Suitability Of High Tibial Osteotomy And Unicompartmental Knee Arthroplasty In The Treatment Of Unicompartmental Osteoarthritis Of The Knee

Background:Debate remains whether high tibial osteotomy(HTO)or unicompartmental knee arthroplasty(UKA)is more beneficial for the treatment of unicompartmental knee osteoarthritis.Closing-wedge was the method of choice in many years,but nowadays,surgeons prefer Opening-wedge as their treatment of choice for HTO.Introduction of UKA also acquire controversies due to frequent and early failures cited in initial studies,however it is further acknowledge as an excellent-producing treatment recently after years of technique and component advancement.The purpose of this study is to evaluate the suitability and outcome of both technique for treatment of unicompartmental osteoarthritis of the knee.Method:We performed a systematic review of published literature from 1982 through 2017.Randomized and Non-Randomized controlled trials article related to comparison of UKA and HTO as well as opening-wedge(OWHTO)and closing-wedge HTO(CWHTO)were extracted according to inclusion and exclusion criteria.All included studies then subjected to a meta-analysis.Result:In comparison of UKA and HTO,no significant difference was noted with respect to free walking(velocity),knee score,deterioration of the contralateral or patellofemoral knee,or revision rate and total knee arthroplasty.UKA produced better outcomes compared to HTO in terms of the functional results,pain assessment,and complications,although patients who underwent HTO tended to have slightly better range of motion.On the other hand,there is a statistically significant difference between Opening-and Closing-wedge High Tibial Osteotomy in terms of Posterior Tibial Slope Angle,Patellar height measured by Caton Index and Blackburn peel index,limb length change,common peroneal nerve palsy,removal of Osteosynthesis and Revision to Total Knee Arthroplasty(TKA)incidence.However,both group have equal clinical outcome in terms of Visual Analogue Scale(VAS)knee pain,Lysholm score,and Hospital for Special Surgery(HSS)score.Conclusion:Valgus HTO provides better physical activity for younger patients whereas UKA is more suitable for older patients due to shorter rehabilitation time and faster functional recovery.Opening-wedge with fixed-angle plate is more preferred method for high tibial osteotomy.Nevertheless,all treatment option yielded pleasing results.Therefore,we are unable to conclude that either method is superior.Accurate identification of indications,including age,level of activity,grade of OA and ROM of the knee,and careful patient selection are essential for all OA patients.