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Schröter S, Klink J, Ihle C, Gueorguiev BG, Herbst M, Maiotti M, Histing T, Ahrend MD. Long-term Outcomes after Medial Open Wedge High Tibial Osteotomy - A Retrospective Study of 69 Patients. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:465-473. [PMID: 37647923 DOI: 10.1055/a-2120-0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
High tibial osteotomy (HTO) is a widespread option to avoid or delay total knee arthroplasty (TKA). The present study aimed to assess the long-term survival rate and postoperative subjective knee function after isolated medial open wedge HTO in patients with symptomatic medial compartment knee osteoarthritis (OA) and varus malalignment.Sixty-nine patients (48.8 ± 6.7, 35-66 years; preoperative mechanical tibiofemoral angle [mTFA] -5.3 ± 3.4; -14.9-0.0° varus) treated with medial open wedge HTO using a TomoFix plate were included in this retrospective study, with a follow-up of at least 10 years (11.8 ± 1.0 years). The survival rate after HTO was calculated after 5 and 10 years. Subjective knee function was assessed using Hospital for Special Surgery (HSS), Oxford knee, Lequesne, and Lysholm scores.Thirty-three patients underwent conversion to TKA, on average, 7.0 ± 3.4 (1.3-13.7) years after HTO. Five- and ten-year survival rates were 84.1 and 60.9%, respectively. Patients without conversion to TKA showed a Lysholm score of 64.5 (35-92), Lequesne score of 7 (1-13), HSS score of 71 (56-86), and Oxford knee score of 38.5 (25-44) at the last follow-up (more than 10 years). Significantly higher scores were registered at the last follow-up compared to the preoperative state regarding the Lysholm score (preoperative: 43.5 [12-95]; follow-up: 64.5 [35-92]; p < 0.001). The HSS score (preoperative: 69.5 [43-93]; follow-up: 71 [56-86]; p = 0.6941) showed no statistically significant change during the 10-year follow-up period. The Lequesne score was significantly lower than the preoperative score (preoperative: 11.5 [0.5-22]; follow-up: 7 [1-13]; p < 0.001), indicating a lower handicap.The majority of patients with a valgus medial compartmental knee OA treated with HTO with fixation using the TomoFix plate can expect no conversion to TKA for more than 10 years. Furthermore, patients without conversion to TKA after 10 years still had a significantly higher subjective knee function than preoperatively. Further research is needed to identify risk factors for conversion to TKA. This helps to guide surgeons in selecting patients who will benefit most from HTO.
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Affiliation(s)
- Steffen Schröter
- Klinik für Unfall- und Wiederherstellungschirurgie, Diakonie Klinikum GmbH Jung-Stilling, Siegen, Germany
- Mitglied Osteotomie Komitee der Deutschen Kniegesellschaft
| | - Julian Klink
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Christoph Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | | | - Moritz Herbst
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Marco Maiotti
- Orthopedics, Shoulder Unit Villa Stuart Clinic (Rome), Rome, Italy
| | - Tina Histing
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
- Mitglied Osteotomie Komitee der Deutschen Kniegesellschaft
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Nazlıgül AS, Gürler A, Tecimel O, Yılmaz S, Doğan M, Akkaya M. The effect of high tibial osteotomy and unicompartmental knee arthroplasty on patellofemoral joint in young patients with medial knee arthrosis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05480-6. [PMID: 39271496 DOI: 10.1007/s00402-024-05480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/23/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Osteoarthritis of the knee is a debilitating disease. In most cases, only the medial compartments are affected. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are the two main procedures commonly used in the surgical treatment of unicompartmental knee osteoarthritis patients not responding to conservative treatment. The aim of our study was to compare UKA and biplanar medial open-wedge HTO in terms of patellofemoral changes and functional score in patients under 60 years of age with medial compartment arthrosis. MATERIALS AND METHODS A retrospective study. A total of 79 patients (37 HTO, 42 UKA) who received one of the two treatments in a single center were examined preoperatively and at a single postoperative follow-up. Posterior tibial slope, lateral patellofemoral angle (LPFA), Q-angle, patellar height, Cincinnati Rating System and Knee Injury and Osteoarthritis Outcome Score (KOOS) functional scores were evaluated in all patients preoperatively and at the 6-month follow-up examination. RESULTS Insall-Salvati ratio remained stable in the HTO group, while there was a minor decrease in the UKA group and the changes between the groups were not statistically significant. Caton-Deschamps ratio increased in the UKA group and decreased in the HTO group, and this change was statistically significant (p < 0.001). LPFA did not change in the UKA group in the postoperative period, while it increased in the HTO group (p < 0.001). Changes in Q angle and Cincinnati Rating System scores were statistically similar between the UKA and HTO groups (p = 0.827 and p = 0.340). CONCLUSIONS In our study, biplanar medial open-wedge HTO and UKA performed with appropriate surgical technique had no negative effect on patellofemoral joint. In patients under 60 years of age with medial compartment osteoarthritis of the knee, both surgical treatments can be performed with appropriate patient selection.
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Affiliation(s)
- Ali Said Nazlıgül
- Department of Orthopaedics and Traumatology, Sincan Training and Research Hospital, Ankara, Turkey
| | - Ahmet Gürler
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Osman Tecimel
- Department of Orthopaedics and Traumatology, Memorial Hospital, Ankara, Turkey
| | - Sinan Yılmaz
- Department of Orthopaedics and Traumatology, Memorial Hospital, Ankara, Turkey
| | - Metin Doğan
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopaedics and Traumatology, Güven Hospital, Ankara, Turkey.
- Ankara Guven Hospital, Department of Joint Surgery, Cayyolu Health Campus, 06810 Cayyolu, Ankara, Turkey.
- Yuksek Ihtisas University, Department of Orthopaedics and Traumatology, 06530 Cankaya, Ankara, Turkey.
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Uchio Y, Ishijima M, Ikeuchi M, Ikegawa S, Ishibashi Y, Omori G, Shiba N, Takeuchi R, Tanaka S, Tsumura H, Deie M, Tohyama H, Yoshimura N, Nakashima Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of Osteoarthritis of the knee - Secondary publication. J Orthop Sci 2024:S0949-2658(24)00139-8. [PMID: 39127581 DOI: 10.1016/j.jos.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, Japan.
| | | | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi University, Nankoku, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, Center for Integrated Medical Science (IMS), RIKEN, Tokyo, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Shiba
- Department of Orthopaedics, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryohei Takeuchi
- Department of Joint Surgery Center, Yokohama Sekishinkai Hospital, Yokohama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Oita, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | | | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, University of Tokyo, Tokyo, Japan
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Teo SJ, Purnomo G, Koh DTS, Soong J, Yeo W, Razak HRBA, Lee KH. High tibial osteotomy versus unicompartmental knee arthroplasty in advanced medial compartmental knee arthrosis: A comparative study with propensity score matched analysis. Knee 2024; 49:116-124. [PMID: 38909589 DOI: 10.1016/j.knee.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/07/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Isolated knee medial compartmental osteoarthritis(MOA) can be treated with High Tibial Osteotomy (HTO) or Unicompartmental Knee Arthroplasty (UKA). This study aims to describe and compare outcomes of HTO and UKA in patients with isolated severe MOA. The authors hypothesized that similar outcomes can be achieved. METHODS Data was collected prospectively of HTOs and UKAs performed between January-2016 and April-2021 by a knee surgeon. Oxford Knee Score (OKS), Knee Society Knee Score (KSKS) and Function Score (KSFS) were collected pre-operatively, six-months and two-years post-surgery. OA severity was graded on pre-operative radiograph. Medial Proximal Tibia Angle (MPTA), Lateral Distal Femoral Angle (LDFA), Joint Line Convergence Angle (JLCA) and Hip-Knee-Ankle Angle (HKAA), were measured on full-length radiograph. 47 HTO and 74 UKA were included. Propensity score matching was performed, accounting for preoperative scores, age, gender and body mass index (BMI), before statistical analysis. Level of significance was set at 0.05. RESULTS Both groups were similar in age(56.42 vs 58.57, p = 0.067), BMI(29.82 vs 29.09, p = 0.484), gender distribution (p = 0.663) and laterality (p = 0.836). Pre-operatively, both groups were similar in clinical scores and lower limb alignment. On follow-up, both groups achieved similar improvements in clinical scores. However, the HTO group reported poorer extension at 6-months (7.91° vs 4.80°, p = 0.013) and 2-years (5.57° vs 3.24°, p = 0.018). Three cases of hinge fracture and six cases of implant removal occurred in the HTO group. One case of tibial fracture occurred in the UKA group. CONCLUSIONS In severe MOA, similar outcomes were achieved with HTO and UKA at two years.
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Affiliation(s)
- Shao Jin Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Glen Purnomo
- St. Vincentius a Paulo Catholic Hospital, Surabaya, Indonesia
| | | | - Junwei Soong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Callan KT, Smith E, Karasavvidis T, Wang D. Comparison of Trends and Complications of Unicompartmental Knee Arthroplasty Versus Periarticular Knee Osteotomy Among ABOS Part II Oral Examination Candidates. Orthop J Sports Med 2024; 12:23259671241257818. [PMID: 39100213 PMCID: PMC11295226 DOI: 10.1177/23259671241257818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/01/2024] [Indexed: 08/06/2024] Open
Abstract
Background While unicompartmental knee arthroplasty (UKA) and osteotomy procedures are commonly used to treat knee osteoarthritis, the differences in complication profiles between procedures are still poorly understood. Purpose/Hypothesis The purpose of this study was to assess the trends and complication rates of UKA and periarticular knee osteotomy for knee osteoarthritis among newly trained surgeons by using the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database. It was hypothesized that more adult reconstruction fellowship-trained surgeons would perform UKA, while more sports medicine fellowship-trained surgeons would perform osteotomy, and that both procedures would have low rates of complications. Study Design Cross-sectional study; Level of evidence, 3. Methods The ABOS database was queried for patients who underwent UKA, high tibial osteotomy, and distal femoral osteotomy procedures in examination years 2011 to 2021. Patient characteristics, surgeon fellowship training history, surgeon-reported postoperative complications, and readmission and reoperation rates were recorded. Comparisons between the UKA and osteotomy groups were performed using independent t tests and chi-square tests. Results There were 2524 patients in the UKA group and 270 patients in the osteotomy group. The majority of newly trained surgeons performing UKA (70.5%) had fellowship training in adult reconstruction, while the majority of those performing osteotomy (57.8%) had fellowship training in sports medicine (P < .001). The incidence of UKA and osteotomy increased during the study period (18.8 UKAs and 1.8 osteotomies performed per 10,000 cases in 2011 vs 39.5 UKAs and 4.2 osteotomies performed per 10,000 cases in 2021). Rates were significantly higher for osteotomy compared with UKA regarding anesthetic complications (2.2% vs 0.6%; P = .015), surgical complications (23.7% vs 7.3%; P < .001), reoperation (5.2% vs 1.9%; P = .002), and infection (6.7% vs 1.4%; P < .001). There were no significant differences in rates of medical complication, readmission, deep vein thrombosis, pulmonary embolism, or stiffness/arthrofibrosis. Conclusion Among newly trained surgeons taking the ABOS Part II Oral Examination, the incidence of UKA and periarticular knee osteotomy increased over the past decade. Compared with UKA, complication rates were higher after osteotomy, with an overall surgical complication rate of 23.7%.
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Affiliation(s)
- Kylie T. Callan
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| | - Eric Smith
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| | - Theofilos Karasavvidis
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
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Pullen WM, Slone H, Abrams G, Sherman SL. High Tibial Osteotomy in Knee Reconstruction and Joint Preservation. J Am Acad Orthop Surg 2024; 32:577-586. [PMID: 38175969 DOI: 10.5435/jaaos-d-23-00323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024] Open
Abstract
High tibial osteotomy is a dynamic operation, used as an effective procedure in both joint preservation and knee stability. Applications and indications are expanding, with good results in the treatment of malalignment associated with arthrosis, knee instability, meniscus deficiency or transplants, and/or cartilage restoration. Appropriate patient selection and preoperative planning are critical to achieving good outcomes after surgery. Coronal and sagittal plane corrections made through the proximal tibia can effectively alter joint mechanics creating a more favorable environment for cartilage, meniscus, and ligamentous structures about the knee. Advancing techniques and technologies have allowed for more precise planning and execution of osteotomies.
