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Risk of Revision and Adverse Outcomes Following Partial Knee Replacement and High Tibial Osteotomy for Unicompartmental Knee Osteoarthritis: A Nationwide Cohort Study

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Abstract

Purpose

To investigate comparative study for potential associations of adverse outcomes as well as survival rates after high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA).

Methods

We reviewed the Korean National Health Insurance claims database from January 1, 2007 to May 31, 2019. A total of 90,705 patients aged 30–90 years who were newly treated for HTO or UKA were identified considering their eligibility. We performed four rounds of propensity score matching to reduce imbalance of baseline characteristics, especially disparities among different age groups. Multivariable logistic regression models were used to compare the risk of revision and various unwanted medical problems between HTO and UKA treatment groups after propensity score matching.

Results

23,563 matched patients were assigned to each group on the basis of propensity score. HTO showed higher risk of revision than UKA at 5 years, 10 years and the whole observed period (hazard ratio: 1.21, 95% CI 1.10–1.34). Deep vein thromboembolism (0.27, 0.21–0.35), and surgical site infection (0.37, 0.30–0.44) were less likely for HTOs than UKAs. Postoperative admission to intensive care unit was significantly lower with HTO (odds ratio: 0.40, 0.29–0.54) while rehospitalization within 30 days (1.27, 1.16–1.38) and 90 days (1.24, 1.18–1.30) were higher than UKA.

Conclusion

When choosing the surgical method for unicompartmental knee OA, not only the survival rate, but also the risk of other adverse outcomes should be considered. In particular, attention should be paid to the risk of developing deep vein thromboembolism and surgical site infection.

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Availability of Data and Materials

Korean National Health Insurance Claims Data are available on reasonable request. Study protocol, statistical code: available from the author JKS (e-mail, seonbell@jnu.ac.kr). Dataset: de-identified datasets generated and analysed during the present study will be made available by request from the Health Insurance & Assessment Service of Korea at https://opendata.hira.or.kr/. After user approaval by the Health Insurance Review and Assessment Service, a remote analysis system (https://ras.hira.or.kr) can be used by receiving a virtualized ID.

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Acknowledgements

We appreciate the Ministry of Health and Welfare and the Health Insurance Review & Assessment Service of Korea for sharing invaluable national health insurance claims data. The interpretation and conclusions contained in this study are those of the authors alone. Support was received from Chonnam National University Hwasun hospital.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea

    Sun-Ho Lee, Eun-Kyoo Song & Jong-Keun Seon

  2. College of Natural Science, School of Statistics, University of Seoul, Seoul, Republic of Korea

    Hae-Rim Kim

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Contributions

SHL, EKS, and JKS were responsible for study design. SHL and HRK take responsibility for the integrity of the data and the accuracy of the data analysis. SHL, HRK, EKS, and JKS were responsible for data interpretation. SHL and JKS prepared and edited the manuscript.

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Correspondence to Jong-Keun Seon.

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Lee, SH., Kim, HR., Song, EK. et al. Risk of Revision and Adverse Outcomes Following Partial Knee Replacement and High Tibial Osteotomy for Unicompartmental Knee Osteoarthritis: A Nationwide Cohort Study. JOIO 55, 1101–1110 (2021). https://doi.org/10.1007/s43465-021-00517-z

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