Elsevier

The Knee

Volume 8, Issue 3, October 2001, Pages 187-194
The Knee

High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis:: 7–10-year follow-up prospective randomised study

https://doi.org/10.1016/S0968-0160(01)00097-7Get rights and content

Abstract

The clinical outcome of patients treated either by high tibial osteotomy or unicompartmental arthroplasty for medial unicompartmental osteoarthritis of the knee was compared in a prospective randomised study. In total, 32 patients received a high tibial osteotomy (HTO) and 28 patients a unicompartmental arthroplasty (UKA). More intra- and postoperative complications were observed after HTO. Patients were assessed at an average of 2.5 (1.6–5), 4.5 (3.6–7), and 7.5 years (6.6–10) after the operation. Using the Knee Society Score, 71% (15) of patients after osteotomy and 65% (13) after replacement had a knee score of excellent or good 7–10 years postoperatively. The Kaplan–Meier survival analysis 7–10 years postoperatively showed a survivorship of 77% for UKA and 60% for HTO. Although the unicompartmental prosthesis used in this series has not shown promising results, we conclude that with the advanced design of unicompartmental prosthesis today, UKA offers better long-term success.

Introduction

The surgical treatment for unicompartmental gonarthrosis is still a controversial issue today. The options to treat this disease today are non-operative or operative treatment such as arthroscopy, high tibial osteotomy, unicompartmental, and bi- or tricompartmental arthroplasty.

Early in the evolution of unicompartmental arthroplasty, conflicting reports cast doubt on its efficacy [1], [2], between insertion of the patellar ligament and the tibiofemoral contact point [3], at the same time that excellent early results were being reported for high tibial osteotomy [4], [5], [6], [7]. However, recent reports from a varied group of authors demonstrated excellent clinical results for unicompartmental arthroplasty, even after 10 years [8], [9], [10], [11], [12], [13], [14], [15]. In contrast, although the results of high tibial osteotomy seem to be good initially, this may not last over a longer period of time [16], [17], [18].

In the literature, only four retrospective reports comparing high tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) can be found. Karpman and Volz reviewed the records of patients treated by high tibial osteotomy or unicompartmental arthroplasty with an average follow-up of 21 and 41 months. In their opinion, unicompartmental replacement offers a viable, if not preferable, alternative to high tibial osteotomy [19]. In 1986, Broughton and co-workers compared the results of high tibial osteotomies and unicompartmental arthroplasties 5–10 years after the operation [20]. They concluded that the results of unicompartmental arthroplasty have been significantly better than those of high tibial osteotomy. In 1994, Weale and Newman looked at the same cohort with a follow up period of 12–17 years and confirmed this statement [21]. Ivarsson and Gillquist observed the rehabilitation after high tibial osteotomy and unicompartmental arthroplasty. Muscle torque was measured by a Cybex II dynamometer. The results 6 months postoperatively were better in the patients treated by unicompartmental arthroplasty than they were 12 months postoperatively in the patients treated by high tibial osteotomy. In this difference, they saw an argument for arthroplasty in aged patients [22].

This paper presents the 7–10-year results of a prospective randomised study directly comparing the two operative procedures. Patients included into the study have given their informed consent and the study has been approved by the institutional Ethics Review Board (No. 2055).

Section snippets

Materials and methods

The study group included 60 patients (62 knees) with medial unicompartmental osteoarthritis, who received either a high tibial osteotomy (32 patients with 32 knees) or a unicompartmental arthroplasty (28 patients with 30 knees) between June 1988 and December 1991 (Table 1). Criteria for inclusion in this study were medial unicompartmental osteoarthritis, varus malalignment <10°, flexion contraction <15°, ligament instability <2nd degree, and age over 60 years. Patients were computer-randomised.

Results

A total of 32 patients (13 women and 19 men) had a high tibial osteotomy, with 11 procedures performed on the right and 21 on the left. The mean age at the time of surgery was 67 years (60–79). The unicompartmental arthroplasty group consisted of 28 patients (22 women and six men). The mean age of this group was 67 years (60–80) (Table 1).

Patients were evaluated using the Knee Society Clinical Rating System, as described above. Preoperatively knee score averaged 32 points in both groups. At

Discussion

The best treatment for a patient with osteoarthritis isolated to a single compartment in the knee has been debated extensively. Surgical options include arthroscopy, high tibial osteotomy, unicompartmental, and bi- or tricompartmental arthroplasty.

The advantages of osteotomy include the facts that no prosthetic material is used; unlimited activity is permitted; and bone stock is not severely compromised. The result of high tibial osteotomy is most likely to be successful over the long term when

References (53)

  • P. Hernigou et al.

    Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study

    J Bone Joint Surg

    (1987)
  • A. Carr et al.

    Medial unicompartmental arthroplasty. A survival study of the Oxford Meniscal Knee

    Clin Orthop

    (1993)
  • D.A. Heck et al.

    Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation

    Clin Orthop

    (1993)
  • L. Marmor

    Unicompartmental knee arthroplasty. A 10- to 13-year follow-up

    Clin Orthop

    (1988)
  • L. Marmor

    Unicompartmental arthroplasty of the knee with a minimum ten-year follow-up period

    Clin Orthop

    (1988)
  • R.D. Scott et al.

    Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis

    Clin Orthop

    (1991)
  • J. Goodfellow et al.

    The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases

    J Bone Joint Surg

    (1988)
  • M.B. Coventry

    Upper tibial osteotomy for osteoarthritis

    J Bone Joint Surg

    (1998)
  • J.N. Insall et al.

    High tibial osteotomy for varus gonarthrosis

    J Bone Joint Surg

    (1984)
  • M.J. Stuart et al.

    Late recurrence of varus deformity after proximal tibial osteotomy

    Clin Orthop

    (1990)
  • R.R. Karpman et al.

    Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee

    Orthopedics

    (1998)
  • N.S. Broughton et al.

    Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee

    J Bone Joint Surg

    (1986)
  • A.E. Weale et al.

    Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee’

    Clin Orthop

    (1994)
  • I. Ivarsson et al.

    Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty’

    Clin Orthop

    (1991)
  • B.G. Weber et al.

    Zuggurtungsosteosynthese bei Tibiakopfosteotomie

    Z Orthop

    (1980)
  • N.O. Christensen

    Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital

    Clin Orthop

    (1991)
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