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Affiliation(s)
- W Michael Pullen
- From the Department of Orthopaedic Surgery, Medical University of South Carolina (Pullen, and Slone), and the Department of Orthopaedic Surgery, Stanford University (Abrams, and Sherman)
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Debopadhaya S, Acosta E, Ortiz D. Trends and outcomes in the surgical management of young adults with knee osteoarthritis using high tibial osteotomy and unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05362-x. [PMID: 38771360 DOI: 10.1007/s00402-024-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION A significant portion of knee osteoarthritis is diagnosed in patients under the age of 55, where greater activity demands make total knee arthroplasty less desirable. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are useful alternatives, but there is little understanding of which procedure is advantageous. Hence, this study examines the utilization, complication, and reoperation rates among the HTO vs. UKA in young patients with primary osteoarthritis. METHODS A retrospective review of the National Surgical Quality Improvement Program was performed to identify 2318 patients < 55 years of age who received either a HTO or UKA for primary osteoarthritis between 2011 and 2021. Bivariate analyses compared preoperative and intraoperative characteristics among each procedure. Then, multivariate analyses examined if either procedure was associated with worse 30-day postoperative complications or need for reoperation, independent of the statistically significant pre- and intraoperative disparities. RESULTS UKAs were performed 14.2 times more commonly than HTOs, and the patients selected for HTO were more likely to be younger, have a lower BMI, have the healthiest ASA Class score, and less likely to have hypertension requiring medication (p < 0.001). HTOs took 17.5% longer to perform and had a longer average length of stay (p < 0.001), while UKAs were more likely to be performed out-patient (p < 0.001). HTOs also had higher rates of serious complications (p = 0.02), overall complications (p = 0.004), and need for reoperation (p = 0.004). Multivariate modelling demonstrated that procedure type was not a predictor of serious complications, but the use of HTO was significantly associated with any complications (odds ratio = 3.63, p = 0.001) and need for reoperation (3.21, p = 0.029). CONCLUSION Although healthier patients were selected for HTOs, UKAs were found to have a lower risk of complications and immediate reoperation. Additionally, UKAs had the advantage of lower operative burden, shorter length of stay, and a higher efficacy in outpatient settings.
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Affiliation(s)
- Shayom Debopadhaya
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA
| | - Ernesto Acosta
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA
| | - Dionisio Ortiz
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA.
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Wyatt FW, Al-Dadah O. Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes. World J Orthop 2024; 15:444-456. [PMID: 38835690 PMCID: PMC11145972 DOI: 10.5312/wjo.v15.i5.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/05/2024] [Accepted: 04/12/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis. However, which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate. Simultaneously, there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes, preoperatively and following HTO or UKA. AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis: Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this. METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA (n = 23) and HTO (n = 19) to treat medial compartment knee osteoarthritis. Patient-reported outcome measures (PROMs) were collected to evaluate clinical outcome. These included two disease-specific (Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score) and two generic (EQ-5D-5L, Short Form-12) PROMs. The radiographic parameters of knee alignment assessed were the: Hip-knee-ankle angle, mechanical axis deviation and angle of Mikulicz line. RESULTS Statistical analyses demonstrated significant (P < 0.001), preoperative to postoperative, improvements in the PROM scores of both groups. There were, however, no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group. Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively (P < 0.05). Postoperatively, two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters (hip-knee-ankle angle, mechanical axis deviation) within the HTO group; yet no such associations were observed within the UKA group. CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis. Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively; however, a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
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Affiliation(s)
- Frederick William Wyatt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom
| | - Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom
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Park DY, Park KH, Jin YJ, Yun HW, Lee JM, Chung JY, Park JY, Min BH, Lim S. Fixed-Bearing Unicompartmental Knee Arthroplasty in Tibia Vara Knees Results in Joint Surface Malalignment and Varus Joint Line Obliquity, but Does Not Affect Functional Outcomes at Greater Than 5 Years Follow-Up. J Arthroplasty 2024; 39:645-650. [PMID: 37757984 DOI: 10.1016/j.arth.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical outcomes of fixed-bearing medial unicompartmental knee arthroplasty (UKA) for tibia vara knees and the associated changes in joint space malalignment (JSM) and joint line obliquity (JLO). METHODS We retrospectively analyzed a consecutive group of 100 patients who underwent fixed-bearing medial UKA with a preoperative medial proximal tibia angle (MPTA) ≥86° (n = 50) and MPTA <86° (n = 50) and who had a minimum 5-year follow-up. Radiological parameters, including the hip-knee-ankle angle, MPTA, and the postoperative JSM and JLO, were measured. Functional evaluation was performed using the range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index score. RESULTS The MPTA <86° group showed significantly higher postoperative JLO (91.8 versus 90.4°, respectively; P = .002) and JSM (6.1 versus 4.2°, respectively; P = .026) compared to the MPTA ≥86° group. Functional outcomes, including range of motion, visual analog scale, Knee Society Knee Score, Knee Society Function Score, and Western Ontario and McMaster Universities Osteoarthritis Index scores, were not significantly different between the 2 groups. CONCLUSIONS Fixed-bearing medial UKA is a safe and effective surgical option for patients who have tibia vara knees, as an increase in JLO and JSM postoperatively does not have a clinically relevant impact, even after a minimum 5-year follow-up.
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Affiliation(s)
- Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea; Ajou University Leading Convergence of Healthcare and Medicine, Institute of Science and Technology, School of Medicine, Ajou University, Suwon, Korea
| | - Ki-Hoon Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Daprtment of Orthopedic Surgery, Armed Forces Yangju Medical Center, Yangju-si, Korea
| | - Yong Jun Jin
- Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Hee-Woong Yun
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Jong Min Lee
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, CHA University, CHA Bundang Medical Center, Seongnam-si, Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Korea
| | - Sumin Lim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
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Anter Abdelhameed M, Jacquet C, Ollivier M, Argenson JN. The unintentional effect of unicompartmental knee arthroplasty on extraarticular deformity and of high tibial osteotomy on intraarticular deformity for the treatment of anteromedial osteoarthritis. Arch Orthop Trauma Surg 2024:10.1007/s00402-023-05193-2. [PMID: 38300289 DOI: 10.1007/s00402-023-05193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Unicompartmental Knee Arthroplasty (UKA) and High Tibial Osteotomy (HTO) are two valid options in the treatment of Anteromedial Osteoarthritis (AMOA) of the knee with UKA being mainly performed in cases of Intraarticular deformity (IA) and HTO in cases of Extraarticular deformity (EA). The exact unintentional effect of UKA on EA deformity and HTO on IA deformity is still not well understood. The aim of this study was to assess this unintentional effect of UKA on EA and HTO on IA deformities respectively. MATERIALS AND METHODS This a single-center retrospective study in which 50 patients who underwent UKA and 50 patients who underwent medial opening wedge HTO (MWOHTO) for the treatment of AMOA were included. Overall, 35 males and 15 females underwent HTO with a mean age of 44.3 ± 11.2 years while the mean age of the UKA group was 71.8 ± 7.9 years in 23 males and 27 females. The radiological effect of UKA and HTO on each of the following angles: Hip-Knee-Ankle angle (HKA), Medial Proximal Tibial Angle (MPTA), mechanical Lateral Distal Femoral Angle (mLDFA) and Joint Line Convergence Angle (JLCA) on long film radiographs both pre- and postoperatively was measured. The postoperative values were compared to the preoperative values to detect the expected and unintended effects of each technique on IA and EA deformities. RESULTS In the HTO group, the MPTA has changed significantly as expected from 83.1 ± 4.5 preoperatively to 88.9 ± 3.9 postoperatively (p value < 0.001) correcting the existing preoperative EA varus without overcorrection. Similarly in the UKA group, the JLCA has also changed significantly as expected to correct the IA varus from 3.8 ± 1.7 preoperatively to 0.9 ± 1 postoperatively (p value < 0.001). On the other hand, the JLCA was unintentionally changed in the HTO group from 2.6 ± 2.1 preoperatively to 1.6 ± 2.4 postoperatively (p value = 0.03) partly correcting the IA varus deformity. Similarly, the MPTA showed a significant change that occurred inadvertently in the UKA group from 84.8 ± 2.1 to 86.3 ± 1.6 postoperatively (p value < 0.001). This unintentional increase in the MPTA also partly corrected the preexisting EA varus deformity. The mLDFA did not show a significant change neither in the HTO group (p value = 0.96) nor in the UKA group (p value = 0.94). CONCLUSION In addition to intraarticular varus correction, UKA can partly correct the extraarticular varus deformity in AMOA even when resurfacing is exclusively attempted. Additionally, intraarticular deformity can be also partially managed by HTO along with the extraarticular varus correction even without performing overcorrection.
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Affiliation(s)
- Mohammed Anter Abdelhameed
- Orthopedic and Traumatology Department, Faculty of Medicine, Assiut University Hospital, Assiut, Arab Republic of Egypt
| | - Christophe Jacquet
- Institute for Locomotion, Hospital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009, Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Matthieu Ollivier
- Institute for Locomotion, Hospital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009, Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Hospital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009, Marseille, France.
- Aix Marseille University, APHM, CNRS, ISM, Marseille, France.
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Karasavvidis T, Fackler NP, Callan KT, Lung BE, Wang D. Comparison of Early Complication Rates After High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Knee Osteoarthritis. Orthop J Sports Med 2024; 12:23259671231219975. [PMID: 38188617 PMCID: PMC10768598 DOI: 10.1177/23259671231219975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 01/09/2024] Open
Abstract
Background Although both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) can be utilized to treat unicompartmental osteoarthritis (OA) in select patients, the early complication rates between the 2 procedures are not well understood. Understanding of the complication profiles for both procedures would help clinicians counsel patients with unicompartmental knee OA who may be eligible for either treatment option. Purpose To compare the 30-day complication rates after HTO versus UKA for the treatment of knee OA using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Study Design Cohort study; Level of evidence, 3. Methods NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing HTO and UKA for knee OA. Patients >60 years of age were excluded. Patient demographics, preoperative comorbidities, and intraoperative data were collected. Postoperative 30-day complications, including venous thromboembolism (VTE), urinary tract infection (UTI), transfusion, surgical-site infection (SSI), and reoperations were recorded. Complication rates between treatment groups were compared using a multivariate logistic regression model adjusted for sex, age, body mass index, steroid use, respiratory status (smoking/dyspnea/chronic obstructive pulmonary disease), diabetes, and hypertension. Results A total of 156 patients treated with HTO and 4755 patients treated with UKA for knee OA were identified. Mean patient ages were 46 years for the HTO group and 53.4 years for the UKA group. Operative time was significantly longer in the HTO group versus the UKA group (112 minutes vs 90 minutes; P < .001). Multivariate analyses found no significant differences in VTE (1.3% vs 0.6%), UTI (0.6% vs 0.3%), transfusion (0.6% vs 0.2%), deep SSI (0.6% vs 0.1%), and reoperation (1.3% vs 1%) rates between HTO and UKA groups. The HTO group had a higher rate of superficial SSI compared with the UKA group (2.6% vs 0.6%; P = .006) (adjusted odds ratio, 4.2; 95% CI, 1.4-12.5; P = .01). Conclusion There were no differences in 30-day VTE, UTI, transfusion, deep SSI, and reoperation rates for HTO versus UKA in the treatment of knee OA. HTO was associated with a higher rate of superficial SSI compared with UKA. These findings serve to guide clinicians in counseling patients regarding the early risks after HTO and UKA.
