Zhan Wang1, Yihua Zeng2, Wei She1, Xiangli Luo1, Liyang Cai3. 1. Department of Orthopaedics, Gansu Provincial Hospital, 204 Donggangxi Road, 730000, Lanzhou, Gansu Province, China. 2. Department of Internal Medicine, Gansu Province Hospital Rehabilitation Center, Lanzhou City, Chengguan Dingxi Road No. 53, 730050, Lanzhou, Gansu Province, China. 3. Department of Orthopaedics, Gansu Provincial Hospital, 204 Donggangxi Road, 730000, Lanzhou, Gansu Province, China. Electronic address: kelun19680619@126.com.
Abstract
BACKGROUND: High tibial osteotomy (HTO) is an effective surgical technique that can stop or inhibit progression of knee osteoarthritis (OA) and avoid or postpone the need for knee arthroplasty. This meta-analysis determined whether opening-wedge high tibial osteotomy (OWHTO) was superior to closing-wedge high tibial osteotomy (CWHTO) in treatment of unicompartmental OA. METHODS: Databases (PubMed, Embase, Web of Science, Cochrane Library and Google) were searched from the time of their establishment to 1st August 2018 for randomized controlled trials (RCTs) comparing OWHTO and CWHTO in patients with unicompartmental OA. The Cochrane risk of bias tool was used to assess methodological quality. Statistical analysis was performed with Stata 12.0. RESULTS: Nine RCTs (599 participants) were included in this meta-analysis. The pooled results showed that there were no significant differences between OWHTO and CWHTO VAS knee pain scores, HSS knee scores, walking distances or hip-knee-ankle (HKA) angles (P > 0.05). Furthermore, there were no significant differences between the two groups in complication and survival rates (p > 0.05). Nevertheless, there was a significantly greater tibial slope angle in OWHTO patients (P < 0.00001). CONCLUSION: CWHTO reduced the inclination of the tibial plateau, whereas OWHTO increased the posterior tilt, and these factors should be considered in the specific need of an individual patient when choosing the type of osteotomy. Therefore, we are unable to conclude which method is superior.
BACKGROUND: High tibial osteotomy (HTO) is an effective surgical technique that can stop or inhibit progression of knee osteoarthritis (OA) and avoid or postpone the need for knee arthroplasty. This meta-analysis determined whether opening-wedge high tibial osteotomy (OWHTO) was superior to closing-wedge high tibial osteotomy (CWHTO) in treatment of unicompartmental OA. METHODS: Databases (PubMed, Embase, Web of Science, Cochrane Library and Google) were searched from the time of their establishment to 1st August 2018 for randomized controlled trials (RCTs) comparing OWHTO and CWHTO in patients with unicompartmental OA. The Cochrane risk of bias tool was used to assess methodological quality. Statistical analysis was performed with Stata 12.0. RESULTS: Nine RCTs (599 participants) were included in this meta-analysis. The pooled results showed that there were no significant differences between OWHTO and CWHTO VAS knee pain scores, HSS knee scores, walking distances or hip-knee-ankle (HKA) angles (P > 0.05). Furthermore, there were no significant differences between the two groups in complication and survival rates (p > 0.05). Nevertheless, there was a significantly greater tibial slope angle in OWHTO patients (P < 0.00001). CONCLUSION: CWHTO reduced the inclination of the tibial plateau, whereas OWHTO increased the posterior tilt, and these factors should be considered in the specific need of an individual patient when choosing the type of osteotomy. Therefore, we are unable to conclude which method is superior.
Authors: Jichao Bian; Bin Deng; Zhimeng Wang; Long Yuan; Sen Li; Xiaowei Zhao; Yuanmin Zhang; Guodong Wang Journal: Medicine (Baltimore) Date: 2021-08-13 Impact factor: 1.817