Knee OUTcome Study: A Comparison of the Patient Perceived Outcome between High Tibial Osteotomy, Unicompartmental and Total Knee Arthroplasty for Medial Compartment Osteoarthitis in Men under age 55.

Abstract

Objectives:Managing medial compartment osteoarthritis (OA) in the younger male patient is challenging because these patients tend to be physically high demand. Traditionally, High Tibial Osteotomy (HTO) has been the favoured surgical option, but Total (TKA) and Unicompartmental (UKA) knee arthroplasty have been more recently utilized. Our aims were to compare patient reported outcome, revision and reoperation rates with these 3 procedures.Methods:Using our hospital data bases we retrieved the details of male patients under 55 who had one of the 3 procedures performed between 2005-2013, for medial compartment OA by 6 knee surgeons in our group. All 6 surgeons used the 3 procedures in this cohort. The TKA database was analysed to exclude patients who did not meet the criteria for HTO/UKA of isolated medial OA. The 3 groups had their satisfaction assessed retrospectively using the Forgotten Joint Score (FJS), information on occupation, reoperation and duration of satisfaction were also questioned. Hospital records were reviewed for the reoperation and revision rate on all of the patients identified.Results:We identified 117 TKA in patients under 55, 27 TKA which met our criteria, 75 HTO (medial opening wedge) and 95 UKA (Oxford cementless). The mean followup periods for HTO/UKA/TKA were 8.1, 6.1, 7.5 years respectively. Of the HTO group, 19 (25%) were revised to TKA at a mean 4.8 years, 8 underwent reoperation for mal/nonunion, and 10 had reoperation for fixation issues. Overall a reoperation rate of 50% and projected 10 year survivorship of 58% for HTO. Of the UKA group, there was 1 revision to TKA at 1 year for tibial component loosening and 3 reoperations for bearing instability, retaining the primary implant. Reoperation rate 4% and projected 10 year survivorship 99%. Of the TKA group there were 2 revisions at 4 years for tibial component loosening, no non-revision reoperations, reoperation rate 7.5% with projected 10 year survivorship 92.5%. The Forgotten Joint Score results (0-100) were median 21 for HTO, 38 for TKA, 67 for UKA. All comparisons between the three groups were significant. TKA vs HTO p value 0.04 (CI 0.67-36.54), UKA vs TKA p value 0.02 (CI 2.26-35.58), UKA vs HTO p value 0.00001 (CI 25.36-49.68). Further analysis of the HTO cohort revealed that 75% of the unrevised cases considered the benefit of the index procedure had expired at a mean 3.1 years, yet they had not sought further surgery, despite a mean FJS of only 18 in this subgroup.Conclusion:In this retrospective cohort study with medium term followup of 3 procedures performed by 6 knee surgeons, patients were highly matched by virtue of gender (male), age (<55 years), activity level (Tegner scores), pathology (isolated medial compartment OA). Regarding survivorship of the index procedure, the outcome for Osteotomy was poor with 58% at 10 yrs and high reoperation/complication rate of 50% at mean 4.8 years. The best survivorship/reoperation rates were in the UKA group (99% and 4% respectively). Regarding patient reported outcome using Forgott...

Patient factors predictive of failure following high tibial osteotomy

“…Several studies have reported on long-term survival rates following HTO. 13,17,21,23 The 85.3% survival probability rate reported in our investigation following HTO at 10-year follow-up is within the 58% to 91.6% range reported in prior studies, supporting the long-term success of the operation in appropriately selected patients.…”

Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis

“…Nineteen studies reported procedure-related complications. [9][10][11]13,14,19,21,23,24,[26][27][28][29]31,[36][37][38][39]41] Complications occurred at a significantly higher rate in the HTO group than in the UKA group (OR, 4.88, 95% CI: 2.92-6.86, I 2 = 20%, P < .00001; Fig. 3).…”

“…One study included 38 OWHTO and 19 CWHTO, [25] and 1 study included 57 OWHTO and 36 Demo-HTO. [28] UKA protheses have been reported as fixed-bearing [9,11,13,14,19,20,23,25,26,[29][30][31][32] and mobile-bearing UKA [10,21,22,24,27,28,[33][34][35][36]38,39] in 13 and 12 studies, respectively, but 4 studies did not mention the UKA type. [18,37,40,41] Tables 1,2 show the details of the included studies, and Tables 3,4 show their quality.…”

“…There are several different scoring systems to compare the postoperative functional outcomes between the 2 groups. [9][10][11]13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]35,36,[38][39][40][41] However, only a few studies provided the mean and standard deviation (SD) of the same scoring system used in our meta-analysis. Seven studies [11,23,25,33,[38][39][40] involving 644 patients reported a lower Lysholm score in the HTO group than in the UKA group (MD −2.78, 95% CI: −5.37 to −0.18, I 2 = 78%, P =.04; Fig.…”

“…HTO is designed to increase the life span of articular cartilage by unloading and redistributing the mechanical forces over the unaffected compartment, while UKA is introduced to resurface the degenerative compartment and preserve the unaffected compartment. Several studies compared the outcomes of HTO and UKA, [9][10][11][12][13][14] and the predominance of either procedure is ambiguous. Generally, HTO is regarded as a better option for younger and physically active patients, and those treated with UKA benefit from a faster recovery process.…”