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The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Both high tibial valgus osteotomy (HTO) and unicompartmental medial knee arthroplasty (UKA) are established methods for the treatment for moderate stages of OA. This is the first global meta-analysis to compare the long-term effects of both methods regarding survival, outcomes and complications of total arthroplasty.

Methods

Literature research was performed using established medical databases: MEDLINE (via PubMed), EMBASE (via OVID) and the Cochrane register. Criteria for inclusion were as follows: English or German papers, a clinical trial with a clear description of survival, an outcome evaluation using a well-described knee score and a follow-up >5 years. Statistical analysis was performed using the special meta-analysis software called “Comprehensive Meta Analysis” (version 2.0; Biostat, Englewood, NJ, USA).

Results

Final meta-analysis after the full-text review included 46 studies about valgus HTO and 43 studies about medial UKA. There were no significant differences between valgus HTO and medial UKA in terms of the number of total required replacements. After a 5- to 8-year follow-up, 91.0% of the valgus HTO patients and 91.5% of medial UKA patients did not need a total replacement. This value was 84.4% for valgus HTOs and 86.9% for medial UKAs after a 9- to 12-year follow-up. Mean survival time to TKA was 9.7 years after valgus HTO and 9.2 years after medial UKA. Clinical outcome was significantly better after medial UKA in a 5- to 12-year follow-up. After more than 12 years, results were comparable in both groups. No significant differences were seen in the complication rates.

Conclusions

This meta-analysis aimed to find the advantages and disadvantages of two established methods for the treatment for medial compartment knee osteoarthritis. Valgus HTO is more appropriate for younger patients who accept a slight decrease in their physical activity. Medial UKA is appropriate for older patients obtaining sufficient pain relief but with reduced physical activity.

Level of evidence

II.

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Authors and Affiliations

  1. Center of Trauma and Orthopaedic Surgery Eisenach, Sophienstr. 16, 99817, Eisenach, Germany

    Gunter Spahn

  2. Departments of Traumatology and Orthopaedic Surgery, Friedrich-Schiller-University of Jena and Trauma Center Halle, Erlanger Allee 101, 07740, Jena, Germany

    Gunther O. Hofmann

  3. Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle, Magdeburger Straße 22, 06112, Halle (Saale), Germany

    Lars Victor von Engelhardt

  4. Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany

    Mengxia Li

  5. Institute of Radiology, University of Wuerzburg, Wuerzburg, Germany

    Henning Neubauer

  6. Orthopaedic Department, Georg-August-Universitäty Göttingen, Post Box 3742, 37070, Göttingen, Germany

    Hans Michael Klinger

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  6. Hans Michael Klinger
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Correspondence to Gunter Spahn.

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Spahn, G., Hofmann, G.O., von Engelhardt, L.V. et al. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21, 96–112 (2013). https://doi.org/10.1007/s00167-011-1751-2

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