Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: A 22-year population-based study

Abstract

Purpose Both tibial and femoral osteotomies have been used for the treatment of knee osteoarthritis (OA). Due to the clinical success of total knee arthroplasty (TKA) the current role and incidence of osteotomies remains unknown. The aim of this population-based study was to assess the incidence of osteotomies and compare it with that of knee arthroplasties. Methods From the Finnish National Hospital Discharge Register, we identified all patients, aged 18 years or more, who had undergone osteotomy for the treatment of knee OA between 1987 and 2008. The number of arthroplasties was extracted from the Arthroplasty Register. Results A total of 6,004 osteotomies were performed for 5,734 patients. The average osteotomy incidence has steadily decreased by 6.2%, and TKA incidence has increased by 9.8% annually. However, in patients aged less than 50 years the osteotomy incidence has increased by 1.4% annually. The decline of osteotomy incidence has been steeper in females than in males (9.0% vs. 3.6%), and during the last decade osteotomies were more commonly performed in male patients. ConclusionIncidence of osteotomies for the treatment of knee OA has decreased during last two decades. However, in patients aged less than 50 years the osteotomy incidence has slightly increased. In a comparison by gender, females are more likely to undergo arthoplasty than osteotomy, and it would therefore appear that the current use of osteotomies is predominantly reserved for the treatment of knee OA in relatively young males.

Trends in High Tibial Osteotomy and Knee Arthroplasty Utilizations and Demographics in Korea From 2009 to 2013

“…In addition, the utilization of HTO was more than twice that of UKA in 2013. These findings do not concur with recent Western studies reporting the higher use of UKA compared with HTO [18,35]. The reasons why the use of HTO in Korea is larger than that of UKA is unclear, but this finding may be the result of a higher prevalence of varus knee alignment which might be more appropriate indication for HTO in Asian compared with Western population [30][31][32][36][37][38].…”

“…Of the 23 identified nationwide registries, 16 were excluded because of unavailable information or using their own languages. After exclusion, there were seven TKA registries: one North American, two Oceanian, and four European registries, in the final analysis [21][22][23][24][25][26]35]. Full reports were reviewed by one of the authors (H.S.Y.).…”

Reduced survival of total knee arthroplasty after previous unicompartmental knee arthroplasty compared with previous high tibial osteotomy: a propensity-score weighted mid-term cohort study based on 2,133 observations from the Danish Knee Arthroplasty Registry

“…More specifically, the risk of revision more than doubled when TKA was preceded by UKA compared with HTO. During recent years, UKA has gained popularity while the use of HTO has decreased, indicating a trend towards treating patients with UKA instead of HTO (Niinimäki et al 2012, Henkel et al 2019. While both UKAs and HTOs relieve pain, the procedures differ.…”

High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis

“…With the rise of knee arthroplasty (KA) surgery in the 1970s, use of these procedures declined rapidly [4, 5] as osteotomies were considered more demanding than KA and the outcomes and complications less predictable [4]. However, KAs clearly also have their limitations, especially for younger patients in terms of the low percentage of patients returning to high-impact activities, and the possible higher risk of polyethylene wear if they do [6, 7].…”