A Meta-analysis Of The Efficacy Of High Tibial Osteotomy And Unicompartmental Knee Arthroplasty For Knee Osteoarthritis

Background:There is a femoral condyle above the knee joint,a tibial plateau below,and a tibia in front.These three kinds of bony tissues form the "skeleton" of the knee joint,and at the same time,various soft tissues such as muscle,fat and synovium attached to the bone maintain the stability of the knee joint flexion,extension and rotation.The three bony structures are not in direct contact,but are related by soft tissue,thus forming three gaps,which are the medial compartment in the medial region of the knee joint,the lateral compartment in the temporal side of the knee joint,and the tibia and femur.Between the stock room.In any of the patients with knee osteoarthritis,lesions may occur.Initially,the pathological changes are only included in one compartment[1],and the medial joint space lesions appear to occur more frequently than the other compartments.In the early stage,when the symptoms of osteoarthritis are not serious,conservative treatment can achieve better results[2].For patients who do not improve their symptoms with conservative treatment,surgical treatment of the affected knee joint is needed to change the patient's symptoms.Clinically,the surgical methods for improving the symptoms of KOA patients include high tibial osteotomy(HTO),single ankle replacement(UKA),and total knee replacement(TKA).The key to improving pain in HTO is to shift the patient's weight from the injured side to the relatively healthy side.It is an effective means of treating KOA.UKA uses a oscillating saw to remove the surface of the inter-articular compartment and does not treat other structures in the knee joint.It has a preserved cruciate ligament,small surgical trauma,less bleeding,quick recovery,and fewer complications,and low cost and other advantages.The current clinical results suggest that both treatments have good results.There is controversy about which surgical procedure to use for patients with early single-compartment lesions.To help clinically collect evidence,a meta-analysis of HTO and UKA studies at home and abroad was conducted.Method1.This paper identifies search strategies based on PICOS principles(Partcipant,Intervention,Comparotor,Outcome,and Study design).2.Use a computer to search the Cochrane Library,Embase,Pubmed,Web of Science.A systematic and comprehensive study of the high-level osteotomy and single-sacral replacement for the treatment of knee joint single-compartment osseous joints.The search date is until February 2019.According to the proposed inclusion criteria and exclusion criteria,the selected literatures were selected,and the selected literatures were evaluated for quality,the literature was carefully read,relevant data was extracted and collected,and META analysis was performed on the extracted valid data.The indicators of the study were:1.Comparison of postoperative excellent rate;2.Comparison of postoperative repair rate;3.Comparison of postoperative complications;4.Comparison of postoperative pain and VAS score;5.Knee joint Comparison of Lysholm.3.This study strictly adheres to the Cochrane Handbook and the PRISMA Statement.4.Perform a META analysis of the data using Revman 5.3 software.ResultA total of 11 clinical controlled studies were included in this META analysis,including 2 clinical randomized controlled trials(RCT)and 11 retrospective analyses(nRCT).A total of 6266 knee joints were included,including 910 patients with high tibial osteotomy and 5356 patients with monosodium replacement.The results of this meta-analysis showed that there was no significant difference in the excellent rate of knee joint function between the high tibial osteotomy group and the monoterpene replacement group(OR=0.54,95%CI 0.14-2.15,P=0.38);The incidence of postoperative complications was higher in the skeletal group than in the single sputum replacement group.The difference was statistically significant(OR=2.11,95%CI 1.07-4.16,P=0.03);in terms of postoperative VAS score and pain incidence,The high tibial osteotomy group was higher than the single ankle replacement group,the difference was statistically significant(MD=0.82,95%CI 0.09-1.84,P=0.03).In terms of revision rate,the high tibial osteotomy group and the monoterpene replacement group were not obvious.Differences(OR=1.20,95%CI 0.50-2.88,P=0.69);in terms of knee mobility,the high tibial osteotomy group was more advantageous than the monoterpene replacement group,and the difference was statistically significant(MD=9.55,95).%CI 1.66-17.43,P=0.02);There was no significant difference in the Lysholm score of the knee joint between HTO group and the UKA group(MD=-4.24,95%CI-10.77-2.29,P=0.20).ConclusionHigh tibial osteotomy and single iliac crest surgery were used for the treatment of single-compartment knee osteoarthritis.The two had similar excellent rate and Lysholm function score of the knee joint.In the single-ankle replacement group,there were fewer postoperative complications,lower revision rate,lower postoperative pain rate,and lower postoperative VAS score.The high tibial osteotomy group had an advantage in joint mobility.Since this META analysis included fewer randomized controlled trials in the study,it is still necessary to further rationally design and implement a rigorous,large-sample,multi-center randomized controlled trial to guide clinical practice.