Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in p
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(2020) 15:545
SYSTEMATIC REVIEW
Open Access
Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in patients older than 50 years Filippo Migliorini1* , Arne Driessen1, Francesco Oliva2, Gayle D. Maffulli3, Markus Tingart1 and Nicola Maffulli2,4,5
Abstract Background: Both compartmental knee arthroplasty (CKA) and open-wedge high tibial osteotomy (HTO) may be used to treat patients older than 50 years of age with advanced compartmental osteoarthritis (OA) secondary to leg axis deformities. A meta-analysis was conducted to clarify the role of open-wedge HTO versus CKA for patients older than 50 years with advanced compartmental knee OA. The present investigation aimed to analyse the clinical outcomes, implant failure and survivorship. Methods: This meta-analysis was performed in accordance with the PRISMA guidelines. In September 2020, the main online databases were accessed. All clinical trials comparing the outcomes of open-wedge HTO versus CKA for compartmental knee OA were considered. Data analysis was performed through the Review Manager Software 5.3 (the Nordic Cochrane Collaboration, Copenhagen). Implant survivorship was analysed with a Kaplan-Meier (KM) curve that was performed using the STATA/MP software (StataCorp, College Station, TX). Results: Data from 618 (HTO, 307; CKA, 311) patients were collected. Good baseline comparability among patient age, BMI and gender was detected. The Tegner Activity Scale was higher in the CKA group (P = 0.04), as were the Lysholm score (P = 0.001), the International Knee Documentation Committee (P = 0.0001) and the Knee injury and Osteoarthritis Outcome Score (P = 0.05). At a mean follow-up of 5 years, revisions were less in the CKA cohort (OR, 2.27; P = 0.004). The Kaplan-Meier curve evidenced longer implant survivorship in favour of the CKA group (P = 0.01). Conclusion: In patients older than 50 years of age with compartmental knee OA secondary to frontal axis leg deformities, CKA performed better than open-wedge HTO. Keywords: Compartmental knee osteoarthritis, Unicompartmental knee arthroplasty, Open-wedge tibial osteotomy
Introduction Degenerative joint disease, such as osteoarthritis (OA) in the knee, is a common cause of complaint in older patients and carries an increasing financial burden [1]. Although knee OA can affect all three compartments of * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany Full list of author information is available at the end of the article
the knee, up to 30% of patients have evidence of only single compartmental degeneration [2, 3]. Despite multifactorial occurrences, compartmental knee OA is often caused by a deviation of the mechanical axis of the knee [4, 5]. Therefore, unloading the affected compartment may decelerate deterioration of the osteoarthritic joint. Open-wedge high tibial osteotomy (HTO) is considered a suitable surgical option for patients with compartmen
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