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Affiliation(s)
- Theofilos Karasavvidis
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Nathan P. Fackler
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Kylie T. Callan
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
| | - Brandon E. Lung
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
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Wang Y, Xu C, Yang B, Yu F, Guo A. Finite Element Analysis of the Effect of Femoral Prosthesis Varus and Valgus Angle Installation on the Lateral Compartment in Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2024; 91:88-98. [PMID: 38462443 DOI: 10.1272/jnms.jnms.2024_91-110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND This study used finite element analysis (FEA) to investigate the effect of varus and valgus angle on the lateral compartment in unicompartmental knee arthroplasty (UKA). METHODS One patient who underwent UKA was enrolled as the subject. Thirteen working conditions of the femoral prosthesis were simulated at varus and valgus angles of 0°, 2°, 4°, 6°, 8°, 10°, and 12°. A load of 1,000 N was applied downward along the mechanical axis of the femur, and the highest stress values on the surface of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage in each model were recorded. The six highest points were used to calculate the mean value. RESULTS The highest stress values on the surface of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage increased with an increase in the femoral prosthesis varus/valgus angle. As compared with the standard position of the femoral prosthesis, there was no significant difference in the surface stress values of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus and tibial lateral plateau cartilage when the femoral prosthesis varus/valgus angle was less than 4° (p > 0.05). In addition, the stress magnitude on the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage significantly increased when the femoral prosthesis varus/valgus angle was greater than 4° (p < 0.001). CONCLUSIONS The optimal femoral prosthesis varus/valgus angle in UKA was less than 4°.
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Affiliation(s)
- Yonggui Wang
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
- Department of Orthopedics, Xiangyang No. 1 People's Hospital, Hubei University of Medicine
| | - Chongyang Xu
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Bo Yang
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Fei Yu
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Ai Guo
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
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Royse LA, Strother S, Trachsel M, Mehr DR, Hoffman K, Cook JL. Engaging Patients and Caregivers to Develop a Patient-Centered Agenda for Comparative Effectiveness Research Focused on the Treatment of Complex Knee Problems. J Knee Surg 2023; 36:1422-1437. [PMID: 37604174 DOI: 10.1055/s-0043-1772608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Complex articular cartilage loss in the knee is being diagnosed more frequently and earlier in life, and patients are faced with major decisions regarding invasive surgical interventions at increasingly younger ages. There is a critical unmet need to provide patient-centered comparative effectiveness research for the hundreds of thousands of patients faced with these treatment decisions each year. Toward filling the need, we developed the Patient AdvisoR Team iN Orthopaedic ReSearch (PARTNORS) program. We recruited a diverse group of patients and caregivers with lived experiences in dealing with complex knee problems to define patient-centered research priorities for comparative biological and artificial knee surgery research for middle-aged adults. Adapting the Stakeholder Engagement in Question Development and Prioritization Method, PARTNORS defined a 20-question list of patient-centered research questions of factors influencing a patients' choice between biological and artificial knee surgeries. The highest prioritized research question related to functional level postsurgery as it relates to daily activities and recreational activities. The second highest prioritized research questions related to insurance coverage and financial costs. Other prioritized research areas included caregiving needs, implant longevity, recovery and rehabilitation time, patient satisfaction and success rates, individual characteristics, and risks. By engaging a group of patients and caregivers and including them as members of a multidisciplinary research team, comparative effectiveness research that includes patient-centered factors that go beyond typical clinical success indicators for knee surgery can be designed to allow physicians and patients to work together toward evidence-based shared decisions. This shared decision-making process helps to align patients' and health care team's goals and expectations to improve outcomes.
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Affiliation(s)
- Lisa A Royse
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Sandi Strother
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Matt Trachsel
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Kimberly Hoffman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Singh CM, Thakur K, Venunathan G, Prasad M, Pande H, Mahajan S. Angle Stable Plate Fixation vs Hemicallotasis in Medial Opening Wedge High Tibial Osteotomy: A Comparative Study. Indian J Orthop 2023; 57:1793-1799. [PMID: 37881275 PMCID: PMC10593643 DOI: 10.1007/s43465-023-00969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 08/01/2023] [Indexed: 10/27/2023]
Abstract
Background Varus alignment associated with medial compartment degeneration is the most common presentation of knee osteoarthritis and often presents in young active adults where arthroplasty might be unsuitable. Purpose To compare the accuracy of the angle stable medial high tibia plate and self-adjusting HTO (high tibial osteotomy) fixator in achieving correction of varus deformity of the knee by medial opening wedge HTO and to evaluate functionality between the groups. Study Design Prospective randomized control study. Methods Forty patients each underwent medial opening wedge high tibial osteotomy with acute correction and stabilization using the angle stable plate (ASP group) or with the hemicallotasis technique using the self-adjusting HTO external fixator (HCO group). Anatomical and functional outcomes were compared to the pre-operative values at the 6th and 12th month. Results The FTA (femoro-tibial axis), mechanical axis, and functional scores improved significantly in both groups. There was also a significant change in the patellar height and tibial slope. Except for a better KOOS (Knee Injury and Osteoarthritis Outcome Score) in the angle stable plate group at the 6-month follow-up, there were no significant differences between the groups. Conclusion Both methods of performing a medially based proximal tibial osteotomy gave equivalent outcomes at the 1-year follow-up.
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Affiliation(s)
| | - Kamparsh Thakur
- Department of Orthopaedics, 166 Military Hospital, Jammu, Jammu and Kashmir, India
| | - Gopinath Venunathan
- Department of Orthopaedics, Military Hospital Roorkee, Roorkee, Uttarakhand India
| | - Manish Prasad
- Department of Orthopaedics, Indian Field Hospital Level II plus, Juba, UNMISS, Juba, South Sudan
| | | | - Saurabh Mahajan
- Department of Community Medicine, AFMC Pune, Maharashtra, India
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Hoorntje A, Pronk Y, Brinkman JM, van Geenen RCI, van Heerwaarden RJ. High tibial osteotomy versus unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3-4 knee osteoarthritis in younger patients: comparable improvements in patient-reported outcomes, adjusted for osteoarthritis grade and sex. Knee Surg Sports Traumatol Arthrosc 2023; 31:4861-4870. [PMID: 37572139 PMCID: PMC10598142 DOI: 10.1007/s00167-023-07526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/23/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Previous studies comparing high tibial osteotomy (HTO) with unicompartmental knee arthroplasty (UKA) have seldom accounted for differing patient characteristics between both groups. This study compared patient-reported outcomes (PROs) of HTO and UKA patients, adjusted for preoperative PROs, osteoarthritis grade and sex. METHODS A retrospective study was performed analysing prospectively collected PROs, namely the Oxford Knee Score (OKS) and pain/satisfaction scores, collected preoperatively and at 6 months, 12 months and 24 months postoperatively. Consecutive medial opening-wedge HTOs and medial UKAs from 2016-2019, with a preoperative Kellgren-Lawrence grade ≥ 3, aged 50-60 years, were included. Linear mixed model analyses, with the OKS over time as the primary outcome, were used. RESULTS We included 84 HTO patients (mean age 55.0 ± 3.0, 79% male, mean BMI 27.8 ± 3.4, 75% Kellgren-Lawrence grade 3) and 130 UKA patients (mean age 55.7 ± 2.8, 47% male, mean BMI 28.7 ± 4.0, 36% Kellgren-Lawrence grade 3). Response rates were ≥ 87% at all time points. Corrected for preoperative PROs, Kellgren-Lawrence grade and sex, the HTO group had a 2.5 (95% CI 1.0-4.0) points lower OKS over time than the UKA group (p = 0.001). The Numeric Rating Scale scores (NRS; 0-10) for pain at rest and during activity were higher (p < 0.01) in the HTO group. The EQ-5D-descriptive system (p < 0.01), NRS satisfaction (p < 0.01), anchor function and pain scores (p < 0.01) were lower over time in the HTO group. CONCLUSION UKA patients had better OKS scores, pain and satisfaction scores over time than HTO patients. However, the observed differences were below their established minimal clinically important differences. Therefore, from the patients' perspective, HTO did not appear to be inferior to UKA under the indications outlined in this study. Level of evidence Level IV.
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Affiliation(s)
- A Hoorntje
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Program Musculoskeletal Health, Amsterdam, The Netherlands.
| | - Y Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands
| | - J M Brinkman
- Department of Orthopaedic Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - R C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, The Netherlands
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Inaba Y. Radiologic simulation of leg length change after double level osteotomy in preoperative surgical planning. Knee Surg Relat Res 2023; 35:24. [PMID: 37726864 PMCID: PMC10510285 DOI: 10.1186/s43019-023-00198-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/10/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND To evaluate the expected postoperative total leg length change using preoperative radiographs during surgical planning of four different methods of double level osteotomy (DLO). METHODS This study included 34 patients (44 knees) who underwent DLO for varus knee osteoarthritis. Surgical planning was performed so that the postoperative weight bearing line ratio was 62.5%. In DLO, lateral closed or medial open wedge distal femoral osteotomy (LCWDFO, MOWDFO) was performed so that the postoperative mechanical lateral distal femoral angle was 85°, and residual deformity was corrected with medial open or lateral closed wedge high tibial osteotomy (MOWHTO, LCWHTO). Pre- and surgical planning X-rays in the one-leg standing position were compared to assess the change in leg length, and the factors affecting it, in the various surgical groups. The proportion of cases in which Δ total leg length was greater than 6 mm (symptomatic change) was investigated. RESULTS The mean postoperative total leg length increased significantly with LCWDFO + MOWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, while it decreased with LCWDFO + LCWHTO. The proportion of cases with a postoperative total leg length change > 6 mm was 72.7%, 2.3%, 100%, and 6.8% in LCWDFO + MOWHTO, LCWDFO + LCWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, respectively. In addition, the preoperative hip-knee-ankle angle correlated negatively with the postoperative total leg length change in LCWDFO + MOWHTO, MOWDFO + MOWHTO, and MOWDFO + LCWHTO, but not in LCWDFO + LCWHTO. CONCLUSIONS MOWDFO + MOWHTO had the largest postoperative leg length change and MOWDFO + LCWHTO had the smallest. Symptomatic leg length change (> 6 mm) should be considered in MOWDFO + MOWHTO and LCWDFO + MOWHTO.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Gowd AK, Plate JF, Lichtig A, Gencer A, Yanmis O, D'Agostino R, Poehling GG. Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience. J ISAKOS 2023; 8:255-260. [PMID: 37004741 DOI: 10.1016/j.jisako.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. METHODS A prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010-December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. RESULTS In total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ± 10.7 years and mean follow-up was 76.4 ± 17.4 months. Mean BMI was 32.3 ± 6.5 kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p = 0.01), greater operative joint space (p = 0.04), previous surgery (p = 0.01), inlay implant (p = 0.04) and pain syndrome (p = 0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p < 0.01), history of pain syndrome (p < 0.01) and greater preoperative joint space (>2 mm) (p < 0.01). There was no association of BMI to conversion to TKA. CONCLUSION Robotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Asher Lichtig
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Ahmet Gencer
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Orhan Yanmis
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Ralph D'Agostino
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Ge H, Huang Y, Yan H, Zeng Y, Zeng J. What is the difference in proprioception between single condylar arthroplasty and high tibial osteotomy? a comparative study on both knees of the same patient. J Orthop Surg Res 2023; 18:486. [PMID: 37415243 DOI: 10.1186/s13018-023-03965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE This study aims to investigate the efficacy and outcomes of different surgical procedures, namely unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), for the treatment of bilateral medial compartment knee osteoarthritis in the same patient. The joint awareness and function of these two surgical methods were evaluated. METHODS A total of 15 patients with bilateral medial compartment knee osteoarthritis who underwent either UKA or HTO between 2012 and 2020 were included in the study. Patient data, including age, gender, body mass index and length of hospital stay, were collected. Pre- and post-operative measurements were conducted, including tibiofemoral angle, tibial plateau posterior inclination angle, proximal tibial medial angle, distance from mechanical axis to knee joint center, hip-knee-ankle angle, pre- and post-operative knee joint scores, knee joint range of motion, and FIS-12 scores at 3, 6, 12, and 24 months postoperatively. The latest follow-up was used for evaluating the outcomes of osteoarthritis treatment. Normality of continuous variables was assessed using the Shapiro-Wilk test. Between-group comparisons were performed using the paired sample t-test or Wilcoxon rank-sum test. Repeated measures analysis of variance was utilized to analyze FJS-12 measurements at different time points, and the correlation between FJS-12 and postoperative clinical results was examined using Pearson's correlation coefficient. Statistical significance was set at P < 0.05. RESULTS Significant differences were observed in FJS between the UKA and HTO groups at 3 and 6 months postoperatively, but no significant difference was found at 1 and 2 years postoperatively. FJS in the UKA group demonstrated a significant increase from 3 to 6 months postoperatively, but no significant difference was observed from 6 to 24 months postoperatively. In contrast, FJS in the HTO group showed a significant increase from 3 to 24 months postoperatively. CONCLUSIONS Patients who underwent UKA exhibited superior joint awareness compared to those who underwent HTO during the early postoperative period. Furthermore, the rate of joint awareness in UKA patients was faster than in HTO patients.
