Long-term Outcomes of High Tibial Osteotomy vs. Unicompartmental Knee Arthroplasty: A Retrospective Study

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Abstract

AbstractBackground:High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are surgical interventions commonly used for medial compartment knee osteoarthritis. Despite their widespread use, there remains uncertainty regarding their comparative effectiveness and long-term outcomes.This study aimed to retrospectively compare HTO and UKA surgeries in terms of clinical, radiological, survival, revision implants, and complications.MethodA retrospective evaluation was conducted on 51 HTO and 87 UKA patients operated on between 2004 and 2014, with an average follow-up period of 11.3 years. Patients were compared clinically using the Oxford Knee Score (OKS) and radiologically using the hip-knee-ankle angle (HKA) values at postoperative year 1 and at the final follow-up. In addition, both techniques were compared in terms of survival rates, complication rates, and the materials used when revisions were necessary.ResultNo significant difference was observed in the OKS values between HTO and UKA at postoperative year 1 and at the final follow-up. It was observed that HTO corrected the alignment better initially, but in the final follow-up, both surgeries showed a recurrence of alignment deviation towards varus. In comparison to UKA, HTO surgery exhibited a higher complication rate; however, there was no statistically significant difference between the two surgeries (15.4% vs 9.2%, p=0.284). However, in UKA patients, the need for revision to total knee arthroplasy (TKA) was notable when complications arose. There was no statistical difference in survival rates between the two surgical techniques. The 5, 10, and 15-year survival rates for HTO and UKA were found to be 96%, 82%, 61% and 91%, 83%, 74%, respectively. Significantly, there was a greater need for tibial stem in revision cases of UKA patients. (42,1% vs 0% p<0,001).ConclusionBoth surgical techniques yield similar results in terms of clinical outcomes, survival, and complication development. However, when complications occur in UKA, there may be a need for revision to TKA, and UKA patients may require a tibial stem during TKA revision.