Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports

Abstract

Purpose

Prior studies have compared unicompartmental knee arthroplasty (UKA) with high tibial osteotomy (HTO) suggesting that both procedures had good functional outcomes. But none had established the superiority of one of the two procedures for patients with high expectation including return to impact sport. The aim of this study was to compare functional outcomes and ability to return to impact sport of active patients defined with a pre-arthritis University of California and Los Angeles activity (UCLA) score > 8, after UKA or HTO procedures.

Methods

A retrospective review of patients with a pre-arthritis UCLA score > 8 operated between January 2014 and September 2017 has identified 91 patients with open-wedge HTO and 117 patients with UKA. A matching process based on age (± 3 years) and gender allowed to include 50 patients in each group for comparative analysis. Patient reported outcomes included Knee Osteoarthritis Outcomes Score (KOOS), UCLA Score, Knee Society Score (KSS) and time to return to sport or previous professional activities at 3, 6, 12 and 24 months following surgery.

Results

Mean time to return to sport activities or previous professional activities were significantly lower for the HTO group than for UKA group [respectively, 4.9 ± 2.2 months for HTO group vs 5.8 ± 6.2 months for UKA group (p = 0.006) and 3 ± 3 months for HTO group vs 4 ± 3 months for UKA group (p = 0.006)]. At 24-month follow-up, UCLA score, KOOS Sports Sub-score and KSS activity score were significantly higher for HTO group than for UKA group (Δ: 2 CI 95% (1.3–2.5 points) p < 0.0001, (Δ: 10.9 CI 95% (2.9–18.9 points) p = 0.04 and Δ: 7.8 CI 95% (2.4–13.4 points) p = 0.006, respectively) and 31 patients (62%) were practicing impact sport in the HTO group versus 14 (28%) in the UKA group (odd-ratio 4.2 CI 95% (1.8–9.7) p < 0.0001).

Conclusion

HTO offers statistically significant quicker return to sport activities and previous professional activities with a higher rate of patients able to practice impact activity (62% for HTO vs 28% for UKA) and better sports related functional scores at two years after surgery compared to UKA.

Level of evidence

III retrospective case–control study.

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CJ and FG have made substantial contributions to acquisition of data, or analysis and interpretation of data. AP, AS, JNA, and SP have been involved in drafting the manuscript or revising it critically. MO has made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. Every authors have given final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Matthieu Ollivier.

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Local ethic committee approved our study protocol prior to investigation. Some of the authors disclosed potential conflict of interest.

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Local Ethical Committee approval was obtained prior to study’s initiation (Comité Informatique et Liberté (CIL)/Assistance Publique des Hopitaux de Marseille (APHM)/ Registration Number 2019–17-03)).

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Jacquet, C., Gulagaci, F., Schmidt, A. et al. Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports. Knee Surg Sports Traumatol Arthrosc 28, 3849–3857 (2020). https://doi.org/10.1007/s00167-020-05857-1

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Keywords

  • Opening wedge high tibial osteotomy
  • Unicompartmental knee arthroplasty
  • Impact sport
  • Patient reported outcomes