High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Ishith Seth; Gabriella Bulloch; Nimish Seth; Damien Gibson; Anish Rastogi; Kirk Lower; Aaron Rodwell; Warwick Bruce

doi:10.1007/s43465-022-00620-9

High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Indian J Orthop. 2022 Mar 21;56(6):973-982. doi: 10.1007/s43465-022-00620-9. eCollection 2022 Jun.

Authors

Ishith Seth^{1

2}, Gabriella Bulloch³, Nimish Seth⁴, Damien Gibson¹, Anish Rastogi¹, Kirk Lower¹, Aaron Rodwell¹, Warwick Bruce⁵

Affiliations

¹ Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia.
² Department of Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC 3550 Australia.
³ Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, VIC 3004 Australia.
⁴ Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, VIC 3010 Australia.
⁵ Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW 2139 Australia.

Abstract

Purpose: High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are commonly performed procedures for the treatment of compartmental knee osteoarthritis; however, the optimal procedure remains controversial. We conducted this systematic review and meta-analysis to compare the functional outcomes and assess complications and revision rates between the two techniques.

Methods: We searched electronic databases for relevant studies comparing HTO versus UKA for unicompartmental knee osteoarthritis. Continuous data as visual analogue scale (VAS), range of motion, and free walking speed were pooled as mean differences (MDs). Dichotomous data as functional knee outcomes, complications, and revision were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software for windows.

Results: Twenty-five studies involving 8185 patients were included. Meta-analysis showed that HTO was associated with higher risk of complications (OR = 2.47, 95% CI [1.52, 4.04]), poorer functional results (excellent/good) (OR = 0.32, 95% CI [0.21, 0.49]), and greater range of motion (MD = 7.05, 95% CI [2.41, 11.68]) compared to UKA. No significant differences were found between the compared groups in terms of VAS (MD = 0.14, 95% CI [- 0.08, 0.36]), revision rates (OR = 1.30, 95% CI [0.65, 2.60]), and free walking speed (MD = - 0.05, 95% CI [- 0.11, 0.00]).

Conclusion: This study showed that UKA achieved fewer complications, better functional outcomes, and less range of motion compared to HTO. No significant differences were detected between HTO and UKA in terms of VAS and revision rate. Treatment options should be personalized to each patient considering factors such as their age, activities of daily living, their body mass index, and severity of osteoarthritis.

Level of evidence: II.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-022-00620-9.

Keywords: Compartmental knee osteoarthritis; High tibial osteotomy; Meta-analysis; Unicompartmental knee arthroplasty.