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Affiliation(s)
- Hao Ge
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yiwei Huang
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Hongsong Yan
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China.
- Baiyun Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Longqi Road 2#, Renhe Town, Baiyun, Guangzhou, 510405, Guangdong, China.
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Chan-Waï-Nam J, Fernandez M, Josse A, Dubrana F. Medial unilateral knee arthroplasty after high tibial osteotomy: A retrospective study of 41 cases. Orthop Traumatol Surg Res 2023; 109:103514. [PMID: 36513325 DOI: 10.1016/j.otsr.2022.103514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION When medial knee osteoarthritis continues to get worse after a high tibial osteotomy (HTO) procedure, a subsequent total knee arthroplasty (TKA) is typically warranted. Medial unilateral knee arthroplasty (UKA) is not recommended. The aim of this study was to evaluate the outcomes of patients who underwent medial UKA after HTO. HYPOTHESIS Good results can be obtained with this procedure, as long as the postoperative valgus is not excessive. MATERIALS AND METHODS This was a retrospective, single-center study of patients operated between January 2005 and June 2019. The primary endpoint was the Oxford Knee Scale (OKS). The Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), range of motion and complications were the secondary endpoints. The average follow-up was 79 months. RESULTS Forty-one knees in 38 patients were analyzed. Four revisions with implant exchange (10%) were needed. Thirty-seven knees had a mean OKS of 20/60±8 (12-39). The mean flexion and extension amplitude were 123°±8° (110-140) and -1.5°±4 (-15-0), respectively. Eight patients had flexion and/or extension contractures. DISCUSSION Good functional and clinical outcomes in the medium term were achieved for the patients in this study who underwent UKA after HTO. These findings reinforce the good results reported in recent studies of UKA after HTO. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Julie Chan-Waï-Nam
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France.
| | - Marie Fernandez
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
| | - Antoine Josse
- Pediatric Surgery Department, Hospices civils de Lyon, hôpital mère-enfant, 3, quai des Célestins, 69002 Lyon, France
| | - Frédéric Dubrana
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
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Motta DP, Faria JLR, Couto A, Aguiar DP, Amaral MVG, Kropf LL, Motta GAVA, Cerqueira FS, Leonetti BD. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023; 18:123-132. [PMID: 37942429 PMCID: PMC10628620 DOI: 10.5005/jp-journals-10080-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To present a review of patients subjected to gradual correction of a valgus deformity of the tibia using a monolateral external fixator. Method This retrospective review included patients from January 2012 to May 2022 who met the following inclusion criteria: deviation of mechanical axis of the limb due to valgus deformity of the tibia; tibial deformity in the coronal plane on radiographic examination; a documented outpatient pre-operative evaluation by an orthopaedic surgeon and age between 10 and 70 years. The following exclusion criteria were applied: the presence of another tibia deformity preventing gradual correction using the proposed assembly; skin conditions incompatible with the surgical procedure; inadequate pre- or post-operative radiological evaluation; and insufficient information in the medical records. Results The mean age of patients with a valgus deformity of the tibia was 30.8 ± 15.9 years. These patients had a body mass index (BMI) of 26.1 ± 5.5 kg/m2. A congenital or developmental aetiology was attributed to 58.3% of the cases. Most commonly, the deformity was found in the middle third of the tibia with a mean deformity of 14.7 ± 6.6 degrees. The total external fixator time ranged from 73 to 229 days (average 149.7 ± 36.1 days). The mean medial proximal and lateral distal tibial angles differed significantly for pre- and post-operative measurements (p ≤ 0.05). There were complications in eight cases; five cases of pin site infections, two cases of medial cortical fracture and one case of peroneal nerve neuropraxia. Conclusion The proposed correction technique produces a satisfactory angular correction and with similar outcomes as described in the literature. How to cite this article Motta DP, Faria JLR, Couto A, et al. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023;18(2):123-132.
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Affiliation(s)
- DP Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - JLR Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - A Couto
- National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - DP Aguiar
- Biophysics Chair, State University of Rio de Janeiro, Brazil
| | - MVG Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - LL Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - GAVA Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - FS Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - BD Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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21
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Bin G, Jinmin L, Cong T, Yuchen T, Xiaohui Z, Yayi X. Surgical interventions for symptomatic knee osteoarthritis: a network meta-analysis of randomized control trials. BMC Musculoskelet Disord 2023; 24:313. [PMID: 37087428 PMCID: PMC10122318 DOI: 10.1186/s12891-023-06403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/06/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Multiple surgical interventions exist for the treatment of symptomatic knee osteoarthritis, but the surgeon and patient may often have difficulty deciding which interventions are the best option. METHODS We conducted a systematic review to identify randomized clinical trials (RCTs) that compared complications, revisions, reoperations, and functional outcomes among TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty), HTO (high tibial osteotomy), BCA (bicompartmental knee arthroplasty), BIU (bi-unicompartmental knee arthroplasty), and KJD (knee joint distraction). The PubMed, Embase, and Cochrane databases were reviewed for all studies comparing two or more surgical interventions. Direct-comparison meta-analysis and network meta-analysis (NMA) were performed to combine direct and indirect evidence. The risk of bias was assessed using the revised Cochrane risk of bias tool for RCTs. RESULTS This NMA and systematic review included 21 studies (17 RCTs), with a total of 1749 patients. The overall risk-of-bias assessment of the RCTs revealed that 7 studies had low risk, 5 had some concerns, and 9 had high risk. SUCRA (the surface under the cumulative ranking curve) rankings revealed that KJD had the greatest risk of appearing postoperative complications, revisions, and reoperations, and UKA or TKA had the lowest risk. The majority of comparisons among various treatments showed no difference for functional outcomes. CONCLUSION Each surgical intervention is noninferior to other treatments in functional outcomes, but UKA and TKA are better options to treat OA according to SUCRA rankings by comparing complications, revisions, and reoperations. KJD is an imperfect option for treating OA. Other treatments should be carefully considered for each patient in accordance with their actual conditions. However, this conclusion is limited by the selection of reviewed publications and individual variation of surgical indications for patients. TRIAL REGISTRATION This study was registered with Research Registry (reviewregistry1395).
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Affiliation(s)
- Geng Bin
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Orthopaedics, Lanzhou, Gansu, China
| | - Liu Jinmin
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tian Cong
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tang Yuchen
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhang Xiaohui
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Orthopaedics, Lanzhou, Gansu, China
| | - Xia Yayi
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
- Gansu Province Clinical Research Center for Orthopaedics, Lanzhou, Gansu, China.
- Lanzhou University Second Hospital, #82 Cuiyingmen, Lanzhou, Gansu, 730000, China.
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22
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Bhattacharyya R, Alloush A, Wilson C, Doonan J, Rooney B, Walker C, Maclean A, Blyth M. Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee: a retrospective cohort study with fourteen years' follow-up. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05802-0. [PMID: 37039819 DOI: 10.1007/s00264-023-05802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study was to evaluate the survivorship of HTO for the treatment of medial compartment osteoarthritis (OA) in young and active patients from two teaching hospitals in a single city. METHODS This is a retrospective cohort multicenter study looking at HTO for treatment of medial compartment OA. We analyzed a case series of HTO's performed by four surgeons in two centres over a 14-year period. Failure was defined as conversion to total knee replacement (TKR). All cases where additional procedures for instability of the knee were performed at the time of the index surgery were excluded. Time to failure was recorded, and a Kaplan-Meir (KM) analysis was performed to evaluate survivorship. Univariate binary regression analysis was undertaken to identify associations between risk factors and failure. RESULTS A total of 96 patients were included in the study with a median age was 45 years. The survivorship at five years post-op was 90.3%, and at ten years post-op, it was 82%. Patients that were 14 years after surgery had a survivorship of 65%. Also, 18.8% of patients required the removal of their metalwork. The overall complication rate was 6.3%. The univariate regression analysis showed that higher age (p = 0.02) and larger corrections requiring the use of bone graft increased the risk of failure (p = 0.02). There was no statistically significant correlation between laterality, gender, complication rate, and pre-operative alignment to survivorship. CONCLUSION This is one of the largest reported case series of HTO's with comparable survivorship at five and ten year follow-up compared to the reported literature. There was an association found between increasing age and larger corrections requiring bone graft at index procedure to increasing failure rate.
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Affiliation(s)
| | | | | | | | - Brian Rooney
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Walker
- Queen Elizabeth University Hospital, Glasgow, UK
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23
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Serbin PA, Do DH, Hinkle A, Wukich D, Huo M, Sambandam S. Comparative Analysis of Unicompartmental Total Knee Arthroplasty and High Tibial Osteotomy: Time to Total Knee Arthroplasty and Other Outcome Measures. Arthroplast Today 2023; 20:101107. [PMID: 37069946 PMCID: PMC10104836 DOI: 10.1016/j.artd.2023.101107] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/22/2022] [Accepted: 01/14/2023] [Indexed: 04/19/2023] Open
Abstract
Background There is no consensus on whether unicompartmental arthroplasty (UKA) or high tibial osteotomy (HTO) is superior for unicompartmental arthritis. While there are studies comparing revision and complication rates, none matched a large number of patients undergoing HTO and UKA in the United States and compared these outcomes. We investigated TKA conversion rate and the complications following HTO or UKA. Methods This retrospective study queried the PearlDiver database of all patients undergoing UKA and HTO using CPT codes between January 2011 and January 2020. We compared propensity-matched populations based on age, gender, Charlson comorbidity index, and Elixhauser comorbidity index to compare odds of complications, TKA conversion, and drug use between UKA and HTO groups. Two-independent sample t-test for unequal variances and test of significance were performed. Results We found 32,583 UKA patients and 816 HTO patients. Each matched group had 535 patients. One-year complication showed higher risk of pneumonia, hematoma, infection, and mechanical complications among HTO patients. UKA patients used narcotics on average of 10.3 days compared to 9.1 days among HTO patients (P < .01). UKA conversion rates were 4.1%, 5.4%, 7.7%, and 9.2% at 1-, 2-, 5-, and 10-year intervals, respectively. HTO conversion rates were less than 2% at 1- and 2-year intervals, 3.4% at 5-year, and 4.5% at 10-year intervals. This difference was statistically significant at 5- and 10-year intervals (P < .01). Conclusions Using large matched cohorts, HTO may be converted to TKA later than UKA in short- to mid-term follow-up, and HTO patients used opioids for shorter duration.
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Affiliation(s)
- Philip A. Serbin
- Corresponding author. Department of Orthopaedic Surgery, UT Southwestern, 1801 Inwood Drive, Dallas, TX 75390, USA. Tel.: +1 423 839 6961.
