee
osteoarthritis. Cochrane Database Syst Rev. 2005;
(1):CD004019.
11. Brouwer RW, Raaij van TM, Bierma-Zeinstra SM, Verhagen
AP, Jakma TS, Verhaar JA. Osteotomy for treating
knee osteoarthritis. Cochrane Database Syst Rev.
2007; (3):CD004019.
12. Brouwer RW, Huizinga MR, Duivenvoorden T, van
Raaij TM, Verhagen AP, Bierma-Zeinstra SM, et al.
Osteotomy for treating knee osteoarthritis. Cochrane
Database Syst Rev. 2014; 12:CD004019.
13. Kim SJ, Koh YG, Chun YM, Kim YC, Park YS, Sung CH. Medial
opening wedge high-tibial osteotomy using a kinematic
navigation system versus a conventional method:
a 1-year retrospective, comparative study. Knee Surg
Sports Traumatol Arthrosc. 2009; 17(2):128-34.
14. Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P,
Flecher X, et al. Posterior tibial slope changes after
opening- and closing-wedge high tibial osteotomy: a
comparative prospective multicenter study. Orthop
Traumatol Surg Res. 2012; 98(1):68-74.
15. Bastos Filho R, Magnussen RA, Duthon V, Demey G,
Servien E, Granjeiro JM, et al. Total knee arthroplasty
after high tibial osteotomy: a comparison of opening
and closing wedge osteotomy. Int Orthop. 2013;
37(3):427-31.
16. Atrey A, Morison Z, Tosounidis T, Tunggal J, Waddell
JP. Complications of closing wedge high tibial
osteotomies for unicompartmental osteoarthritis of
the knee. Bone Joint Res. 2012; 1(9):205-9.
17. King-Martí􀆴nez AC, Cuéllar-Avaroma A, Pérez-Correa
J, Torres-González R, Guevara-López U. High tibial
dome osteotomy complications in genu varum
patients. Rev Med Inst Mex Seguro Soc. 2007;
45(2):111-6.
18. Saragaglia D, Rouchy RC, Krayan A, Refaie R.
Return to sports after valgus osteotomy of the knee
joint in patients with medial unicompartmental
osteoarthritis. Int Orthop. 2014; 38(10):2109-14.