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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. Therefore, we conducted this systematic review and meta-analysis to compare the functional outcomes, complications, and revision 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% con dence interval (CI), using R software for windows.Results Twenty-ve 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]), poor functional results (excellent/good) (OR= 0.32, 95% CI [0.21, 0.49]), and larger range of motion (MD= 7.05, 95% CI [2.41,11.68]) compared to UKA. No signi cant differences were found between the compared groups in terms of VAS (MD= 0.14, 95% CI [-0.08, 0.36]), revision (OR= 1.30, 95% CI [0.65, 2.60]), and free walking speed (MD= -0.05, 95% CI [-0.11, 0.00]). ConclusionThis study showed that UKA achieved fewer complications, better functional outcomes, and less range of motion compared to HTO. No signi cant differences were detected between HTO and UKA in terms of VAS and revision rate.

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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. Therefore, we conducted this systematic review and meta-analysis to compare the functional outcomes, complications, and revision 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]), poor functional results (excellent/good) (OR= 0.32, 95% CI [0.21, 0.49]), and larger 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 (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.