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

El-Galaly, Anders; Nielsen, Poul; Kappel, Andreas; Jensen, Steen Lund

doi:10.1080/17453674.2019.1709711

Cited by 24 publications

(22 citation statements)

References 33 publications

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“…A total of 463 articles were initially retrieved in the literature search, of which 224 were duplicates, while 214 were excluded after screening the titles and abstracts. After reading the full text of 25 articles, nine were ultimately included in the systematic review and meta‐analysis 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

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Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta‐Analysis

Shen

Fang

et al. 2022

Orthopaedic Surgery

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As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.

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Section: Resultsmentioning

confidence: 99%

“…Seven studies addressed postoperative complication rate of revision TKA after HTO and reversion TKA after UKA 7 , 8 , 10 , 12 , 13 , 14 , 15 . Heterogeneity among the studies was statistically significant ( p = 0.03, I 2 = 57%); as such, the random‐effect model was used for meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta‐Analysis

Shen

Fang

et al. 2022

Orthopaedic Surgery

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“…According to the literature this is far from correct. In an effort to save bone stock, the younger population may even be better off with a HTO [ 42 ], whereas two recent meta-analyses have shown UKA to be especially favorable in the elderly population [ 43 , 44 ]. As was also shown in this study, irrespective of age ( Table 2B ), there is solid evidence that UKA is associated with a substantially lower risk of adverse events than TKA [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

The Renaissance of Unicompartmental Knee Arthroplasty appears rational – A radiograph-based comparative Study on adverse Events and patient-reported Outcomes in 353 TKAs and 98 UKAs

Tveit

2021

PLoS ONE

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Purpose Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are both considered suitable for antero-medial osteoarthritis and spontaneous osteonecrosis of the knee. National registry data are consistent in showing higher revision rates for UKA. Adequately adjusted, these findings may be challenged by differences in adverse events and patient-reported outcomes, as both can have serious long-term implications. Based on preoperative radiographs, the aim was to retrospectively compare the two principle surgeries in these respects. Methods All TKA procedures in 2016 in one Swedish county council were, according to certain radiograph-based consensus criteria, visually evaluated for medial UKA suitability. Then, using different regression models, they were compared with the corresponding medial UKAs performed in 2015–2017 regarding complications and patient-reported outcomes one year after surgery. Results The UKA group showed an 82% reduced risk (OR 0.2; 95% CI 0.0–0.6) of any complications, whereas the 55% reduced risk of severe complication did not reach statistical significance (OR 0.5; 95% CI 0.1–2.1). These findings corresponded in high-volume surgeries to an absolute complication rate of 0% in the UKA group and 10% in the TKA group (p = 0.005) and to a severe complication rate of 0% and 5% respectively (p = 0.05). Though no differences were seen in any general patient-reported outcomes, the pain and function based OMERACT-OARSI responder criteria indicated in both around a 60% better chance of any response (OR 1.6 CI % 0.6–4.5) and a high response (OR 1.6; 95% CI 0.7–3.4) in the UKA group. Conclusion No differences were shown in patient-reported outcomes but a clear difference in risk of complications, favoring the UKA procedure.

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“…Konsistent zu den Daten großer Registeruntersuchungen und systematischen Reviews [ 5 , 12 , 22 , 24 ] zeigte sich die HTO-Gruppe mit einem signifikant größeren Anteil an jungen, männlichen und gesunden Patienten. Es ist anzunehmen, dass in der Literatur beschriebene Unterschiede in den Ergebnissen nach Knie-TEP durch diese Gruppenunterschiede verzerrt werden.…”

Section: Diskussionunclassified

Sind die Ergebnisse von Knietotalendoprothesen nach Tibiakopfumstellungsosteotomie schlechter?

et al. 2021

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Zusammenfassung Hintergrund Bei einem Teil der Patienten nach Tibiakopfumstellungsosteotomie (HTO) wird die Implantation einer Knietotalendoprothese (Knie-TEP) notwendig. Durch die HTO kann die Anatomie ungünstig verändert und die Knie-TEP-Operation erschwert sein. Ziel dieser Studie war es zu untersuchen, ob Patienten nach HTO gegenüber denjenigen mit primärer Gonarthrose in gleichem Maße von einer Knie-TEP profitieren. Material und Methoden Im lokalen Register konnten insgesamt 44 Patienten nach HTO und 1703 Patienten mit primärer Gonarthrose identifiziert werden. Zur Reduktion von Confoundern erfolgte eine 1:1 „propensity score matched-pair“-Analyse (Alter, Geschlecht, BMI, Komorbiditäten) bei Patienten mit einem 5‑Jahres-Follow-up. Es resultierten 35 gematchte Paare, welche hinsichtlich Kniefunktion, Schmerzniveau, Zufriedenheit mit dem Operationsergebnis sowie perioperativen Daten (Schnitt-Naht-Zeit, Implantattyp, Komplikationen) und Revisionen verglichen wurden. Ergebnisse Patienten mit vorangegangener HTO hatten prä- und 5 Jahre postoperativ eine vergleichbare Kniefunktion, jedoch ein signifikant höheres prä- und postoperatives Schmerzniveau. Trotz des höheren Schmerzniveaus zeigte sich eine vergleichbare Zufriedenheit mit dem Operationsergebnis. Die Schnitt-Naht-Zeit für die Knie-TEP nach HTO war signifikant länger und es wurden signifikant häufiger modulare Endoprothesen mit Stielverankerung implantiert. Hinsichtlich postoperativer Komplikationen innerhalb der ersten 3 Monate nach Operation unterschieden sich beide Kohorten nicht signifikant. Die Revisionsrate innerhalb von 5 Jahren war bei Patienten nach HTO nicht erhöht. Schlussfolgerung Fünf Jahre nach der Knie-TEP zeigten Patienten mit vorangegangener HTO eine vergleichbare Kniefunktion wie Patienten mit primärer Gonarthrose. Jedoch war bei Patienten nach HTO ein höheres Schmerzniveau zu verzeichnen. Der Operationsaufwand der Knie-TEP nach HTO war deutlich höher.

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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

Cited by 24 publications

References 33 publications

Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta‐Analysis

Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta‐Analysis

The Renaissance of Unicompartmental Knee Arthroplasty appears rational – A radiograph-based comparative Study on adverse Events and patient-reported Outcomes in 353 TKAs and 98 UKAs

Sind die Ergebnisse von Knietotalendoprothesen nach Tibiakopfumstellungsosteotomie schlechter?

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