High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis:: 7–10-year follow-up prospective randomised study
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)
Upper tibial osteotomy for gonarthrosis
Orthop Clin North Am
(1979)- et al.
Unicondylar arthroplasty. A survivorship analysis
J Arthroplasty
(1992) - et al.
Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period
J Arthroplasty
(1996) - et al.
Revision total knee arthroplasty: comparison of outcome primary proximal tibial osteotomy or unicompartmental arthroplasty
J Arthroplasty
(1994) - et al.
Unicompartmental arthroplasty. A long-term follow-up study
J Arthroplasty
(1998) - et al.
Unicondylar knee replacement
Clin Orthop
(1976) - et al.
A five to seven-year follow-up of unicondylar arthroplasty
J Bone Joint Surg
(1980) Unicompartmental tibiofemoral resurfacing arthroplasty
J Bone Joint Surg
(1978)- et al.
High tibial osteotomy. A five-year evaluation
J Bone Joint Surg
(1974) Osteotomy about the knee for degenerative and rheumatoid arthritis: indications, operative technique, and results
J Bone Joint Surg
(1973)
Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study
J Bone Joint Surg
Medial unicompartmental arthroplasty. A survival study of the Oxford Meniscal Knee
Clin Orthop
Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation
Clin Orthop
Unicompartmental knee arthroplasty. A 10- to 13-year follow-up
Clin Orthop
Unicompartmental arthroplasty of the knee with a minimum ten-year follow-up period
Clin Orthop
Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis
Clin Orthop
The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases
J Bone Joint Surg
Upper tibial osteotomy for osteoarthritis
J Bone Joint Surg
High tibial osteotomy for varus gonarthrosis
J Bone Joint Surg
Late recurrence of varus deformity after proximal tibial osteotomy
Clin Orthop
Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee
Orthopedics
Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee
J Bone Joint Surg
Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee’
Clin Orthop
Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty’
Clin Orthop
Zuggurtungsosteosynthese bei Tibiakopfosteotomie
Z Orthop
Unicompartmental prosthesis for gonarthrosis. A nine-year series of 575 knees from a Swedish hospital
Clin Orthop
Cited by (164)
Impact of Proximal Tibial Varus Anatomy on Survivorship After Medial Unicondylar Knee Arthroplasty
2023, Journal of ArthroplastyThe role of proximal tibial osteotomy in joint preservation
2023, Journal of Cartilage and Joint PreservationNew developments in knee surgery Osteotomy
2022, Sports Orthopaedics and TraumatologyA new protocol for obtaining whole leg radiographs with excellent reproducibility
2022, Journal of Cartilage and Joint PreservationUnicompartmental Knee Arthroplasty: More Conversions, Fewer Complications Than Proximal Tibial Osteotomy in a Young Population
2021, Journal of ArthroplastyCitation Excerpt :Indications for each surgery have expanded, causing more overlap among patients who may be candidates for either UKA or PTO [13]. Despite similar survivorship demonstrated by available RCTs and our study, the patient selection remains critical for optimal surgical outcomes [12]. Considerations should include age, desired post-operative activities, time to full weight-bearing, rehabilitation requirements, and perioperative complication profile.
Tibial condylar valgus osteotomy (TCVO): Surgical technique and clinical results for knee osteoarthritis with varus deformity
2021, Journal of Clinical Orthopaedics and Trauma