Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy.

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Abstract

[Indexed for MEDLINE] 4. World J Orthop. 2024 May 18;15(5):444-456. doi: 10.5312/wjo.v15.i5.444. eCollection 2024 May 18. Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes. Wyatt FW(1)(2), Al-Dadah O(1)(3). Author information: (1)Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom. (2)Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom. frederick.wyatt2@northumbria-healthcare.nhs.uk. (3)Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom. BACKGROUND: Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis. However, which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate. Simultaneously, there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes, preoperatively and following HTO or UKA. AIM: To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis: Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this. METHODS: This longitudinal observational study assessed a total of 42 patients that had undergone UKA (n = 23) and HTO (n = 19) to treat medial compartment knee osteoarthritis. Patient-reported outcome measures (PROMs) were collected to evaluate clinical outcome. These included two disease-specific (Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score) and two generic (EQ-5D-5L, Short Form-12) PROMs. The radiographic parameters of knee alignment assessed were the: Hip-knee-ankle angle, mechanical axis deviation and angle of Mikulicz line. RESULTS: Statistical analyses demonstrated significant (P < 0.001), preoperative to postoperative, improvements in the PROM scores of both groups. There were, however, no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group. Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively (P < 0.05). Postoperatively, two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters (hip-knee-ankle angle, mechanical axis deviation) within the HTO group; yet no such associations were observed within the UKA group. CONCLUSION: UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis. Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively; however, a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively. ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved. DOI: 10.5312/wjo.v15.i5.444 PMCID: PMC11145972