Distal femoral osteotomy versus lateral unicompartmental arthroplasty for isolated lateral tibiofemoral osteoarthritis with intra-articular and extra-articular deformity: a propensity score-matched analysis

Abstract

Purpose Lateral unicompartmental arthroplasty (UKA) and distal femoral osteotomy (DFO) represent surgical solutions in cases of valgus malalignment and isolated lateral osteoarthritis (OA) of the knee. The aim of the present study was to assess the clinical results, complications, and the overall postoperative alignment of a series of DFO and lateral UKA with a minimum 2-year follow-up in active middle-aged patients. Methods Patients with valgus knee and isolated lateral OA who underwent opening-wedge DFO or UKA from 2017 to 2019 were reviewed. Each patient was characterized by a joint line convergence angle (JLCA) > 3° and mechanical lateral distal femoral angle (mLDFA) < 87°. We excluded patients who underwent meniscus or osteochondral allograft during DFO. The Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), complications, and postoperative alignment were assessed. Propensity score matching was used to identify comparable patients. Results The DFO and lateral UKA groups consisted of 29 patients each. No statistically significant differences in gender, age, body mass index (BMI), length of follow-up, or limb deformity were reported between the two groups. In the DFO group, OKS was reported to improve from 27.51 to 38.59 (p < 0.05) and KOOS from 51.14 to 67.2 (p < 0.05). Similarly, in the UKA group, OKS improved from 26.23 to 35.43 (p < 0.05) and KOOS from 50.12 to 65.91 (p < 0.05). However, the improvement in OKS and KOOS (delta) did not differ between groups (p = 0.35 and p = 0.95). The DFO and UKA groups were characterized by similar postoperative hip-knee-ankle (HKA) angle measurements of −3.26 and −3.00, respectively (p = 0.65). No patients in the UKA group underwent revision or other knee surgeries during follow-up. No infections were detected in either group. In the DFO group, no cases of nonunion or delayed union were reported. However, 40% of DFO patients underwent plate removal. One patient in each group was characterized by progression of medial OA with Kellgren-Lawrence (KL) grade > 3. Conclusion UKA and DFO represent an effective treatment in lateral knee OA with intra-articular and extra-articular deformity. Both surgeries were able to provide a significant and comparable clinical improvement. Level of evidence: III, comparative retrospective cohort study.

Long‐Term Survival and Predictors of Failure of Opening Wedge High Tibial Osteotomy

“…Information was obtained on any operations on their knee after the HTO procedure, their nature, and the time interval since the index procedure. The mean length of follow-up in the responders was 11.6 years (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Table 1 summarizes the characteristics of patients.…”

“…Although the widespread use of total knee arthroplasty (TKA) has led to a decline in HTO, this procedure has been recently shown to be cost‐effective compared to knee arthroplasty in patients aged 40–60 years with medial OA of the knee 3 . Indeed, the revision rate of TKA in younger, active patients is higher in comparison with older patients 4–7 due to high mechanical stress on the implant. Moreover, a significant number of younger patients reports dissatisfaction with the functional outcome after TKA 8–11 .…”

Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

“…The hip knee ankle angle (HKA) was defined as the angle between the femoral and tibial mechanical axes on an orthoroentgenogram 18 . Detailed analyses of the AP and lateral radiographs were performed to evaluate the positions of the components with α, β, and γ angles using the Knee Society radiological evaluation 19 .…”

Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study

“…In the last 20 years, isolated unicompartmental osteoarthritis has increasingly been treated by unicompartmental knee arthroplasty (UKA), which has a faster short-term recovery and reduced postoperative pain and morbidity than total knee arthroplasty [ 1 , 2 ]. In the past decade, fast-track protocols have been introduced in clinical and care pathways for elective joint replacement [ 3 , 4 ].…”