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Koh DTS, Soong J, Yeo W, Tan MWP, Teo SJ, Wilson A, Lee KH. Large Versus Small Opening Wedge High Tibial Osteotomies Performed With a Protective Wire Over the Lateral Hinge: Incidence of Lateral Hinge Fracture and Early Clinical Outcomes. Am J Sports Med 2023; 51:672-677. [PMID: 36856282 DOI: 10.1177/03635465221148496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND The incidence of lateral hinge fractures (LHFs) during medial opening wedge high tibial osteotomy (MOW-HTO) is unacceptably high, especially with distractions >10 mm. LHFs result in malunion, loss of correction, and recurrence of symptoms adversely affecting clinical outcomes. PURPOSE (1) To investigate the incidence of LHF when a protective guide wire is utilized during MOW-HTO in small and large corrections and (2) to study the effect of correction size on early clinical outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed of 96 knees that underwent MOW-HTO between 2019 and 2020. A protective wire applied intraoperatively across the lateral hinge point before opening wedge distraction was performed for all patients. Patients were divided into 2 groups based on opening wedge sizes: group A (opening distraction <10 mm) and group B (opening distraction ≥10 mm). LHF and wound complications were recorded. Prospective Knee Score and Function Score (Knee Society), Oxford Knee Score, and Physical and Mental Component Summaries of the 36-Item Short Form Health Survey questionnaire were recorded preoperatively and at 6 months and 2 years after surgery. RESULTS Incidence of LHF was low in group A (n = 2; 6.1%) and group B (n = 3; 9.1%). A single case of intraoperative LHF was noted in each group, with each case resulting in a type 1 fracture. The incidence of postoperative fractures was comparable between groups (groups A vs B, n = 1 vs 2). At 6 months, clinical outcomes in group A were superior to those of group B (Knee Score, 85.7 ± 14.7 vs 73.1 ± 20.3, P = 0.028; Function Score, 73.5 ± 16.5 vs 63.1 ± 19.5, P = 0.047; Oxford Knee Score, 20.2 ± 4.7 vs 25.6 ± 8.5, P = 0.008; Physical Component Summary, 46.8 ± 8.1 vs 40.2 ± 10.9, P = 0.018). However, clinical outcomes were comparable at 2 years (P > .05). CONCLUSION A protective wire was associated with a low incidence of LHF, even in larger MOW-HTO corrections. Large corrections had poorer clinical outcomes as compared with small corrections at 6 months. However, clinical outcomes between groups were comparable at 2 years.
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Affiliation(s)
| | - Junwei Soong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Shao Jin Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Adrian Wilson
- London Osteotomy Centre, Harley Street Specialist Hospital, London, UK.,Department of Sports and Exercise, University of Winchester, Winchester, UK
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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25
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Vinet M, Le Stum M, Gicquel T, Clave A, Dubrana F. Unicompartmental knee arthroplasty: A French multicenteric retrospective descriptive study from 2009 to 2019 with projections to 2050. Orthop Traumatol Surg Res 2023; 109:103581. [PMID: 36796624 DOI: 10.1016/j.otsr.2023.103581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) is a reliable and reproducible procedure. While some surgeons have incorporated it into their therapeutic armamentarium, others do not use it routinely, leading to a large disparity in practice. The objective of this study was to investigate in France the epidemiology of UKA from 2009 to 2019 to identify: (1) the evolution of growth trends by sex and age, (2) the evolution of the state of comorbidity of patients during the operation, (3) the evolution of trends according to the regions, (4) the projection best suited to the observations at 2050. HYPOTHESIS Our hypothesis was that in France, an increase would be observed over the period studied, differing according to the characteristics of the population. MATERIALS AND METHOD The study was conducted in France over the 2009-2019 period for each gender and age group. The data was taken from the NHDS (National Health Data System) database, which includes all the procedures carried out in France. Based on the collection of procedures performed, the incidence rates (per 100,000 inhabitants) and their evolution were deduced, as well as the indirect assessment of the patient's comorbidity status. Using linear, Poisson, and logistic projection models, incidence rates were projected to the years 2030, 2040, and 2050. RESULTS Between 2009 and 2019, the incidence rate of UKA increased sharply (from 12.76 to 19.57; +53%), the growth was different in men (from 10.78 to 20.34; +89%) and women (from 14.61 to 18.85; +29%). The male/female sex ratio increased from 0.69 in 2009 to 1.0 in 2019. The increase was greatest among men under 65 (from 4.9 to 9.9; +100%) and lowest among women over 75 (from 41.2 to 40.5; -2%). Over the period studied, the proportion of patients with mild comorbidities (HPG1) increased (from 71.7% to 81.1%) at the expense of the other classes with more severe comorbidities. This dynamic was observed for all age groups: 0-64 years (from 83.3% to 90%), 65-74 years (from 81.4% to 88.4%), 75 years and over (38 .2% to 52.6%) regardless of sex. There was a strong disparity between the regions with a change in the incidence rate ranging from -22% (from 29.8 to 23.1) for Corsica to +251% (from 13.9 to 48.7) for Brittany. The proposed projection models suggested an increase in the incidence rate of +18% in logistic regression, +103% in linear regression by 2050. DISCUSSION Our study showed strong growth in the number of UKAs in France over the period studied, being highest in young men. The proportion of patients with fewer comorbidities increased for all age groups. A disparity in inter-regional practice was identified, with indications that remain ambiguous and differ according to the practitioner. We can expect continued growth in the years to come, adding to the care burden. LEVEL OF EVIDENCE IV; Descriptive epidemiological study.
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Affiliation(s)
- Mathieu Vinet
- Service d'orthopédie, centre hospitalo-universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Mathieu Le Stum
- Institut national de la santé et de la recherche médicale, Inserm, laboratoire de traitement de l'information médicale (LATIM), UMR1101, 22, avenue Camille-Desmoulins, 29200 Brest, France
| | - Thomas Gicquel
- Clinique mutualiste de la porte de L'orient, 3, rue Robert-de-la-Croix, 56324 Lorient, France
| | - Arnaud Clave
- Université de Bretagne Occidentale, UBO, LATIM, UMR 1101, 22, avenue Camille-Desmoulins, 29200 Brest, France; Service d'orthopédie, clinique Saint-George, 2, avenue de Rimiez, 06100 Nice, France
| | - Frédéric Dubrana
- Service d'orthopédie, centre hospitalo-universitaire de Brest, CHRU de Brest, 2, avenue Foch, 29200 Brest, France
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Zhang B, Qian H, Wu H, Yang X. Unicompartmental knee arthroplasty versus high tibial osteotomy for medial knee osteoarthritis: A systematic review and meta-analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231162829. [PMID: 36893443 DOI: 10.1177/10225536231162829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
We aimed to systematically compare the clinical and functional outcomes between unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) for the treatment of medial knee osteoarthritis (KOA). Literatures were searched from PubMed, EMBASE, the Cochrane library, Wanfang DATA, China National Knowledge Infrastructure (CNKI) and SinoMed database until December 2020. Studies comparing postoperative clinical and functional outcomes of UKA versus HTO were included. Totally, 38 studies were included, including 2368 patients with 2393 knees in HTO group and 6536 patients with 6571 knees in UKA group. There was significant difference in postoperative pain, revision rate, complications, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between HTO and UKA groups (p < 0.05). No significant difference was found in excellent/good surgical results, Lysholm, Hospital for Special Surgery (HSS) score, Knee Society Knee (KSS) score, knee and function score of Knee Society (KSFS) score and Tegner score between these two groups (p > 0.05). UKA produced less postoperative pain, less complications and superior WOMAC score, whereas HTO offered extended range of motion (ROM) and less revision rate.
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Affiliation(s)
- Bin Zhang
- Department of Orthopedics, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Hanguang Qian
- Department of Orthopedics, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Hongfu Wu
- Department of Orthopedics, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiaofei Yang
- Department of Orthopedics, 199193Affiliated Hospital of Jiangnan University, Wuxi, China
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27
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Kahan ME, Chen Z, Angerett NR, Sax OC, Bains SS, Assayag MJ, Delanois RE, Nace J. Unicompartmental Knee Arthroplasty Has Lower Infection, Conversion, and Complication Rates Compared to High Tibial Osteotomy. J Knee Surg 2022; 35:1518-1523. [PMID: 36538939 DOI: 10.1055/s-0042-1757597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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.
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Affiliation(s)
- Michael E Kahan
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nathan R Angerett
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Oliver C Sax
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael J Assayag
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.,LifeBridge Health, Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Werner DM, Golightly YM, Tao M, Post A, Wellsandt E. Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury. Rheum Dis Clin North Am 2022; 48:907-930. [PMID: 36333003 DOI: 10.1016/j.rdc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.
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Affiliation(s)
- David M Werner
- Office of Graduate Studies, Medical Sciences Interdepartmental Area, University of Nebraska Medical Center, 987815 Nebraska Medical Center, Omaha, NE 68198-7815, USA; Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center Omaha, NE 68198-4035, USA
| | - Matthew Tao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
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Yoo JD, Huh MH, Shin YS. Risk of revision in UKA versus HTO: a nationwide propensity score-matched study. Arch Orthop Trauma Surg 2022; 143:3457-3469. [PMID: 36264509 DOI: 10.1007/s00402-022-04658-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Our study aims to investigate the incidence rate and risk factors for subsequent revision in patients treated with UKA compared with those treated with HTO. METHODS In this retrospective nationwide cohort study, we used data from the Korean National Health Insurance claims database from January 1, 2009 to December 31, 2017. We compared patients who had undergone UKA or HTO as the primary surgical procedure longer than two years prior. We used multivariable logistic regression models to compare risk of revision between the groups after propensity matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to total knee arthroplasty (TKA) after primary UKA or HTO. RESULTS In this study, 73,902 patients with UKA and 72,215 patients with HTO were identified after applying IPTW. The risk of revision during the entire study period was higher for patients with HTO than for patients with UKA (adjusted hazard ratio [HR] = 1.42). Kaplan-Meier 8-years survival was 96.8% in the UKA group and 95.1% in the HTO group. Patients with HTO who were at higher risk of revision had advanced age (60-69 years [HR = 2.17, 95% CI 1.76-2.67] and 70-79 years [HR = 2.89, 95% CI 1.81-4.62]), female sex (HR = 1.41, 95% CI 1.19-1.66), CHF (HR = 3.12, 95% CI 1.25-7.78), COPD (HR = 1.68, 95% CI 1.34-2.10), PVD (HR = 1.75, 95% CI 1.10-2.78), and CVA or TIA (HR = 1.87, 95% CI 1.13-3.08) compared with those with UKA. CONCLUSION Risk of revision was higher for patients with HTO than for patients with UKA. Risk factors for subsequent revision in patients with HTO were advanced age (60-69, 70-79), female sex, and comorbidities such as CHF, COPD, PVD, CVA, or TIA. However, orthopedic surgeons should also consider that TKA conversion from UKA has higher risk of revision than TKA conversion from HTO before choosing between UKA and HTO.
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Affiliation(s)
- Jae-Doo Yoo
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Yangchuan Anyangchun-Ro, Seoul, 07985, Republic of Korea
| | - Min-Hwan Huh
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Yangchuan Anyangchun-Ro, Seoul, 07985, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Yangchuan Anyangchun-Ro, Seoul, 07985, Republic of Korea.
