Skip to main content

Advertisement

SpringerLink
Log in

High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are commonly performed procedures for the treatment of compartmental knee osteoarthritis; however, the optimal procedure remains controversial. We conducted this systematic review and meta-analysis to compare the functional outcomes and assess complications and revision rates between the two techniques.

Methods

We searched electronic databases for relevant studies comparing HTO versus UKA for unicompartmental knee osteoarthritis. Continuous data as visual analogue scale (VAS), range of motion, and free walking speed were pooled as mean differences (MDs). Dichotomous data as functional knee outcomes, complications, and revision were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software for windows.

Results

Twenty-five studies involving 8185 patients were included. Meta-analysis showed that HTO was associated with higher risk of complications (OR = 2.47, 95% CI [1.52, 4.04]), poorer functional results (excellent/good) (OR = 0.32, 95% CI [0.21, 0.49]), and greater range of motion (MD = 7.05, 95% CI [2.41, 11.68]) compared to UKA. No significant differences were found between the compared groups in terms of VAS (MD = 0.14, 95% CI [− 0.08, 0.36]), revision rates (OR = 1.30, 95% CI [0.65, 2.60]), and free walking speed (MD = − 0.05, 95% CI [− 0.11, 0.00]).

Conclusion

This study showed that UKA achieved fewer complications, better functional outcomes, and less range of motion compared to HTO. No significant differences were detected between HTO and UKA in terms of VAS and revision rate. Treatment options should be personalized to each patient considering factors such as their age, activities of daily living, their body mass index, and severity of osteoarthritis.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of Data and Material

The raw extracted data are available upon request.

Code Availability

Not applicable.

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CW:

Closing wedge

CWHTO:

Close-wedge high tibial osteotomy

HTO:

High tibial osteotomy

MD:

Mean difference

NOS:

Newcastle Ottawa Scale

OR:

Odds ratio

OW:

Opening wedge

OWHTO:

Open-wedge high tibial osteotomy

PCA:

Porous coated anatomic implant

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

PROSPERO:

International Prospective Register of Systematic Reviews

RCT:

Randomized clinical trial

SD:

Standard deviation

UKA:

Unicompartmental knee arthroplasty

VAS:

Visual analogue scale

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

References

  1. March, L. M., Schwarz, J. M., Carfrae, B. H., & Bagge, E. (1998). Clinical validation of self-reported osteoarthritis. Osteoarthritis and Cartilage., 6(2), 87–93.

    Article  CAS  PubMed  Google Scholar 

  2. Tetsworth, K., & Paley, D. (1994). Malalignment and degenerative arthropathy. Orthopedic Clinics of North America., 25(3), 367–377.

    Article  CAS  PubMed  Google Scholar 

  3. McAlindon, T. E., Bannuru, R. R., Sullivan, M., Arden, N., Berenbaum, F., Bierma-Zeinstra, S., et al. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage., 22(3), 363–388.

    Article  CAS  PubMed  Google Scholar 

  4. Akizuki, S., Shibakawa, A., Takizawa, T., Yamazaki, I., & Horiuchi, H. (2008). The long-term outcome of high tibial osteotomy: A ten-to 20-year follow-up. The Journal of Bone and Joint Surgery British Volume., 90(5), 592–596.

    Article  CAS  PubMed  Google Scholar 

  5. Amendola, A. (2003). Unicompartmental osteoarthritis in the active patient: The role of high tibial osteotomy. Arthroscopy, 19(10), 109–116.

    Article  PubMed  Google Scholar 

  6. Rossi, R., Bonasia, D. E., & Amendola, A. (2011). The role of high tibial osteotomy in the varus knee. JAAOS-Journal of the American Academy of Orthopaedic Surgeons., 19(10), 590–599.

    Article  Google Scholar 

  7. Amendola, A., & Panarella, L. (2005). High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Orthopedic Clinics., 36(4), 497–504.

    PubMed  Google Scholar 

  8. Chiang, H., Hsu, H. C., & Jiang, C. C. (2006). Dome-shaped high tibial osteotomy: A long-term follow-up study. Journal of the Formosan Medical Association, 105(3), 214–219.

    Article  PubMed  Google Scholar 

  9. Dettoni, F., Bonasia, D. E., Castoldi, F., Bruzzone, M., Blonna, D., & Rossi, R. (2010). High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: A review of the literature. The Iowa Orthopaedic Journal., 30, 131.

    PubMed  PubMed Central  Google Scholar 

  10. Danford, N., Grosso, M., Heller, M. S., Murtaugh, T., Shah, R. P., Cooper, H. J., et al. (2018). Which do patients prefer, unicompartmental or total knee arthroplasty? Journal of Clinical Orthopaedics and Trauma., 9(4), 292–294.

