Total knee replacement following high tibial osteotomy versus total knee replacement without high tibial osteotomy: a systematic review and meta analysis

Ramappa, Manjunath; Anand, Sanjeev; Jennings, Andrew

doi:10.1007/s00402-013-1838-y

Cited by 37 publications

(30 citation statements)

References 19 publications

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“…52 Although there is con cern regarding increased complexity of total knee replacement following high tibial osteotomy, metaanalysis of published data suggests no differences in functional outcomes, survivor ship or complication rates when total knee replacement is performed in those with or without previous high tibial osteotomy. 53…”

Section: Tibial Osteotomymentioning

confidence: 99%

Management of osteoarthritis of the knee in younger patients

Khan

Adili

Winemaker

et al. 2018

CMAJ

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Section: Tibial Osteotomymentioning

confidence: 99%

Management of osteoarthritis of the knee in younger patients

Khan

Adili

Winemaker

et al. 2018

CMAJ

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“…There have been conflicting reports regarding this issue. A previous meta-analysis, consisting of 11 studies with 421 HTO-TKAs and 1749 primary TKAs found no significant differences in terms of revision, complications and functional outcome [12]. In our analysis, 15 studies with 4646 HTO-TKAs and 140,074 primary TKAs were included, the substantial increase of sample size may help to investigate low-incidence event such as revision.…”

Section: Discussionmentioning

confidence: 82%

“…A previous meta-analysis published in 2013 reported similar outcomes between TKA following HTO and primary TKA in terms of survival and perioperative complications [12]. Most studies included in the previous metaanalysis investigated cohorts of small sample size.…”

Section: Introductionmentioning

confidence: 95%

Higher risk of revision in total knee arthroplasty after high tibial osteotomy: a systematic review and updated meta-analysis

Chen

Yang

et al. 2020

BMC Musculoskelet Disord

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Background: High tibial osteotomy is commonly performed in young patients with high activity demand. Several studies have reported outcome of HTO. The reported 10-year survival ranged from 79 to 97.6%. The reported 15-year survival ranged from 56 to 65.5%, resulting in the need for conversion to TKA. Primary TKA now provides satisfactory long-term outcome in terms of function and survival. Researches have been conducted to compare clinical outcome between primary TKA and TKA after HTO to see if TKA should be the prior treatment rather than HTO in some cases. But the results were inconsistent. This study aims to compare the risk of revision and other parameters between total knee arthroplasty after high tibial osteotomy and primary total knee arthroplasty. Methods: Searches and screens of the relevant literature were conducted, after which data were extracted and pooled analysis was performed to compare the clinical outcomes between the two groups. Results: A total of 14 studies with 144,692 cases were included. Pooled analysis showed significantly more revisions and complications, and more tibial component loosening and impingement in postoperative X-ray in the HTO-TKA group. Surgical complexity during conversion to total knee arthroplasty was summarised and listed in table. Conclusion: High tibial osteotomy offers satisfactory pain relief and functional outcome in selected patients with high activity demand. However, the need for subsequent TKA should be noted, which might be a technically challenging procedure with significantly higher risk of revision comparing to primary TKA.

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“…There were no statistically 20 However, many studies have demonstrated that HTO and DFO can be used without impacting revision TKA outcomes. [21][22][23][24][25] Despite this, longitudinal trends suggest a decline in the use of HTO and DFO in the United States and in favor of unicompartmental or TKA. 19,[26][27][28] This is in contrast to countries such as Japan 29 and Korea 30 that demonstrated increased usage of HTO and DFO for knee OA.…”

Section: Resultsmentioning

confidence: 99%

Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles

et al. 2019

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Knee osteotomies show efficacy in slowing knee osteoarthritis progression and delaying the need for total knee arthroplasty in younger patients. Despite evolutions in indications, techniques, and hardware that have improved outcomes, longitudinal trends demonstrate a decline in high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) use. Unfortunately, knowledge of the current usage and complications associated with HTO and DFO is limited. The purpose of this study was to compare the preoperative demographics and early complication rates of HTO and DFO. We analyzed the HTOs and DFOs performed between 2006 and 2017 using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. We compared both groups for preoperative patient demographics (sex, age, race, body mass index [BMI]) and health status variables including functional scores, ASA (American Society of Anesthesiologists) scores, smoking status, and other comorbidities. Emergency and elective status of the patient case, length of hospital stay, operation time, and 30-day postoperative complications were also analyzed. After the exclusion criteria were applied, 321 HTO and 295 DFO patients were included in the final analysis. The HTO group had higher proportions of younger (p < 0.001) and male (p < 0.001) patients with higher BMI (p = 0.007). Racial profiles were similar between the two groups (p = 0.575). Preoperatively, those in the HTO group had more functional independence, better physical status scores, and fewer chronic conditions (p < 0.05). There were no statistically significant differences between HTO and DFO in operative time, postoperative complications, readmission, and reoperation. HTO patients, however, had shorter hospital stays (p < 0.001). Although there are differences in preoperative and operative characteristics of HTO and DFO, early postoperative complications are similar for both groups. Therefore, HTO and DFO can be considered safe and effective treatment options for younger patients with symptomatic unicompartmental knee osteoarthritis.

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Total knee replacement following high tibial osteotomy versus total knee replacement without high tibial osteotomy: a systematic review and meta analysis

Cited by 37 publications

References 19 publications

Management of osteoarthritis of the knee in younger patients

Management of osteoarthritis of the knee in younger patients

Higher risk of revision in total knee arthroplasty after high tibial osteotomy: a systematic review and updated meta-analysis

Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles

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