Unicompartmental Knee Arthroplasty Has Lower Infection, Conversion, and Complication Rates Compared to High Tibial Osteotomy

Abstract

Introduction Isolated medial knee osteoarthritis can be surgically treated with either unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO). Proponents of UKA suggest superior survivorship, while HTO offers theoretically improved alignment and joint preservation delaying total knee arthroplasty (TKA). Therefore, we compared complications in a large population of patients undergoing UKAs or HTOs. We specifically assessed 90 days, 1 year, and 2 years: (1) periprosthetic joint infection (PJI) rates, (2) conversion to TKA rates, as well as (3) complication rates. Methods A review of an administrative claims database was used to identify patients undergoing primary UKA (n = 13,674) or HTO (n = 1,096) from January 1, 2010 to December 31, 2019. Complication rates at 90 days, 1 year, and 2 years were compared between groups using unadjusted odds ratios (ORs) with 95% confidence intervals. Subsequently, multivariate logistic regressions were performed for PJI and conversion to TKA rates. Results At all time points, patients who underwent UKA were associated with lower rates of infection compared with those who underwent HTOs (all OR ≤ 0.51, all p ≤ 0.010). After 1 year, patients who received UKAs were found to have lower risk of requiring a conversion to a TKA versus those who received HTOs (all OR ≤ 0.55, all p < 0.001). Complications such as dislocations, periprosthetic fractures, and surgical site infections were found at lower odds in UKA compared with HTO patients. Conclusion This study provides large-scale analyses demonstrating that UKA is associated with lower infection rates and fewer conversions to TKA compared with patients who have undergone HTO. Dislocations, periprosthetic fractures, and surgical site infections were also found to be lower among UKA patients. However, with careful patient selection, good results and preservation of the native knee are achieved with HTOs. Therefore, UKA versus HTO may be an important discussion to have with patients in an effort to lower the incidence of postoperative infections and complications.

Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty

“…Although high tibial osteotomy (HTO) also holds a place in the treatment of knee OA with non-TKA, clinical reports suggest that UKA has better clinical efficacy and lower incidence of complications compared with HTO. 20 , 21 The results of this study also revealed that the KSS improved significantly following UKA from an average preoperative score of 64.2 points to 89.7 points postoperatively. According to previous clinical follow-up studies, the ten-year UKA survival rate was between 80.6% and 84.0%.…”

How to Perform Better on Oxford UKA? A Technical Note from over 500 Surgical Experiences

“…The changes in indications and contraindications are listed in Table 1. Many studies have demonstrated that UKA is associated with certain advantages, such as shorter stays in the hospital, fewer complications, better postoperative function and quicker recovery 8,9 . UKA includes two prosthesis bearing designs—fixed‐bearing (FB) and mobile‐bearing (MB)—both with certain advantages and disadvantages.…”

“…Many studies have demonstrated that UKA is associated with certain advantages, such as shorter stays in the hospital, fewer complications, better postoperative function and quicker recovery. 8 , 9 UKA includes two prosthesis bearing designs—fixed‐bearing (FB) and mobile‐bearing (MB)—both with certain advantages and disadvantages. The FB is accepted by most surgeons due to its low dislocation rate and the simplicity of the procedure.…”