    Article  PubMed  Google Scholar 

  11. Borus, T., & Thornhill, T. (2008). Unicompartmental knee arthroplasty. JAAOS-Journal of the American Academy of Orthopaedic Surgeons., 16(1), 9–18.

    Article  Google Scholar 

  12. Santoso, M. B., & Wu, L. (2017). Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. Journal of Orthopaedic Surgery and Research., 12(1), 1–10.

    Article  Google Scholar 

  13. Higgins, J. P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., et al. (2019). Cochrane handbook for systematic reviews of interventions. Wiley.

    Book  Google Scholar 

  14. Seth, I., Seth, N., Bulloch, G., Gibson, D., Lower, K., Rodwell, A., et al. (2021). High tibial osteotomy versus unicompartmental knee arthroplasty for compartmental knee osteoarthritis: a systematic review and meta-analysis. ResearchSquare.

  15. Altman, D. G., & Bland, J. M. (2005). Standard deviations and standard errors. BMJ, 331(7521), 903.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Stang, A. (2010). Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology., 25(9), 603–605.

    Article  PubMed  Google Scholar 

  17. Tabor, O. B., Jr., Tabor, O. B., Bernard, M., & Wan, J. Y. (2005). Unicompartmental knee arthroplasty: Long-term success in middle-age and obese patients. Journal of Surgical Orthopaedic Advances., 14(2), 59–63.

    PubMed  Google Scholar 

  18. Plate, J. F., Augart, M. A., Seyler, T. M., Bracey, D. N., Hoggard, A., Akbar, M., et al. (2017). Obesity has no effect on outcomes following unicompartmental knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy., 25(3), 645–651.

    Article  PubMed  Google Scholar 

  19. Kozinn, S. C., & Scott, R. (1989). Unicondylar knee arthroplasty. Journal of Bone and Joint Surgery. American Volume, 71(1), 145–150.

    Article  CAS  PubMed  Google Scholar 

  20. Pennington, D. W., Swienckowski, J. J., Lutes, W. B., & Drake, G. N. (2003). Unicompartmental knee arthroplasty in patients sixty years of age or younger. JBJS, 85(10), 1968–1973.

    Article  Google Scholar 

  21. Felts, E., Parratte, S., Pauly, V., Aubaniac, J.-M., & Argenson, J.-N. (2010). Function and quality of life following medial unicompartmental knee arthroplasty in patients 60 years of age or younger. Orthopaedics & Traumatology: Surgery & Research., 96(8), 861–867.

    CAS  Google Scholar 

  22. Ziqi, Z., Yufeng, M., Lei, Z., Chunsheng, W., Pei, Y., & Kunzheng, W. (2020). Therapeutic effects comparison and revision case analysis of unicompartmental knee arthroplasty and open wedge high tibial osteotomy in treating medial knee osteoarthritis in patients under 60 years: a 2-6-year follow-up study. Orthopaedic Surgery, 12(6), 1635–1643.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zuiderbaan, H. A., van der List, J. P., Kleeblad, L. J., Appelboom, P., Kort, N. P., Pearle, A. D., et al. (2016). Modern indications, results, and global trends in the use of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of isolated medial compartment osteoarthritis. American Journal of Orthopedics (Belle Mead, N.J.), 45(6), E355–E361.

    Google Scholar 

  24. Trieb, K., Grohs, J., Hanslik-Schnabel, B., Stulnig, T., Panotopoulos, J., & Wanivenhaus, A. (2006). Age predicts outcome of high-tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy., 14(2), 149–152.

    Article  CAS  PubMed  Google Scholar 

  25. Lee, D. C., & Byun, S. J. (2012). High tibial osteotomy. Knee Surgery & Related Research., 24(2), 61.

    Article  Google Scholar 

  26. Smith, W. B., Steinberg, J., Scholtes, S., & Mcnamara, I. R. (2017). Medial compartment knee osteoarthritis: Age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy., 25(3), 924–933.

    Article  PubMed  Google Scholar 

  27. Nwachukwu, B. U., McCormick, F. M., Schairer, W. W., Frank, R. M., Provencher, M. T., & Roche, M. W. (2014). Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. The Journal of Arthroplasty., 29(8), 1586–1589.

    Article  PubMed  Google Scholar 

  28. Sun, H., Zhou, L., Li, F., & Duan, J. (2017). Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: A systematic review and meta-analysis. The Journal of Knee Surgery., 30(02), 158–165.

    Article  PubMed  Google Scholar 

  29. Spahn, G., Hofmann, G. O., von Engelhardt, L. V., Li, M., Neubauer, H., & Klinger, H. M. (2013). The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: A meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy., 21(1), 96–112.

    Article  PubMed  Google Scholar 

  30. Cao, Z., Mai, X., Wang, J., Feng, E., & Huang, Y. (2018). Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A systematic review and meta-analysis. The Journal of Arthroplasty., 33(3), 952–959.

