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Prior high tibial osteotomy is not a contraindication for medial unicompartmental knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To report on the outcome and complications of minimal invasive medial unicondylar knee arthroplasty (UKA) after failed prior high tibial osteotomy (HTO) as treatment for medial osteoarthritis in the knee. The hypothesis was that good results can be achieved, if no excessive postoperative valgus alignment and abnormal proximal tibial geometry is present.

Methods

All medial UKAs after failed prior HTO (n = 30), performed between 2010 and 2018 were retrospectively reviewed. The patients were followed for revision surgery and survival of the UKA (defined as revision to TKA). Clinical examination using the Knee Society Score (KSS), Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as radiological examination was performed. Radiographs were studied and the influence of the demographic factors and the radiographic measurements on the survival and the clinical outcome was analysed.

Results

After a follow-up of 4.3 ± 2.6 years (2.1–9.9) 27 UKAs were available. The survival rate was 93.0%. Two UKAs were revised to TKA (excessive valgus alignment and tibial loosening with femoropatellar degeneration). Two further patients had revision surgery (hematoma and lateral meniscus tear). Follow-up clinical and radiological examination was performed in 21 cases: KSS 82.9 ± 10.1 (54.0–100.0), KSS (function) 93.3 ± 9.7 (70.0–100.0); OKS 42.7 ± 6.0 (25.0–48.0); WOMAC 7.9 ± 15.6 (0.0–67.1). No significant influence of demographic factors or radiological measurements on the clinical outcome was present.

Conclusion

Prior HTO is not a contraindication for medial UKA, because good-to-excellent results can be achieved in selected patients with medial osteoarthritis and previous HTO, treated with medial UKA, in a midterm follow-up. Excessive mechanical valgus axis should be avoided; therefore, patient selection and accurate evaluation of medial laxity, preoperative mechanical axis, joint line convergence and proximal tibial geometry are important.

Level of evidence

III.

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Authors and Affiliations

  1. Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany

    Michael Schlumberger, Damian Oremek, Moritz Brielmaier, Uli Buntenbroich, Philipp Schuster & Bernd Fink

  2. Department of Orthopedics and Traumatology, Clinic Nuremberg, Paracelsus Medical Private University, Breslauer Straße 201, 90471, Nuremberg, Germany

    Philipp Schuster

  3. Orthopedic Department, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Bernd Fink

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  1. Michael Schlumberger
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Correspondence to Michael Schlumberger.

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The authors received no financial support for the research, authorship, and/or publication of this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Investigation performed at Clinic of Joint Replacement, General and Rheumatic Orthopedics, Orthopedic Clinic Markgroeningen, Germany.

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Schlumberger, M., Oremek, D., Brielmaier, M. et al. Prior high tibial osteotomy is not a contraindication for medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 29, 3279–3286 (2021). https://doi.org/10.1007/s00167-020-06149-4

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