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30
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Liu J, Zhu D, Wang W, Chen Y, Chen L. Comparison of the effect of high tibial osteotomy and total knee arthroplasty on postoperative pain in patients with knee arthritis. Minerva Surg 2022; 77:516-518. [PMID: 34889567 DOI: 10.23736/s2724-5691.21.09289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jing Liu
- Department of Orthopedics, Gongan Country People's Hospital, Jingzhou, China
| | - Daoping Zhu
- Department of Orthopedics, Gongan Country People's Hospital, Jingzhou, China
| | - Wei Wang
- Department of Orthopedics, Gongan Country People's Hospital, Jingzhou, China
| | - Yang Chen
- Department of Orthopedics, Gongan Country People's Hospital, Jingzhou, China
| | - Liang Chen
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China -
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Ping H, Wen J, Liu Y, Li H, Wang X, Kong X, Chai W. Unicompartmental knee arthroplasty is associated with lower pain levels but inferior range of motion, compared with high tibial osteotomy: a systematic overview of meta-analyses. J Orthop Surg Res 2022; 17:425. [PMID: 36153554 PMCID: PMC9509560 DOI: 10.1186/s13018-022-03319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to overview the findings of reported meta-analyses on unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 (PRISMA 2020) guidelines were followed. Two independent reviewers conducted a literature search of PubMed, Embase, the Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses comparing UKA and HTO that were published prior to September 2021. Literature screening, data extraction, and article quality appraisal were performed according to the study protocol registered online at PROSPERO (CRD42021279152). Results A total of 10 meta-analyses were identified, and different studies reported different results. Five of the seven meta-analyses showed that the proportion of subjects with excellent or good functional results was higher for UKA than for HTO. All three meta-analyses showed that UKA was associated with lower pain levels, and all six of the studies that included an analysis of range of motion (ROM) reported that UKA was inferior to HTO. Four of the eight meta-analyses found that total complication rates were lower for UKA. Only 3 of the 10 meta-analyses found that UKA had lower revision rates. Moreover, in the subgroup analysis, the revision and complication rates of UKA were similar to those of opening-wedge HTO but much lower than those of closing-wedge HTO. Conclusions Compared to HTO, UKA was associated with lower pain levels but inferior postoperative ROM. The results were inconclusive regarding whether UKA yielded better knee function scores and lower revision or complication rates than HTO. Accurate identification of indications and appropriate patient selection are essential for treating individuals with OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03319-7.
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Fang Q, Zhang Z, Wang D, Wang L, Xiong W, Tang Y, Liu W, Wang G. Effect of Tranexamic Acid on Blood Management during a High Tibial Osteotomy: A Systematic Review and Meta-analysis. Orthop Surg 2022; 14:1940-1950. [PMID: 35913385 PMCID: PMC9483069 DOI: 10.1111/os.13407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/31/2022] [Accepted: 06/26/2022] [Indexed: 02/05/2023] Open
Abstract
This study aimed to evaluate the efficiency and safety of tranexamic acid for blood management during high tibial osteotomy (HTO). A systematic search was conducted in Medline, Embase, and the Cochrane library database. Six studies and 208 patients were included in this meta‐analysis using Review Manager V.5.3 and Stata 15.1 software. For primary outcomes, tranexamic acid lowered the total blood loss (WMD = –219.47, 95% CI [−355.61, −83.33], P = 0.002). For secondary outcomes, a significant reduction was found for decreased hemoglobin (POD1: WMD = –9.86, 95% CI [−13.45, −6.28], P < 0.05; POD2: WMD = –8.41, 95% CI [−11.50, −5.32], P < 0.05; POD5: WMD = –11.48, 95% CI [−14.56, −8.39], P < 0.05) and drainage (total: WMD = –105.93, 95% CI [−187.08, −24.78], P < 0.05; POD1: WMD = –122.195, 95% CI [−168.902, −75.488], P < 0.05). The sex difference (male/female ratio) was determined (total blood loss: P = 0.025; total drainage amount: p = 0.018) using meta‐regression analysis. Females benefited more from tranexamic acid in terms of total blood loss (M/F > 40%: WMD = –53.11, 95% CI [−100.16, −6.05], P = 0.03; 40% ≥ M/F ≥ 20%: WMD = –362.20, 95% CI [−423.96, −300.45], P < 0.05; M/F < 20%: WMD = –263.00, 95% CI [−277.17, −248.83], P < 0.05) and total drainage (M/F > 40%: WMD = –7.11, 95% CI [−10.75, −3.47], P < 0.05; 40% ≥ M/F ≥ 20%: WMD = –104.72, 95% CI [−155.36, −54.08], P < 0.05; M/F < 20%: WMD = –222.00, 95% CI [−297.42, −146.58], P < 0.05). No significant differences were found for drainage on POD2 and POD3, wound complications, orthromboembolic events. In conclusion, tranexamic acid is effective and safe for blood management during HTO. Females appeared to benefit more from it, and an additional postoperative dose is suggested fora better effect.
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Affiliation(s)
- Qian Fang
- West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Zhang
- West China Hospital, Sichuan University, Chengdu, China
| | - Dong Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Limin Wang
- West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xiong
- West China Hospital, Sichuan University, Chengdu, China
| | - Yunfeng Tang
- West China Hospital, Sichuan University, Chengdu, China
| | - Wenzheng Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - Guanglin Wang
- West China Hospital, Sichuan University, Chengdu, China
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Huang L, Xu Y, Wei L, Yuan G, Chen W, Gao S, Liu W, Tan Z, Zhao J. Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29576. [PMID: 35905249 PMCID: PMC9333480 DOI: 10.1097/md.0000000000029576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are widely used for the treatment of medial unicompartmental knee osteoarthritis (OA). However, the best approach remains controversial. This study aimed to present a systematic review and a meta-analysis to directly compare the clinical outcomes between HTO and UKA. We hypothesized that the clinical outcomes after UKA and HTO would be similar. METHODS Electronic databases (Web of Science, PubMed, Embase, CENTRAL, and Biosis Preview) were searched for related studies published before November 30, 2021. Retrospective and prospective studies that directly compared the postoperative outcomes between UKA and HTO were included. Odds ratio (ORs) and 95% confidence interval (CIs) for complications, revision to total knee arthroplasty (TKA), and weighted mean difference (MD) and 95% CIs in range of motion (ROM), pain, walking speed and function score were evaluated. Two reviewers independently assessed the quality of the studies. Subgroup and sensitivity analyses were performed to explore the heterogeneity. RESULTS Twenty-three retrospective and 6 prospective studies were included. A total of 3004 patients (3084 knees) were evaluated for comparison. Complications (OR, 4.88, 95% CI: 2.92-6.86) were significantly greater in the HTO group than in the UKA group. Postoperative function scores including Lysholm score (MD, -2.78, 95% CI: -5.37 to -0.18) and Hospital for Special Surgery (HSS) score (MD, -2.80, 95% CI: -5.39 to -0.20) were significantly lower in the HTO group than the UKA group. The postoperative ROM was similar between HTO and mobile-bearing UKA (MD, -3.78, 95% CI: -15.78 to 8.22). However, no significant differences were observed between the HTO and UKA group in terms of postoperative pain, walking speed, and revision to TKA. CONCLUSIONS UKA is superior to HTO in minimizing complications and enhancing postoperative function scores. Mobile-bearing UKA has a similar ROM compared with HTO. Both HTO and UKA provide satisfactory clinical outcomes in terms of walking speed, relieving pain, and revision to TKA. UKA appears to be more suitable for the elderly, and both mobile-bearing UKA and HTO are viable surgical options for younger active individuals.
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Affiliation(s)
- Linke Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Yinglong Xu
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Linhua Wei
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- The Affiliated Nanning Infectious Disease Hospital of Guangxi Medical University, The Fourth People’s Hospital of Nanning, Nanning, GuangxiChina
| | - Guangzhi Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Weiwei Chen
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, GuangxiChina
| | - Shiyao Gao
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Wei Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Zhen Tan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Jinmin Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- * Correspondence: Jinmin Zhao MD, Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi, China (e-mail: )
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Piovan G, Farinelli L, Screpis D, Iacono V, Povegliano L, Bonomo M, Auregli L, Zorzi C. Distal femoral osteotomy versus lateral unicompartmental arthroplasty for isolated lateral tibiofemoral osteoarthritis with intra-articular and extra-articular deformity: a propensity score-matched analysis. Knee Surg Relat Res 2022; 34:34. [PMID: 35851077 PMCID: PMC9290203 DOI: 10.1186/s43019-022-00164-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Lateral unicompartmental arthroplasty (UKA) and distal femoral osteotomy (DFO) represent surgical solutions in cases of valgus malalignment and isolated lateral osteoarthritis (OA) of the knee. The aim of the present study was to assess the clinical results, complications, and the overall postoperative alignment of a series of DFO and lateral UKA with a minimum 2-year follow-up in active middle-aged patients. Methods Patients with valgus knee and isolated lateral OA who underwent opening-wedge DFO or UKA from 2017 to 2019 were reviewed. Each patient was characterized by a joint line convergence angle (JLCA) > 3° and mechanical lateral distal femoral angle (mLDFA) < 87°. We excluded patients who underwent meniscus or osteochondral allograft during DFO. The Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), complications, and postoperative alignment were assessed. Propensity score matching was used to identify comparable patients. Results The DFO and lateral UKA groups consisted of 29 patients each. No statistically significant differences in gender, age, body mass index (BMI), length of follow-up, or limb deformity were reported between the two groups. In the DFO group, OKS was reported to improve from 27.51 to 38.59 (p < 0.05) and KOOS from 51.14 to 67.2 (p < 0.05). Similarly, in the UKA group, OKS improved from 26.23 to 35.43 (p < 0.05) and KOOS from 50.12 to 65.91 (p < 0.05). However, the improvement in OKS and KOOS (delta) did not differ between groups (p = 0.35 and p = 0.95). The DFO and UKA groups were characterized by similar postoperative hip-knee-ankle (HKA) angle measurements of −3.26 and −3.00, respectively (p = 0.65). No patients in the UKA group underwent revision or other knee surgeries during follow-up. No infections were detected in either group. In the DFO group, no cases of nonunion or delayed union were reported. However, 40% of DFO patients underwent plate removal. One patient in each group was characterized by progression of medial OA with Kellgren-Lawrence (KL) grade > 3. Conclusion UKA and DFO represent an effective treatment in lateral knee OA with intra-articular and extra-articular deformity. Both surgeries were able to provide a significant and comparable clinical improvement. Level of evidence: III, comparative retrospective cohort study.
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Affiliation(s)
- Gianluca Piovan
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Daniele Screpis
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Venanzio Iacono
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Lorenzo Povegliano
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Marco Bonomo
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Ludovica Auregli
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Claudio Zorzi
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Esser T, Saier T, Valle C, Schmitt-Sody M, Feucht MJ, Prodinger PM, Minzlaff P. Surgeons' expectations of osteotomies around the knee. Arch Orthop Trauma Surg 2022; 142:1613-1622. [PMID: 34402929 DOI: 10.1007/s00402-021-04100-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION High tibial osteotomy (HTO) is a valid and joint preserving surgical technique to treat medial degenerative osteoarthritis (OA) in young and active patients. A recent study shows that patients' expectations of osteotomy around the knee are high, but OA progression and potential conversion to a total knee arthroplasty (TKA) were underestimated. The aim of this study was to investigate surgeons' expectations of HTO and to compare the results to the patients' expectations and actual outcomes reported in the literature. METHODS 461 surgeons were questioned online using the 'Hospital for Special Surgery Knee Surgery Expectations Survey (HFSS-KSES)' and a ten-item non-validated questionnaire to investigate the expectations of HTO. Two subgroups were formed to investigate differences regarding the surgeons' experience. Statistical analysis was performed using IBM SPSS Statistics. RESULTS Surgeons' expectations of HTO were rated between very and little important with pain reduction being the most important item on the HFSS-KSES. Furthermore, 'improving the ability to walk', 'to perform daily activities', 'having confidence in the knee', and 'avoiding future degeneration' were rated of high importance. An important difference regarding the experience was the lower expectations on delay/prevention of TKA of less-experienced surgeons. CONCLUSION Surgeons' expectations of HTO are high but nevertheless different to the patients' expectations reported in the literature. Also, expectations for the delay/prevention of TKA differed regarding the experience of surgeons. While pain reduction represents one of the most important items for surgeons and patients, the expected outcome regarding the delay/prevention of a TKA and returning to sports differs to the patients' expectations and to the actual outcome reported in the literature. This should be considered when performing the preoperative informed consent.
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Affiliation(s)
- Thekla Esser
- Abteilung Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Hausham, Germany
| | - Tim Saier
- Benedictus Krankenhaus Tutzing, Tutzing, Germany.,Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | | | | | - Matthias J Feucht
- Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Peter M Prodinger
- Abteilung Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Hausham, Germany.,Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Philipp Minzlaff
- Klinikum Rechts der Isar der Technischen Universität München, München, Germany. .,Sportorthopädie Orthoclinic, Krankenhaus Agatharied, Hausham, Germany.
