High tibial osteotomy with an external fixator or unicompartmental knee arthroplasty for varus knee in young patients?

Amit Kumar Yadav; Mangal Parihar; Ilaria Mariani; Riccardo Giorgino; Laura Mangiavini; Nicola Ursino; Riccardo D'Ambrosi

doi:10.1016/j.jor.2022.09.006

High tibial osteotomy with an external fixator or unicompartmental knee arthroplasty for varus knee in young patients?

J Orthop. 2022 Sep 13:34:254-259. doi: 10.1016/j.jor.2022.09.006. eCollection 2022 Nov-Dec.

Authors

Amit Kumar Yadav¹, Mangal Parihar², Ilaria Mariani³, Riccardo Giorgino^{4

5}, Laura Mangiavini^{4

5}, Nicola Ursino⁴, Riccardo D'Ambrosi^{4

5}

Affiliations

¹ Sir HN Reliance Foundation Hospital and Research Center, Mumbai, India.
² Mangal Ananad Hospital, Swastik Park Chembur East, Mumbai, Maharashtra, India.
³ Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
⁴ IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
⁵ Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy.

Abstract

Purpose: This study compares the functional results and survivorship of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with an external fixator for medial compartment osteoarthritis (OA) of the knee.

Methods: Two cohorts of patients aged less than 60 years who had undergone either a cemented medial mobile-bearing UKA or an HTO with an external fixator were included in the study. The first cohort included patients undergoing a series of 197 consecutive medial UKA procedures (UKA group). The second cohort consisted of 60 consecutive patients undergoing HTO with an external fixator (HTO group). Each patient was assessed based on the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Subjective International Knee Documentation Committee (IKDC) score/questionnaire. A clinical evaluation was conducted on the day of the surgery (T₀) and at the follow-up visit (T₁) (minimum follow-up time was 60 months). Complications and failures resulting from the surgery were recorded for each patient.

Results: Only the age of the patients at the pre-operative time differed significantly between the two groups, with the HTO group being significantly younger (47.7 ± 8.0 versus 55.8 ± 2.2).After the final follow-up visit, all scores improved in both groups (p < 0.05).IKDC and Oxford scores were higher for the UKA group (p < 0.05). In the HTO group, three complications occurred (5%), including two superficial infections and one deep infection. On the other hand, the UKA group reported four complications (2%): three aseptic mobilisations and one infection requiring revision surgery. There was no difference in the complication rate between the two groups (p = 0.208).

Conclusions: In young patients (<60 years) with an isolated medial knee OA, both HTO and UKA led to good to excellent clinical results with a low rate of complications at mid-term follow-up; both surgical procedures may be considered in this patient population.

Level of evidence: Level III.

Keywords: High tibial osteotomy; IKDC; Medial knee osteoarthritis; Oxford knee score; Unicompartmental knee arthroplasty.