Effectiveness of concurrent procedures during high tibial osteotomy for medial compartment osteoarthritis: a systematic review and meta-analysis

Lee, O-Sung; Ahn, Soyeon; Ahn, Jin Hwan; Teo, Seow Hui; Lee, Yong Seuk

doi:10.1007/s00402-017-2826-4

Cited by 41 publications

(32 citation statements)

References 19 publications

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“…These treatments have been applied in regular care for a long time and have been evaluated extensively. [4][5][6][7] Unicompartmental knee arthroplasty is an option in unilateral OA as well. A newer joint-preserving treatment for knee OA is knee joint distraction (KJD).…”

Section: Introductionmentioning

confidence: 99%

Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

et al. 2020

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Objective Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. Design MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. Results Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. Conclusions Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.

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Section: Introductionmentioning

confidence: 99%

Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

et al. 2020

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“…The pooled results of our analysis indicated that the medium-and long-term clinical outcomes were not related to the arthroscopic and histologic outcomes, this question was also mentioned by several studies, 17,33,34 the reason maybe as follows: First, the mechanical properties and durability of neoformative cartilage are different from healthy hyaline cartilage. Second, it is probable that growth of repair cartilage after marrow stimulation progresses slowly and it will take more than 5 years.…”

Section: Discussionmentioning

confidence: 56%

“…10 To improve the longterm outcomes many cartilage repair procedures appeared, such as microfractures (MFs) and autologous chondrocyte implantation (ACI). 11 Some researcher reported that cartilage repair procedures had a significant effect on cartilage regeneration and improved clinical outcomes obviously, [12][13][14][15] while some authors reported that the procedures have little beneficial effect on cartilage regeneration or clinical outcomes, 16,17 even had an opposite effect. 10 Therefore, whether we should perform cartilage repair procedures during HTO for osteoarthritic knee is controversial.…”

mentioning

confidence: 99%

Effectiveness of High Tibial Osteotomy with or without Other Procedures for Medial Compartment Osteoarthritis of Knee: An Update Meta-Analysis

Yao

Liu

et al. 2020

J Knee Surg

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To improve the long-term outcomes of high tibial osteotomy (HTO) for gonarthritis, many cartilage repair procedures appeared, but their effects were controversial. To evaluate the efficacy of cartilage repair procedures during HTO for gonarthritis, we performed this update meta-analysis. We performed the system retrieval for clinical trials using various databases and then pooled the outcomes of the included studies. Fifteen studies were involved. The pooled results indicated that there were no significant differences in Kellgren and Lawrence (KL) scale (mean difference [MD] = 0.02, 95% confidence interval [CI] = −0.01 to 0.06, p = 0.24), the femorotibial angle (MD = 0.06, 95% CI = −0.04 to 0.16, p = 0.22), and magnetic resonance imaging (MRI) outcomes (MD = 12.53, 95% CI = −2.26 to 27.32, p = 0.10) of patients in experimental group than control. The subgroup analysis showed that the clinical outcomes of abrasion arthroplasty (AA) were worse than control group (standardized mean difference [SMD] −2.65, 95% CI = −3.67 to −1.63, p < 0.001), while mesenchymal stem cells (MSCs) injection improved the clinical outcomes (SMD = 2.37, 95% CI = 1.25–3.50, p < 0.001). There were significant differences between the two groups in arthroscopic (SMD = 1.38, 95% CI = 0.82–1.94, p < 0.001) and histologic results (relative risk [RR] = 1.77, 95% CI = 1.36–2.29, p < 0.001). The pain relief (MD = 0.17, 95% CI = −3.26 to 3.61, p = 0.92) and operative complications (RR = 1.42, 95% CI = 0.83–2.42; p = 0.19) of the two groups had no significant differences. Our analysis supports that concurrent cartilage repair procedures might improve arthroscopic and histologic outcomes, but they have no beneficial effect on clinical outcomes, radiograph, MRI, and pain relief. The concurrent procedures do not increase the risk of operative complication. Furthermore, MSC has some beneficial effects on clinical outcomes, while AA might play an opposite role.

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“…However, osteoarthritis progression may occur with a long term follow-up, and requiring conversion to TKA [30][31][32]. In addition, a systematic review and meta-analysis [33] found the HTO with concurrent cartilage procedures such as marrow stimulation procedure, mesenchymal stem cell transplantation, and injection were performed, but the concurrent procedures would produce little beneficial effect regarding clinical and radiological outcomes compared with HTO alone. In the included studies, the mean time interval between HTO and TKA ranged from 58 to 150 months (Table 1), which suggests that HTO is still a successful and reliable treatment method for unicompartmental knee osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty

Sun

Wang

2020

Arch Orthop Trauma Surg

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Background This study was performed to compare the clinical and radiographic outcomes of total knee arthroplasty (TKA) following high tibial osteotomy (HTO) versus primary TKA. Methods Relevant trials were identified via a search of Ovid, PubMed and the Cochrane Central Register of Controlled Trials from inception to 10 January 2019. A meta-analysis was performed to compare postoperative outcomes between revising HTO to TKA (RHTO) and primary TKA (PTKA) with respect to Knee Society Score (KSS), 10-year survival rate, operative time, flexion and extension angle, infection rate and radiographic results. Results Sixteen of 340 studies involving 103,552 adult patients (RHTO group, n = 3955; PTKA group, n = 99,597) were eligible for inclusion in the meta-analysis. Compared with primary TKA, revising HTO to TKA required longer operative time and had a higher infection rate (P < 0.05). The PTKA group had better flexion angle than the RHTO group (P < 0.05). There were no significant differences between the two groups in the KSS, extension angle, radiographic results and 10-year survival rate (P > 0.05). Conclusion Patients who undergo conversion of HTO to TKA have similar 10-year survival rate, KSS, extension angle and radiographic results as patients who undergo primary TKA. However, conversion of HTO to TKA required longer operative time and had a higher infection rate than performing primary TKA. Moreover, conversion of HTO to TKA is associated with poorer flexion angle than primary TKA.

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Effectiveness of concurrent procedures during high tibial osteotomy for medial compartment osteoarthritis: a systematic review and meta-analysis

Cited by 41 publications

References 19 publications

Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

Effectiveness of High Tibial Osteotomy with or without Other Procedures for Medial Compartment Osteoarthritis of Knee: An Update Meta-Analysis

A meta-analysis of total knee arthroplasty following high tibial osteotomy versus primary total knee arthroplasty

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