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Clinical and functional outcomes of TKA after HTO or UKA: a New Zealand Joint Registry Study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Surgical options for patients with unicompartmental knee osteoarthritis include high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA). When managing younger patients with a higher chance of further surgery, the outcome of any subsequent conversion to total knee arthroplasty (TKA) also needs to be considered. The aim of this study was to compare implant survivorship and patient-reported outcomes for patients undergoing TKA after previous HTO or UKA, with comparisons for age, gender and comorbidities.

Methods

Revision risk and 6-month Oxford Knee Scores (OKS) from the New Zealand Joint Registry were compared for patients who underwent TKA after HTO (HTO-TKA; n = 1556) or UKA (UKA-TKA; n = 965) between 1999 and 2019, with a comparison group of primary TKA (n = 110,948). Mean follow-up was 8.2 years.

Results

Adjusted revision risk was similar for HTO-TKA and UKA-TKA groups (hazard ratio (HR) 1.04, p = 0.84); and risk for both groups were higher than primary TKA (HTO-TKA HR 1.45, p = 0.002; UKA-TKA HR 1.51, p = 0.01). Overall adjusted mean OKS at 6 months for HTO-TKA (36.2) was similar to primary TKA (36.8, p = 0.23); and both were higher than UKA-TKA (34.2, p < 0.001). For the youngest patient group (< 55 years), revision rates of UKA-TKA were two-fold higher than HTO-TKA (2.8 vs. 1.3 per 100 component yrs, p < 0.03). HTO-TKA had better OKS (37.5 vs. 34.1, p < 0.0001) for males. Mean OKS for UKA-TKA was lower than HTO-TKA for patients with ASA 1–2 (35.6 vs. 37.5, p < 0.01).

Conclusion

The findings from this study suggest that revision rate following TKA after HTO and UKA are similar. However, TKA after HTO have superior functional outcomes compared with TKA after UKA and are comparable to functional outcomes post primary TKA. The results support the use of HTO for young, male and less co-morbid patients.

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Data availability

Data sharing is not applicable to this article as no new data were created or analysed in this study.

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Funding

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand

    Jaeha Lee, Mei Lin Tay & Simon W. Young

  2. Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand

    Chris M. Frampton

  3. Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand

    Simon W. Young

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Contributions

SWY and JL conceptualised the study. SWY, CMF and JL developed study methodology. CMF and JL curated the data. JL, MLT and CMF performed formal analysis and data visualisation. All authors participated in data interpretation and investigation. JL, MLT wrote the original draft and all authors took part in reviewing and editing the manuscript.

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Correspondence to Jaeha Lee.

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Conflict of interest

One author is a paid consultant and receives research support from Stryker and Smith + Nephew. All other authors declare that they have no conflict of interest.

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The New Zealand Joint Registry has ethical approval to use data for research purposes.

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Lee, J., Tay, M.L., Frampton, C.M. et al. Clinical and functional outcomes of TKA after HTO or UKA: a New Zealand Joint Registry Study. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05302-9

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