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Fixed-bearing unicompartmental knee arthroplasty provides a lower failure rate than mobile-bearing unicompartimental knee arthroplasty when used after a failed high tibial osteotomy: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Despite the fact that the choice of bearing design has been thought to influence the functional outcomes and longevity of unicompartimental knee arthroplasty (UKA), there is a lack of clinical evidence supporting the decision-making process in patients who have undergone high tibial osteotomy (HTO). A systematic review of studies was carried out that reported the outcomes of fixed-bearing (FB) or mobile-bearing (MB) medial UKA in patients with a previous HTO. A random effect meta-analysis using a generalized linear mixed-effects model to calculate revision rates was done. Seven retrospective cohort studies were included for this study. Regarding the fixation method, 40 were the FB-UKA and 47 were MB-UKA. For both groups, the mean post-operative follow-up was 5.8 years. The survival rates were 92% for the FB-UKA with a mean follow-up of 10 years. For the MB-UKA, it ranged from 35.7 to 93%, with a mean follow-up of 4.2 years. For the FB, the time to revision was reported as 9.3 years, while 1.2, 2.5 and 2.91 years was reported for the MB. The results of the meta-analysis showed that the revision rate for the patients receiving a FB-UKA after failed HTO was 8%, compared to 17% in those who received an MB-UKA. The results of the review suggest that the use of the FB-UKA is associated with lower revision rates and a longer survival time than the MB-UKA and have similar functional ability scores.

Level of evidence: III (systematic review of level-III studies).

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References

  1. Abu Al-Rub Z, Lamb JN, West RM, Yang X, Hu Y, Pandit HG (2020) Survivorship of fixed vs mobile bearing unicompartmental knee replacement: a systematic review and meta-analysis of sixty-four studies and National Joint Registries. Knee 27:1635–1644

    Article  CAS  Google Scholar 

  2. Campi S, Tibrewal S, Cuthbert R, Tibrewal SB (2018) Unicompartmental knee replacement—current perspectives. J Clin Orthop Trauma 9:17–23

    Article  Google Scholar 

  3. Cao Z, Niu C, Gong C, Sun Y, Xie J, Song Y (2019) Comparison of fixed-bearing and mobile-bearing unicompartmental knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 34:3114–3123

    Article  Google Scholar 

  4. Chalmers BP, Limberg AK, Tibbo ME, Perry KI, Pagnano MW, Abdel MP (2019) Total Knee arthroplasty after high tibial osteotomy results in excellent long-term survivorship and clinical outcomes. J Bone Jt Surg 101:970–978

    Article  Google Scholar 

  5. Cheng T, Chen D, Zhu C, Pan X, Mao X, Guo Y, Zhang X (2013) Fixed- versus mobile-bearing unicondylar knee arthroplasty: are failure modes different? Knee Surg Sports Traumatol Arthrosc 21:2433–2441

    Article  Google Scholar 

  6. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. an arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608

    Article  CAS  Google Scholar 

  7. Heyse TJ, Khefacha A, Peersman G, Cartier P (2012) Survivorship of UKA in the middle-aged. Knee 19:585–591

    Article  Google Scholar 

  8. Higgins J, Li T (2019) Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook. Accessed on 6 Jul 2021

  9. Huang F, Wu D, Chang J, Zhang C, Qin K, Liao F, Yin Z (2021) A Comparison of mobile and fixed-bearing unicompartmental knee arthroplasties in the treatment of medial knee osteoarthritis: a systematic review and meta-analysis of 1861 patients. J Knee Surg 34:434–443

    Article  Google Scholar 

  10. Johal S, Nakano N, Baxter M, Hujazi I, Pandit H, Khanduja V (2018) Unicompartmental knee arthroplasty: the past, current controversies, and future perspectives. J Knee Surg 31:992–998

    Article  Google Scholar 

  11. Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D, Miralles-Muñoz FA, Lopez-Prats FA (2020) Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sport Traumatol Arthrosc 28:1473–1478

    Article  Google Scholar 

  12. Mittal A, Meshram P, Kim WH, Kim TK (2020) Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 21:15

    Article  Google Scholar 

  13. Price AJ, Svard U (2011) A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res 469:174–179

    Article  Google Scholar 

  14. Rees JL, Price AJ, Lynskey TG, Svärd UCG, Dodd CAF, Murray DW (2001) Medial unicompartmental arthroplasty after failed high tibial osteotomy. J Bone Joint Surg Br 83:1034–1036

