Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics
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Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing unicompartmental knee arthroplasty (UKA) in patients with similar demographics.
Sixty HTOs and 50 UKAs completed between 1992 and 1998 were retrospectively reviewed. There were no significant differences in pre-operative demographics. The mean follow-up period was 10.7 ± 5.7 years for HTO and 12.0 ± 7.1 years for UKA (n.s.). The Knee Society knee and function scores, WOMAC, and range of motion (ROM) were investigated. The mechanical axis and femorotibial angle were evaluated. Kaplan–Meier survival analysis was performed (failure: revision to TKA) and the failure modes were investigated.
Most of the clinical and radiographic results were not different at the last follow-up, except ROM; ROM was 135.3° ± 12.3° in HTO and 126.8° ± 13.3° in UKA (p = 0.005). The 5-, 10-, 15-, and 20-year survival rates were 100%, 91.0%, 63.4%, and 48.3% for closed-wedge HTO, respectively, and 90.5%, 87.1%, 70.8%, and 66.4% for UKA (n.s.). The survival rate was higher than that for UKA until 12 years post-operatively but was higher in UKAs thereafter, following a remarkable decrease in HTO. The most common failure mode was degenerative osteoarthritic progression of medial compartment in HTO and femoral component loosening in UKA.
Long-term survival did not differ significantly between closed-wedge HTO and fixed-bearing UKA in patients with similar pre-operative demographics and knee conditions. The difference in post-operative ROM and failure mode should be considered when selecting a procedure.
Level of evidence
KeywordsKnee Osteoarthritis Osteotomy Unicompartmental arthroplasty Survival
No external funding was used.
Compliance with ethical standards
Conflict of interest
No benefits in any form were received or will be received from any commercial party related directly or indirectly to the subject of this article.
All procecures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of our hospital.
- 7.Cho WJ, Kim JM, Kim WK, Kim DE, Kim NK, Bin SI (2018) Mobile-bearing unicompartmental knee arthroplasty in old-aged patients demonstrates superior short-term clinical outcomes to open-wedge high tibial osteotomy in middle-aged patients with advanced isolated medial osteoarthritis. Int Orthop. https://doi.org/10.1007/s00264-018-3880-4 Google Scholar
- 8.Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R (2010) High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 30:131–140Google Scholar
- 16.Khoshbin A, Sheth U, Ogilvie-Harris D, Mahomed N, Jenkinson R, Gandhi R et al (2017) The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc 25(3):887–894CrossRefGoogle Scholar
- 25.Scott WN, Diduch DR, Long WJ (2018) Insall & Scott surgery of the knee, vol 1. Elsevier, Philadelphia, pp 374–387Google Scholar
- 31.Tuncay I, Bilsel K, Elmadag M, Erkocak OF, Asci M, Sen C (2015) Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis. Acta Orthop Traumatol Turc 49(3):280–287Google Scholar
- 34.Weale AE, Newman JH (1994) Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12- to 17-year follow-up period. Clin Orthop Relat Res (302):134–137Google Scholar