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Seth I, Bulloch G, Seth N, Gibson D, Rastogi A, Lower K, Rodwell A, Bruce W. High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Indian J Orthop 2022; 56:973-982. [PMID: 35669023 PMCID: PMC9123137 DOI: 10.1007/s43465-022-00620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Purpose High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are commonly performed procedures for the treatment of compartmental knee osteoarthritis; however, the optimal procedure remains controversial. We conducted this systematic review and meta-analysis to compare the functional outcomes and assess complications and revision rates between the two techniques. Methods We searched electronic databases for relevant studies comparing HTO versus UKA for unicompartmental knee osteoarthritis. Continuous data as visual analogue scale (VAS), range of motion, and free walking speed were pooled as mean differences (MDs). Dichotomous data as functional knee outcomes, complications, and revision were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software for windows. Results Twenty-five studies involving 8185 patients were included. Meta-analysis showed that HTO was associated with higher risk of complications (OR = 2.47, 95% CI [1.52, 4.04]), poorer functional results (excellent/good) (OR = 0.32, 95% CI [0.21, 0.49]), and greater range of motion (MD = 7.05, 95% CI [2.41, 11.68]) compared to UKA. No significant differences were found between the compared groups in terms of VAS (MD = 0.14, 95% CI [- 0.08, 0.36]), revision rates (OR = 1.30, 95% CI [0.65, 2.60]), and free walking speed (MD = - 0.05, 95% CI [- 0.11, 0.00]). Conclusion This study showed that UKA achieved fewer complications, better functional outcomes, and less range of motion compared to HTO. No significant differences were detected between HTO and UKA in terms of VAS and revision rate. Treatment options should be personalized to each patient considering factors such as their age, activities of daily living, their body mass index, and severity of osteoarthritis. Level of evidence II. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00620-9.
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Affiliation(s)
- Ishith Seth
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
- Department of Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC 3550 Australia
| | - Gabriella Bulloch
- grid.1623.60000 0004 0432 511XDepartment of Orthopaedic Surgery, The Alfred Hospital, Melbourne, VIC 3004 Australia
| | - Nimish Seth
- grid.1008.90000 0001 2179 088XFaculty of Science, Medicine and Health, University of Melbourne, Melbourne, VIC 3010 Australia
| | - Damien Gibson
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Anish Rastogi
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Kirk Lower
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Aaron Rodwell
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Warwick Bruce
- grid.414685.a0000 0004 0392 3935Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW 2139 Australia
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Vaishya R, Vaish A, Ansari AH, Suryant S. Bilateral genu varum deformity correction in an adult by medial opening-wedge high tibial osteotomy without internal fixation. BMJ Case Rep 2022; 15:e250044. [PMID: 35649623 PMCID: PMC9161078 DOI: 10.1136/bcr-2022-250044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
A young adult man in 20s presented with bow leg deformity of both the knees, since childhood and bilateral knee pain for the last 4 years. Plain radiographs of both the knees confirmed bilateral genu varum deformity, more on the right side (16.2°) as compared with left (12.3°). He was managed surgically by a single-stage bilateral medial opening wedge high tibial osteotomy, using a synthetic bone substitute of a tri calcium phosphate. After the healing of osteotomies at 3 months, the patient was pain free and walked comfortably with normal lower limb alignment.
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Affiliation(s)
- Raju Vaishya
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Abhishek Vaish
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Aabid Husain Ansari
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Sumit Suryant
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
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Comparison of joint awareness after medial unicompartmental knee arthroplasty and high tibial osteotomy: a retrospective multicenter study. Arch Orthop Trauma Surg 2022; 142:1133-1140. [PMID: 34269892 DOI: 10.1007/s00402-021-03994-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are established treatments for medial compartment osteoarthritis (OA) or osteonecrosis (ON) of the knee joint, and the predominance of either procedure is inconclusive. We compared the awareness of the knee after UKA and HTO using the Forgotten joint score-12 (FJS). MATERIALS AND METHODS This was a retrospective, multicenter study. Ninety-six knees of 90 patients who received UKA or HTO and were followed-up for at least 1 year were analyzed. Postoperative FJS was compared between the two groups and evaluated for the effect of patient-related factors and clinical outcomes. Multiple linear regression analysis was performed to predict FJS. RESULTS There was no significant difference in the FJS between the UKA and HTO groups (p = 0.24). FJS did not correlate with any of the patient-related factors. There was a correlation between the FJS and each item of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Lysholm Knee Scoring Scale (LKS). In multiple linear regression analysis, lower BMI, the diagnosis of OA Kellgren-Lawrence (KL) grade ≥ 3, and ON were significant predictors of better FJS. In both groups, FJS was correlated with each item of the KOOS and LKS. Internal consistency in terms of Cronbach's alpha was excellent. CONCLUSIONS There was no significant difference in FJS between patients who underwent UKA and HTO. Lower BMI, the diagnosis of OA KL grade ≥ 3, and ON were significant predictors of better FJS.
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Shen G, Shen D, Fang Y, Li X, Cui L, Wei B, Wu L. Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Surg 2022; 14:1549-1557. [PMID: 35611758 PMCID: PMC9363736 DOI: 10.1111/os.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022] Open
Abstract
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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Affiliation(s)
- Gaobo Shen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Danhong Shen
- Nanjing University of Science and Technology, Nanjing, China
| | - Yuan Fang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuefei Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Longkang Cui
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bing Wei
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lianguo Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Ciolli G, Proietti L, Mercurio M, Corona K, Maccauro G, Schiavone Panni A, Cerciello S. Return to sport following distal femur osteotomy: a systematic review. Orthop Rev (Pavia) 2022; 14:33774. [PMID: 35774926 PMCID: PMC9239358 DOI: 10.52965/001c.33774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/04/2022] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Distal femur osteotomies (DFOs) are well-accepted procedures in treating unicompartmental knee osteoarthritis associated with valgus malalignment. This study aims to investigate the Return to sport (RTS) after DFO. MATERIALS AND METHODS We conducted a systematic review of the literature according to the PRISMA guidelines, including all articles published in English, with no time limit, excluding double-level knee osteotomies. RESULTS Five articles were included for an overall cohort of 76 patients. The mean follow-up was 45.53 months. The mean age of the patients at the time of surgery was 33.87 years, and the mean malalignment was 5.59° in valgus. In 70 cases, patients received a lateral DFO, while in 6 cases, a medial closing-wedge DFO. An RTS of 86.1% was observed after DFO and a mean time to RTS of 12.3 months. 76.8% of patients recovered to a level equal to or higher than that practiced before the onset of symptoms. No statistically significant differences were observed in the RTS rate between those who performed lateral or medial DFO. CONCLUSIONS RTS after DFO is ubiquitous and occurs around one year after surgery. In most cases, patients report improved performance compared to what they experienced before the onset of symptoms. Unfortunately, while athletes often have RTS at a similar or better level, other patients often see a return to lower impact sports.
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Affiliation(s)
- Gianluca Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy
| | - Lorenzo Proietti
- Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simone Cerciello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy; Marrelli Hospital, Crotone, Italy
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On the Effect of Electroacupuncture in Promoting Healing after High Tibial Osteotomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6428759. [PMID: 35341011 PMCID: PMC8947899 DOI: 10.1155/2022/6428759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/15/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
Abstract
Purpose To explore the clinical effect of electroacupuncture in promoting the healing of the osteotomy area after high tibial osteotomy. Methods 50 patients with knee osteoarthritis who underwent open wedge high tibial osteotomy (OWHTO) were selected and randomly divided into the observation group and control group. The control group got the common postoperative treatment, and the observation group was added electroacupuncture from the 3rd day after the operation on the basis of the control group. The electroacupuncture acupoints were selected SP10, ST34, ST32, EX-LE2, ST40,KI6, KI3, SP6, and ST41, once a day, and 14 days were a course of treatment. And then we contrasted the index of the Lane-Sandhu X-ray score, the skin incision healing time, the swelling subsided time, Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC), and Lysholm in different time. Results The Lane-Sandhu X-ray score of the observation group was better than that of the control group at all time points (P < 0.05), and the time to achieve bone healing was about 2 weeks earlier than that of the control group. The skin healing and swelling were the subsided time in the osteotomy area. Both were better than the control group, and the difference was statistically significant (P < 0.05). The VAS score, WOMAC score, and Lysholm score of the two groups were significantly improved compared with preoperatively, and the difference was statistically significant (P < 0.05). The improvement of the observation group's VAS score, WOMAC score, and Lysholm score at 1 week, 4 weeks, and 8 weeks after the end of the treatment course was better than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion Electroacupuncture can quicken the healing of bone tissue and surrounding soft tissues in the osteotomy area after high tibial osteotomy, and at the same time, it can help the relief of knee joint pain and improve knee joint function.
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Radhakrishnan GT, Magan A, Kayani B, Asokan A, Ronca F, Haddad FS. Return to Sport After Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221079285. [PMID: 35321207 PMCID: PMC8935568 DOI: 10.1177/23259671221079285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Patients undergoing unicompartmental knee arthroplasty (UKA) often want to return to sport (RTS) after surgery. However, the time taken to RTS and proportion of patients who RTS after UKA remain unknown. Purpose: To determine the time to RTS and proportion of patients who RTS after UKA. Study Design: Systematic review; Level of evidence, 4. Methods: A search was performed using PubMed, Medline, Embase, SPORTDiscus and the Cochrane Library databases for clinical trials reporting on RTS after UKA published between database inception and September 2021. In addition, a manual search was performed of relevant sports medicine and orthopaedic journals, and bibliographies were reviewed for eligible trials. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to undertake this study. Results: This meta-analysis included 11 studies (749 patients) that reported on RTS after UKA. The proportion of patients returning to sports increased over time: 6 studies (432 patients) demonstrated an overall pooled proportion of 48.1% (95% CI, 36.3%-60.2%) of patients who returned to sport at 3 months after surgery, while 7 studies (443 patients) demonstrated an overall pooled proportion of 76.5% (95% CI, 63.9%-87.1%) of patients who returned to sport at 6 months after surgery. Overall, 92.7% (95% CI, 85.8%-97.4%) of 749 patients were able to RTS at 4 years after surgery. Overall excellent patient-reported functional outcomes scores and low risk of complications with RTS after UKA were reported. Conclusion: The authors found that 48.1% of patients were able to RTS at 3 months after surgery and 76.5% were able to RTS at 6 months after UKA. Pooled proportion analysis showed that >90% of patients undergoing UKA were able to RTS at 48 months after surgery. The majority of patients who were able to RTS after UKA did so at a lower level of intensity than their preoperative level. RTS after UKA was associated with good patient-reported functional outcomes scores and a low risk of complications.
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Affiliation(s)
- Ganan T. Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Ajay Asokan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Flaminia Ronca
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Fares S. Haddad
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
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Cook JL, Stannard JP, Stoker AM, Rucinski K, Crist BD, Cook CR, Crecelius C, Smith MJ, Stucky R. Biologic Joint Restoration: A Translational Research Success Story. MISSOURI MEDICINE 2022; 119:115-121. [PMID: 36036037 PMCID: PMC9339389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment options that result in consistently successful outcomes for young and active patients with joint disorders are needed. This article summarizes two decades of rigorous research using a bedside-to-bench- to-bedside translational approach based on the One Health - One Medicine concept that culminated in successful clinical use of biologic joint restoration options for treatment of knee, hip, ankle, and shoulder problems in this growing patient population.