    Article  PubMed  Google Scholar 

  31. Dean, C. S., Liechti, D. J., Chahla, J., Moatshe, G., & LaPrade, R. F. (2016). Clinical outcomes of high tibial osteotomy for knee instability: A systematic review. Orthopaedic Journal of Sports Medicine., 4(3), 2325967116633419.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Koshino, T., Saito, T., Orito, K., Mitsuhashi, S., Takeuchi, R., & Kurosaka, T. (2002). Increase in range of knee motion to obtain floor sitting after high tibial osteotomy for osteoarthritis. The Knee., 9(3), 189–196.

    Article  PubMed  Google Scholar 

  33. Koh, I. J., Kim, M. S., Sohn, S., Song, K. Y., Choi, N. Y., Jung, H., et al. (2019). Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis. Orthopaedics & Traumatology: Surgery & Research., 105(1), 77–83.

    Google Scholar 

  34. Kim, M. S., Koh, I. J., Sohn, S., Jeong, J. H., & In, Y. (2019). Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. International Orthopaedics., 43(11), 2493–2501.

    Article  PubMed  Google Scholar 

  35. Takeuchi, R., Umemoto, Y., Aratake, M., Bito, H., Saito, I., Kumagai, K., et al. (2010). A mid term comparison of open wedge high tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment osteoarthritis of the knee. Journal of Orthopaedic Surgery and Research., 5(1), 1–8.

    Article  Google Scholar 

  36. Jeon, Y. S., Ahn, C. H., & Kim, M.-K. (2017). Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA. Journal of Orthopaedic Surgery., 25(1), 2309499016684092.

    Article  PubMed  Google Scholar 

  37. Ryu, S. M., Park, J. W., Na, H. D., & Shon, O. J. (2018). High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients. Knee surgery & Related Research., 30(1), 17.

    Article  Google Scholar 

  38. Börjesson, M., Weidenhielm, L., Mattsson, E., & Olsson, E. (2005). Gait and clinical measurements in patients with knee osteoarthritis after surgery: A prospective 5-year follow-up study. The Knee., 12(2), 121–127.

    Article  PubMed  Google Scholar 

  39. Jacquet, C., Gulagaci, F., Schmidt, A., Pendse, A., Parratte, S., Argenson, J.-N., et al. (2020). Opening wedge high tibial osteotomy allows better outcomes than unicompartmental knee arthroplasty in patients expecting to return to impact sports. Knee Surgery, Sports Traumatology, Arthroscopy., 28(12), 3849–3857.

    Article  PubMed  Google Scholar 

  40. Jin, Q. H., Lee, W.-G., Song, E.-K., Jin, C., & Seon, J.-K. (2021). Comparison of long-term survival analysis between open-wedge high tibial osteotomy and unicompartmental knee arthroplasty. The Journal of Arthroplasty., 36(5), 1562–67.e1.

    Article  PubMed  Google Scholar 

  41. Bouguennec, N., Mergenthaler, G., Gicquel, T., Briand, C., Nadau, E., Pailhé, R., et al. (2020). Medium-term survival and clinical and radiological results in high tibial osteotomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthopaedics & Traumatology: Surgery & Research., 106(8), S223–S230.

    Google Scholar 

  42. Belsey, J., Yasen, S. K., Jobson, S., Faulkner, J., & Wilson, A. J. (2021). Return to physical activity after high tibial osteotomy or unicompartmental knee arthroplasty: a systematic review and pooling data analysis. American Journal of Sports Medicine, 49(5), 1372–1380.

    Article  PubMed  Google Scholar 

  43. El-Ganzoury, I. M., Zakaria, Z. M., Elsayed, A., & Elwarwary, A. E. (2021). Unicompartmental knee arthroplasty versus high tibial osteotomy in treatment of isolated medial compartment Osteoarthritis of knee: A systematic review and meta analysis. QJM An International Journal of Medicine., 114(Supplement 1), hcab104.002.

    Article  Google Scholar 

  44. Krych, A. J., Reardon, P., Sousa, P., Pareek, A., Stuart, M., & Pagnano, M. (2017). Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5–7 years. JBJS, 99(2), 113–122.

    Article  Google Scholar 

  45. Petersen, W., & Metzlaff, S. (2016). Open wedge high tibial osteotomy (HTO) versus mobile bearing unicondylar medial joint replacement: Five years results. Archives of Orthopaedic and Trauma Surgery., 136(7), 983–989.

    Article  PubMed  Google Scholar 

  46. Stukenborg-Colsman, C., Wirth, C., Lazovic, D., & Wefer, A. (2001). High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. The Knee., 8(3), 187–194.

    Article  CAS  PubMed  Google Scholar 

  47. Yim, J.-H., Song, E.-K., Seo, H.-Y., Kim, M.-S., & Seon, J.-K. (2013). Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum follow-up of 3 years. The Journal of Arthroplasty., 28(2), 243–247.