    Article  CAS  Google Scholar 

  15. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR (2016) High tibial osteotomy: a systematic review and current concept. Arch Bone Jt Surg 4:204

    PubMed  PubMed Central  Google Scholar 

  16. Schlumberger M, Oremek D, Brielmaier M, Buntenbroich U, Schuster P, Fink B (2020) Prior high tibial osteotomy is not a contraindication for medial unicompartmental knee arthroplasty. Knee Surg Sport Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06149-4

    Article  Google Scholar 

  17. Seitz AM, Nelitz M, Ignatius A, Dürselen L (2019) Release of the medial collateral ligament is mandatory in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:2917–2926

    Article  Google Scholar 

  18. Shankar S, Tetreault MW, Jegier BJ, Andersson GB, Della Valle CJ (2016) A cost comparison of unicompartmental and total knee arthroplasty. Knee 23:1016–1019

    Article  Google Scholar 

  19. Smith WB 2nd, Steinberg J, Scholtes S, Mcnamara IR (2017) Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:924–933

    Article  Google Scholar 

  20. Valenzuela GA, Jacobson NA, Buzas D, Korecki TD, Valenzuela RG, Teitge RA (2013) Unicompartmental knee replacement after high tibial osteotomy: Invalidating a contraindication. Bone Joint J 10:1348–1353

    Article  Google Scholar 

  21. Verdonk R, Cottenie D, Almqvist KF, Vorlat P (2005) The Oxford unicompartmental knee prosthesis: A 2–14 year follow-up. Knee Surg Sports Traumatol Arthrosc 13:163–166

    Article  CAS  Google Scholar 

  22. Vorlat P, Putzeys G, Cottenie D, Van Isacker T, Pouliart N, Handelberg F, Casteleyn P-P, Gheysen F, Verdonk R (2006) The Oxford unicompartmental knee prosthesis: an independent 10 year survival analysis. Knee Surg Sports Traumatol Arthrosc 14:40–45

    Article  Google Scholar 

  23. Vorlat P, Verdonk R, Schauvlieghe H (2000) The Oxford unicompartmental knee prosthesis: a 5 year follow-up. Knee Surg Sport Traumatol Arthrosc 8:154–158

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González”, Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México

    Rodolfo Morales-Avalos, José Ramón Padilla-Medina, Víctor M. Peña-Martínez & Félix Vilchez-Cavazos

  2. Department of Human Anatomy, Col. Mitras Centro, School of Medicine, Universidad Autonoma de Nuevo León (U.A.N.L.), Av. Francisco I. Madero and Av. Dr. Eduardo Aguirre Pequeño, s/n, C.P. 64460, Monterrey, Nuevo León, México

    Rodolfo Morales-Avalos & Santos Guzmán-López

  3. Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L’Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain

    Rodolfo Morales-Avalos, Simone Perelli & Juan Carlos Monllau

  4. Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain

    Simone Perelli & Juan Carlos Monllau

  5. Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México

    Karina Raygoza-Cortez & Francisco J. Barrera

  6. Facultad de Ingeniería Mecánica Y Eléctrica (FIME), Universidad Autónoma de Nuevo León (U.A.N.L.), San Nicolás de los Garza, Nuevo León, México

    José M. Diabb Zavala

Authors
  1. Rodolfo Morales-Avalos
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  2. Simone Perelli
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  3. Karina Raygoza-Cortez
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  5. Víctor M. Peña-Martínez
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  6. Santos Guzmán-López
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  7. José M. Diabb Zavala
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  8. Francisco J. Barrera
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  9. Félix Vilchez-Cavazos
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  10. Juan Carlos Monllau
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Corresponding author

Correspondence to Santos Guzmán-López.

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Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and followed the registered protocol: (PROSPERO registration: CRD42020207858) and its preparation was approved by the Systematic Reviews and Meta-Analysis Unit of the Ethics Committee and Research Committee of the Research Sub-Directorate of the U.A.N.L. School of Medicine with registration number RVS20-029.

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Morales-Avalos, R., Perelli, S., Raygoza-Cortez, K. et al. Fixed-bearing unicompartmental knee arthroplasty provides a lower failure rate than mobile-bearing unicompartimental knee arthroplasty when used after a failed high tibial osteotomy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30, 3228–3235 (2022). https://doi.org/10.1007/s00167-021-06707-4

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