A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea

Abstract

Background Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, over the past 20 years, results of comparisons of long-term survival rates and outcomes have remained controversial. Furthermore, in patients at the boundary age, from 50 to 70 years, considering age as a treatment indication, selecting a surgical method is difficult. Therefore, we aimed to investigate conversion rates to total knee arthroplasty (TKA) and perioperative adverse outcomes between the two surgical methods in mid-age patients. Methods We extracted data from the Korean National Health Insurance claims database. A total of 70,464 patients aged between 50 and 70 years, considered as mid-age patients were included in the final study population. We used a multivariable Cox proportional hazard regression model, adjusting for potential confounders such as age, sex, insurance type, region of residence, hospital type, comorbidities, and the Charlson comorbidity Index (CCI). Results Of the 70,464 patients, 21,194 were treated with UKA and 49,270 were treated with HTO. HTO showed a higher risk of revision than UKA at five, and 10 years and during the whole observation period. The incidence of deep vein thromboembolism, and surgical site infection was significantly higher in UKA than in HTO. Conclusions It is important to choose an appropriate surgical method considering that UKA has better results in terms of long-term survival rates but may have a higher incidence of various complications.

Comparison of Early Complication Rates After High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Knee Osteoarthritis

“…13,42 In a study of 70,464 patients aged between 50 and 70 years from the Korean National Health Insurance claims database, HTO showed a higher risk of reoperation than UKA at 10-year follow-up, while postoperative DVT and SSI were significantly higher in UKA than in HTO. 19 A retrospective comparative study including patients from the Military Health System also demonstrated that HTO was associated with a higher reoperation rate when compared with UKA. 27 Stukenborg-Colsman et al 36 conducted one of the few relevant randomized controlled trials that can be identified in the literature, comparing 32 patients treated with HTO and 28 patients treated with UKA, and concluded that HTO was associated with more intraoperative and postoperative complications.…”

High tibial osteotomy versus unicompartmental knee arthroplasty for Kellgren–Lawrence grade 3–4 knee osteoarthritis in younger patients: comparable improvements in patient‐reported outcomes, adjusted for osteoarthritis grade and sex

“…Also, postoperative recovery is generally quicker after UKA than HTO [ 23 ]. For postoperative complications, several reviews report lower rates after UKA [ 6 , 14 , 34 ], although a 2022 South Korean registry study including 21,194 UKAs and 49,270 HTOs found higher rates of deep venous thrombosis and surgical site infection after UKA [ 25 ]. Complications found in both groups in the present study are comparable to those reported in other studies.…”