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Affiliation(s)
- James L Cook
- William and Kathryn Allen Distinguished Chair in Orthopaedic Surgery; Director, Thompson Laboratory for Regenerative Orthopaedics (TLRO) and Mizzou BioJoint® Center; and Vice Chair, Orthopaedic Research Division, University of Missouri - Columbia, Columbia, Missouri
| | - James P Stannard
- TLRO and Department of Orthopaedic Surgery (DOS), University of Missouri - Columbia, Columbia, Missouri
| | - Aaron M Stoker
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Kylee Rucinski
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Brett D Crist
- TLRO and DOS, University of Missouri - Columbia, Columbia, Missouri
| | - Cristi R Cook
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Cory Crecelius
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | | | - Renee Stucky
- TLRO, University of Missouri - Columbia, Columbia, Missouri
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Lee SH, Kim HR, Seo HY, Seon JK. A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea. BMC Musculoskelet Disord 2022; 23:127. [PMID: 35135508 PMCID: PMC8827168 DOI: 10.1186/s12891-022-05080-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, over the past 20 years, results of comparisons of long-term survival rates and outcomes have remained controversial. Furthermore, in patients at the boundary age, from 50 to 70 years, considering age as a treatment indication, selecting a surgical method is difficult. Therefore, we aimed to investigate conversion rates to total knee arthroplasty (TKA) and perioperative adverse outcomes between the two surgical methods in mid-age patients. Methods We extracted data from the Korean National Health Insurance claims database. A total of 70,464 patients aged between 50 and 70 years, considered as mid-age patients were included in the final study population. We used a multivariable Cox proportional hazard regression model, adjusting for potential confounders such as age, sex, insurance type, region of residence, hospital type, comorbidities, and the Charlson comorbidity Index (CCI). Results Of the 70,464 patients, 21,194 were treated with UKA and 49,270 were treated with HTO. HTO showed a higher risk of revision than UKA at five, and 10 years and during the whole observation period. The incidence of deep vein thromboembolism, and surgical site infection was significantly higher in UKA than in HTO. Conclusions It is important to choose an appropriate surgical method considering that UKA has better results in terms of long-term survival rates but may have a higher incidence of various complications.
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Affiliation(s)
- Sun-Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Republic of Korea
| | - Hyoung-Yeon Seo
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
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Bin Abd Razak HR, Campos JP, Khakha RS, Wilson AJ, van Heerwaarden RJ. Role of joint distraction in osteoarthritis of the knee: Basic science, principles and outcomes. J Clin Orthop Trauma 2022; 24:101723. [PMID: 34938647 PMCID: PMC8654974 DOI: 10.1016/j.jcot.2021.101723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/25/2022] Open
Abstract
The burden of knee osteoarthritis (OA) is increasing worldwide. Advanced tibiofemoral joint OA in young patients is particularly a problem with inferior results seen with total knee arthroplasty in this patient population. Knee joint distraction (KJD) has been evaluated recently as a joint preserving procedure for young patients with advanced tibiofemoral osteoarthritis, to delay the need for a primary total knee arthroplasty (TKA). This will decrease the risk for revision TKA later in life. KJD temporarily unloads the knee joint and keeps the tibia and femur separated over a course of 6 weeks. Outcomes of KJD appear promising. Through this article, the authors hope to share from their collective experience as well as the available literature on the basic science, principles of surgery and outcomes of KJD.
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Affiliation(s)
- Hamid Rahmatullah Bin Abd Razak
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - João Pedro Campos
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Serviço de Ortopedia e Traumatologia, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Matosinhos, Portugal
| | - Raghbir S. Khakha
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Department of Orthopaedics, Guys & St Thomas's Hospital, Great Maze Pond, SE1 9RT, United Kingdom
| | - Adrian J. Wilson
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester, SO22 4NR, United Kingdom
| | - Ronald J. van Heerwaarden
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Wu C, Fukui N, Lin YK, Lee CY, Chou SH, Huang TJ, Chen JY, Wu MH. Comparison of Robotic and Conventional Unicompartmental Knee Arthroplasty Outcomes in Patients with Osteoarthritis: A Retrospective Cohort Study. J Clin Med 2021; 11:220. [PMID: 35011960 PMCID: PMC8745819 DOI: 10.3390/jcm11010220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Robotic-arm-assisted unicompartmental knee arthroplasty (RUKA) was developed to increase the accuracy of bone alignment and implant positioning. This retrospective study explored whether RUKA has more favorable overall outcomes than conventional unicompartmental knee arthroplasty (CUKA). A total of 158 patients with medial compartment osteoarthritis were recruited, of which 85 had undergone RUKA with the Mako system and 73 had undergone CUKA. The accuracy of component positioning and bone anatomical alignment was compared using preoperative and postoperative radiograph. Clinical outcomes were evaluated using questionnaires, which the patients completed preoperatively and then postoperatively at six months, one year, and two years. In total, 52 patients from the RUKA group and 61 from the CUKA group were eligible for analysis. The preoperative health scores and Kellgren-Lawrence scores were higher in the RUKA group. RUKA exhibited higher implant positioning accuracy, thus providing a superior femoral implant angle, properly aligned implant placement, and a low rate of overhang. RUKA also achieved higher accuracy in bone anatomical alignment (tibial axis angle and anatomical axis angle) than CUKA, but surgical time was longer, and blood loss was greater. No significant differences were observed in the clinical outcomes of the two procedures.
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Affiliation(s)
- Christopher Wu
- College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Nobuei Fukui
- Department of Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan;
| | - Yen-Kuang Lin
- Research Center of Statistics, College of Management, Taipei Medical University, Taipei 110, Taiwan;
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaoshiung Medical University Hospital, Kaoshiung 807, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaoshiung Medical University, Kaoshiung 807, Taiwan
- Orthopedic Research Center, Kaoshiung Medical University, Kaoshiung 807, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jen-Yuh Chen
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, Postal Hospital, Taipei 100, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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Rodkey DL, McMillan LJ, Slaven SE, Treyster DA, Dickens JF, Cody JP. Unicompartmental Knee Arthroplasty: More Conversions, Fewer Complications Than Proximal Tibial Osteotomy in a Young Population. J Arthroplasty 2021; 36:3878-3882. [PMID: 34481695 DOI: 10.1016/j.arth.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with isolated medial compartment osteoarthritis requiring surgical intervention generally have two surgical options: unicompartmental knee arthroplasty (UKA) and proximal tibial osteotomy (PTO). Outcomes of reoperation rates and survivorship are important for counseling patients on treatment options. METHODS A retrospective, comparative cohort study was performed for a consecutive series of patients in the Military Health System who underwent either UKA or PTO between 2003 and 2018. All patients were between 18 and 55 years old and diagnosed with isolated medial compartmental arthritis. Cases with concurrent meniscal or cartilage procedures were included, while cases with concurrent ligament reconstruction were excluded. A minimum 2-year follow-up was required. The primary outcome was conversion to total knee arthroplasty, and the secondary outcome was reoperation for any reason. RESULTS A total of 383 procedures were performed for isolated medial compartment arthritis in 303 patients (UKA 270, PTO 113). A multivariate analysis showed that PTO was associated with decreased risk of conversion to TKA compared to UKA (P = .0364). However, the reoperation due to complications was significantly higher in the PTO group (21.2% vs 2.2%; P ≤ .01). The 5-year conversion rate was 13.7% for UKA and 3.5% for PTO (P = .0033) with an average time to conversion of 3.1 years for UKA and 2.9 years for PTO (P = .7805). CONCLUSIONS In young patients with isolated medial compartment arthritis, conversion rates to TKA are higher with UKA compared to PTO. However, overall reoperation rate is higher with PTO, secondary to complications and revision procedures. Overall survivorship is acceptable for both procedures.
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Affiliation(s)
| | | | - Sean E Slaven
- Walter Reed National Military Medical Center, Bethesda, MD
| | | | | | - John P Cody
- Walter Reed National Military Medical Center, Bethesda, MD
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Ishizuka S, Hiraiwa H, Yamashita S, Oba H, Kawamura Y, Sakaguchi T, Idota M, Hasegawa Y, Imagama S. Long-Term Survivorship of Closed-Wedge High Tibial Osteotomy for Severe Knee Osteoarthritis: Outcomes After 10 to 37 Years. Orthop J Sports Med 2021; 9:23259671211046964. [PMID: 34692884 PMCID: PMC8532226 DOI: 10.1177/23259671211046964] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: High tibial osteotomy (HTO) was developed as a joint-preserving procedure to treat relatively young patients with isolated medial compartmental knee osteoarthritis (OA). Long-term survivorship after HTO is important to determine whether patients will need additional surgery. Purpose: To determine the long-term (>35-year) survivorship and prognostic factors for closed-wedge HTO (CWHTO) for severe medial OA. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively evaluated patients who underwent CWHTO for severe medial knee OA between 1983 and 2009 at our institution, Nagoya University Graduate School of Medicine (Nagoya, Japan). Patient demographics, follow-up period, and pre- and postoperative femoral-tibial angle (FTA) were reviewed. The patients or the relatives of the patients were interviewed by telephone to record postoperative status, including conversion to total knee arthroplasty (TKA). Results: Of the 74 CWHTO procedures performed, we evaluated 56 procedures in 45 patients (mean age at time of surgery, 56.8 years). The mean follow-up period was 17.1 years. Nine knees (16.1%) underwent conversion to TKA. The mean time to TKA conversion was 15.6 years. Kaplan-Meier analysis revealed a 10-year survival rate of 90.1%, a 15-year rate of 83.8%, a 20-year rate of 75.9%, and a 35-year rate of 75.9%. Log-rank test showed that age ≥55 years (P = .044), body mass index (BMI) ≥25 kg/m2 (P = .0016), and preoperative FTA <185° (P = .0034) were risk factors associated with TKA conversion. Multivariate analyses adjusted for age and sex identified BMI ≥25 kg/m2 (hazard ratio [HR], 13.4; 95% CI, 1.7-106.9; P = .014) and preoperative FTA <185° (HR, 4.2; 95% CI, 1.1-16.6; P = .04) as risk factors associated with TKA conversion. Conclusion: The survival rate of CWHTO for severe medial knee OA was 90.1% at 10 years, 83.8% at 15 years, and 75.9% at 20 years and 35 years. Furthermore, a BMI ≥25 kg/m2 and FTA <185° were the independent risk factors associated with TKA conversion after CWHTO.
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Affiliation(s)
- Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Hiraiwa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yamashita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Oba
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Kawamura
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takefumi Sakaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaru Idota
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Risk of Revision and Adverse Outcomes Following Partial Knee Replacement and High Tibial Osteotomy for Unicompartmental Knee Osteoarthritis: A Nationwide Cohort Study. Indian J Orthop 2021; 55:1101-1110. [PMID: 34824709 PMCID: PMC8586119 DOI: 10.1007/s43465-021-00517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/05/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate comparative study for potential associations of adverse outcomes as well as survival rates after high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). METHODS We reviewed the Korean National Health Insurance claims database from January 1, 2007 to May 31, 2019. A total of 90,705 patients aged 30-90 years who were newly treated for HTO or UKA were identified considering their eligibility. We performed four rounds of propensity score matching to reduce imbalance of baseline characteristics, especially disparities among different age groups. Multivariable logistic regression models were used to compare the risk of revision and various unwanted medical problems between HTO and UKA treatment groups after propensity score matching. RESULTS 23,563 matched patients were assigned to each group on the basis of propensity score. HTO showed higher risk of revision than UKA at 5 years, 10 years and the whole observed period (hazard ratio: 1.21, 95% CI 1.10-1.34). Deep vein thromboembolism (0.27, 0.21-0.35), and surgical site infection (0.37, 0.30-0.44) were less likely for HTOs than UKAs. Postoperative admission to intensive care unit was significantly lower with HTO (odds ratio: 0.40, 0.29-0.54) while rehospitalization within 30 days (1.27, 1.16-1.38) and 90 days (1.24, 1.18-1.30) were higher than UKA. CONCLUSION When choosing the surgical method for unicompartmental knee OA, not only the survival rate, but also the risk of other adverse outcomes should be considered. In particular, attention should be paid to the risk of developing deep vein thromboembolism and surgical site infection. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00517-z.
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Tveit M. 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. PLoS One 2021; 16:e0257233. [PMID: 34529691 PMCID: PMC8445477 DOI: 10.1371/journal.pone.0257233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Magnus Tveit
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
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