Nicolas Bouguennec1, Guillaume Mergenthaler2, Thomas Gicquel3, Cyril Briand4, Elodie Nadau5, Régis Pailhé6, Jean Luc Hanouz7, Jean Marie Fayard8, Goulven Rochcongar2. 1. Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Nègrevergne, 33700 Merignac, France. Electronic address: nbouguennec@gmail.com. 2. Département de Chirurgie Orthopédique et Traumatologique, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France. 3. Clinique Mutualiste de la Porte de L'Orient, 3, rue Robert de La Croix, 56100 Lorient, France. 4. Service de Chirurgie Orthopédique, Traumatologique et Réparatrice, CHU de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France. 5. Service de Chirurgie Orthopédique, Traumatologique, CHU Amiens Picardie, 80054 Amiens cedex 1, France. 6. Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres, Hôpital Sud - CHU de Grenoble, Laboratoire TIMC-GMCAO UMR 5525 UGA/CNRS, 38000 Grenoble, France. 7. Service d'Anesthésie Réanimation, CHU de Caen, 14033 Caen cedex, France. 8. Centre Orthopédique Santy-Hopital Privé Jean Mermoz-Ramsay Générale de Santé, 69008 Lyon, France.
Abstract
INTRODUCTION: High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two surgical solutions for isolated medial tibiofemoral osteoarthritis. Results depend on preoperative criteria and patient selection, but also on postoperative factors: implant positioning, limb alignment. Factors for HTO survival need identifying to reduce risk of failure requiring total knee arthroplasty (TKA). HYPOTHESIS: Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival. MATERIAL AND METHOD: As part of a symposium of the French Society of Arthroscopy (SFA), a multicenter retrospective study compared 2 series. The HTO series comprised 488 patients: 153 female (31.4%); mean age, 55.1 years; mean weight, 83.1kg; mean body-mass index (BMI), 28.6. The UKA series comprised 284 patients: 172 female (60.6%); mean age, 64.1 years; mean weight, 75.3kg; mean BMI, 27.6. The main endpoint was comparative survival at 5, 8 and 10 years; secondary endpoints comprised pre- and post-operative hip-knee-ankle (HKA) angle, mechanical femoral angle (mFA) and mechanical tibial angle (mTA), surgical technique, satisfaction, time to and level of return to work, WOMAC and Tegner scores and complications rates. The significance threshold was set at p<0.05; 95% confidence intervals were calculated. RESULTS: Age>54 years, male gender, BMI>25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction<8°, postoperative HKA<180° and hinge fracture were significantly associated with poorer survival. There was no impact of type of osteotomy, navigation assistance or postoperative HKA 183-186°. Ten-year survival was 74.3% for HTO and 71% for UKA (non-significant); however, survival curves crossed at 6 years. CONCLUSION: HTO showed survival and functional results comparable to those of UKA in selected patients when target limb alignment correction was achieved. The present study determined selection criteria. A predictive score for results of either procedure would facilitate decision-making. LEVEL OF EVIDENCE: IV, retrospective cohort study.
INTRODUCTION:High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two surgical solutions for isolated medial tibiofemoral osteoarthritis. Results depend on preoperative criteria and patient selection, but also on postoperative factors: implant positioning, limb alignment. Factors for HTO survival need identifying to reduce risk of failure requiring total knee arthroplasty (TKA). HYPOTHESIS: Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival. MATERIAL AND METHOD: As part of a symposium of the French Society of Arthroscopy (SFA), a multicenter retrospective study compared 2 series. The HTO series comprised 488 patients: 153 female (31.4%); mean age, 55.1 years; mean weight, 83.1kg; mean body-mass index (BMI), 28.6. The UKA series comprised 284 patients: 172 female (60.6%); mean age, 64.1 years; mean weight, 75.3kg; mean BMI, 27.6. The main endpoint was comparative survival at 5, 8 and 10 years; secondary endpoints comprised pre- and post-operative hip-knee-ankle (HKA) angle, mechanical femoral angle (mFA) and mechanical tibial angle (mTA), surgical technique, satisfaction, time to and level of return to work, WOMAC and Tegner scores and complications rates. The significance threshold was set at p<0.05; 95% confidence intervals were calculated. RESULTS: Age>54 years, male gender, BMI>25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction<8°, postoperative HKA<180° and hinge fracture were significantly associated with poorer survival. There was no impact of type of osteotomy, navigation assistance or postoperative HKA 183-186°. Ten-year survival was 74.3% for HTO and 71% for UKA (non-significant); however, survival curves crossed at 6 years. CONCLUSION: HTO showed survival and functional results comparable to those of UKA in selected patients when target limb alignment correction was achieved. The present study determined selection criteria. A predictive score for results of either procedure would facilitate decision-making. LEVEL OF EVIDENCE: IV, retrospective cohort study.
Authors: Raghbir S Khakha; Hamid Rahmatullah Bin Abd Razak; Kristian Kley; Ronald van Heerwaarden; Adrian J Wilson Journal: J Clin Orthop Trauma Date: 2021-10-01