Editorial Commentary: High Tibial Osteotomy Is Effective, Even in Patients With Severe Osteoarthritis: Contradiction of Another Dogma From the Past

Schuster, Philipp; Richter, Joerg

doi:10.1016/j.arthro.2020.11.025

Arthroscopy: The Journal of Arthroscopic & Related Surgery

2021

DOI: 10.1016/j.arthro.2020.11.025

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Editorial Commentary: High Tibial Osteotomy Is Effective, Even in Patients With Severe Osteoarthritis: Contradiction of Another Dogma From the Past

Philipp Schuster

Joerg Richter²

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Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow‐up

Solaro,

Andriolo,

Di Martino

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to prospectively evaluate the long‐term clinical results and failure rate of patients treated with complex salvage procedures using a combined mechanical and biological approach to address unicompartmental knee osteoarthritis (OA) and postpone the need for joint replacement.MethodsThirty‐nine patients (40.3 ± 10.9 years old) affected by unicompartmental OA (Kellgren–Lawrence 3) in stable joints underwent a personalized surgical treatment depending on the specific requirements of the affected compartment, including high tibial osteotomy, osteochondral scaffold, meniscal scaffold and meniscal allograft transplantation. Patients were evaluated with the International Knee Documentation Committee (IKDC), Visual Analogue Scale (VAS) and Tegner scores before surgery, at 3 years and a minimum of 10 years of follow‐up.ResultsA significant improvement was observed over time in all scores but worsened at the final follow‐up. The IKDC subjective score improved from 46.9 ± 16.2 to 79.8 ± 16.4 at 3 years (p < 0.0005) and then decreased to 64.5 ± 21.4 (p = 0.001) at 12 years. A similar trend was confirmed for VAS and Tegner scores. Only two patients subsequently underwent knee arthroplasty, and nine more patients were considered clinical failure, for a cumulative surgical and clinical failure rate of 28.2% at the final follow‐up.ConclusionA personalized, joint‐preserving, combined mechanical and biological approach, addressing alignment as well as meniscal and cartilage lesions, is safe and effective, providing a clinical benefit and delaying the need for arthroplasty in young patients affected by unicompartmental knee OA. At the final evaluation, the clinical improvement decreased, but more than two‐thirds of the patients still benefited from this treatment at a long‐term follow‐up.Level of EvidenceLevel IV case series.

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Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow‐up

Solaro,

Andriolo,

Di Martino

et al. 2024

Knee surg. sports traumatol. arthrosc.

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High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review

Dal Fabbro,

Grassi,

Agostinone

et al. 2024

Arch Orthop Trauma Surg

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Introduction The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA. Methods A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score. Results A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 − 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up. Conclusion HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population. Level of evidence IV; systematic review of level III-IV studies.

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

Yadav

Parihar²,

Mariani

et al. 2022

Journal of Orthopaedics

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Editorial Commentary: High Tibial Osteotomy Is Effective, Even in Patients With Severe Osteoarthritis: Contradiction of Another Dogma From the Past

Cited by 5 publications

References 9 publications

Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow‐up

Unicompartmental osteoarthritis: High survival rate with a combined mechanical and biological salvage approach as alternative to metal resurfacing: Results at minimum 10 years of follow‐up

High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review

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

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