    Article  PubMed  Google Scholar 

  48. Weidenhielm, L., Svensson, O., Broström, L. -Å., & Rudberg, U. (1992). Change in adduction moment about the knee after high tibial osteotomy and prosthetic replacement in osteoarthrosis of the knee. Clinical Biomechanics., 7(2), 91–96.

    Article  CAS  PubMed  Google Scholar 

  49. Weidenhielm, L., Olsson, E., Broström, L., Börjesson-Hederström, M., & Mattsson, E. (1993). Improvement in gait one year after surgery for knee osteoarthrosis: A comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study. Scandinavian Journal of Rehabilitation Medicine., 25(1), 25–31.

    CAS  PubMed  Google Scholar 

  50. Ivarsson, I., & Gillquist, J. (1991). Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty. A comparative study. Clinical Orthopaedics and Related Research., 266, 139–144.

    Article  Google Scholar 

  51. Ziqi, Z., Yufeng, M., Lei, Z., Chunsheng, W., Pei, Y., & Kunzheng, W. (2020). Therapeutic effects comparison and revision case analysis of unicompartmental knee arthroplasty and open wedge high tibial osteotomy in treating medial knee osteoarthritis in patients under 60 years: a 2–6-year follow-up study. Orthopaedic Surgery., 12(6), 1635–1643.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Tuncay, I., Bilsel, K., Elmadag, M., Erkocak, O.F., ASCI, M., Sen, C. (2015). Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis.

  53. Karamitev, S. S., Stavrev, V. P., & Chifligarov, A. G. (2014). Comparative analysis of the results obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis. Folia Medica (Plovdiv)., 56(1), 11–19.

    Article  PubMed  Google Scholar 

  54. W-Dahl, A., Robertsson, O., & Lidgren, L. (2010). Surgery for knee osteoarthritis in younger patients: a Swedish Register Study. Acta Orthopaedica., 81(2), 161–164.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Weale, A. E., & Newman, J. H. (1994). Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12-to 17-year follow-up period. Clinical Orthopaedics and Related Research., 302, 134–137.

    Google Scholar 

  56. Jefferson, R., & Whittle, M. (1989). Biomechanical assessment of unicompartmental knee arthroplasty, total condylar arthroplasty and tibial osteotom. Clinical Biomechanics., 4(4), 232–242.

    Article  Google Scholar 

  57. Broughton, N., Newman, J., & Baily, R. (1986). Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5–10 years’ follow-up. The Journal of Bone and Joint Surgery British Volume., 68(3), 447–452.

    Article  CAS  PubMed  Google Scholar 

  58. Karpman, R. R., & Volz, R. G. (1982). Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee. Orthopedics, 5(8), 989.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Preprint version of the manuscript was published in Research Square.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia

    Ishith Seth, Damien Gibson, Anish Rastogi, Kirk Lower & Aaron Rodwell

  2. Department of Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC, 3550, Australia

    Ishith Seth

  3. Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia

    Gabriella Bulloch

  4. Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, VIC, 3010, Australia

    Nimish Seth

  5. Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia

    Warwick Bruce

Authors
  1. Ishith Seth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriella Bulloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nimish Seth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Damien Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anish Rastogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kirk Lower
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aaron Rodwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Warwick Bruce
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

IS: methodology, investigation, project administration, formal data analysis, writing—original draft, writing—review and editing. GB: methodology, investigation, project administration, formal data analysis, writing—original draft, writing—review and editing. NS: conceptualization, methodology, investigation, writing—review and editing. DG: methodology, investigation, writing—review and editing. AR: data reviewing, methodology, investigation, writing—review and editing. KL: methodology, investigation, writing—review and editing. AR: methodology, writing—review and editing. WB: conceptualization, methodology, supervision, writing—review and editing.

Corresponding author

Correspondence to Ishith Seth.

Ethics declarations

Conflict of Interest

Ishith Seth declares that he has no conflict of interest. Nimish Seth declares that he has no conflict of interest. Gabriella Bulloch declares that she has no conflict of interest. Damien Gibson declares that he has no conflict of interest. Anish Rastogi declares that he has no conflict of interest. Kirk Lower declares that he has no conflict of interest. Aaron Rodwell declares that he has no conflict of interest. Warwick Bruce declares that he has no conflict of interest.

Ethics Approval

Not applicable.

Ethical Standard Statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

For this type of study informed consent is not required.

Consent to Participate

The authors confirm their participation in the current manuscript.

Consent for Publication

The authors consent to publish the current manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 87 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seth, I., Bulloch, G., Seth, N. et al. High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis. JOIO 56, 973–982 (2022). https://doi.org/10.1007/s43465-022-00620-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00620-9

Keywords

Search

Navigation