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Meta-Analysis
. 2019 Jul;98(30):e16609.
doi: 10.1097/MD.0000000000016609.

Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty: A meta-analysis

Seung-Suk Seo  1 , Kyung-Wook Nha  2 , Tae-Yeong Kim  3 , Young-Soo Shin  3
Affiliations
Meta-Analysis

Survival of total knee arthroplasty after high tibial osteotomy versus primary total knee arthroplasty: A meta-analysis

Seung-Suk Seo et al. Medicine (Baltimore). 2019 Jul.

Abstract

Background: Theoretical considerations suggest that total knee arthroplasty (TKA) is technically more challenging after high tibial osteotomy (HTO), resulting in inferior results compared to primary TKA. However, several studies on this issue have shown contradictory results. The purpose of this meta-analysis to compare survivorship and clinical outcomes between TKA with and without previous HTO.

Methods: We reviewed studies that evaluated pain and function scores, range of motion (ROM), operation time, Insall-Salvati (IS) ratio, complications, and survival rates in patients treated with TKA with previous HTO or with primary TKA with short- to midterm (<10 years) or long-term (>10 years) follow-up.

Results: Fifteen studies were included in the meta-analysis. There were no significant differences between TKA with and without previous HTO in pain score (95% CI: -0.27 to 0.29; P = .94), function score (95% CI: -0.08 to 0.24; P = .32), operation time (95% CI: -5.43 to 26.85; P = .19), IS ratio (95% CI: -0.03 to 0.08; P = .40), complication rates (TKA with previous HTO, 62/1717; primary TKA, 610/31386; OR 1.31, 95% CI: 0.97-1.77; P = .08), and short- to midterm survival rates (TKA with previous HTO, 1860/2009; primary TKA, 37848/38765; OR 0.55, 95% CI: 0.28-1.10; P = .09). Conversely, ROM (95% CI: -7.40 to -1.26; P = .006) and long-term survival rates (TKA with previous HTO, 1426/1523; primary TKA, 29810/31201; OR 0.71, 95% CI: 0.57-0.89; P = .003) were significantly different between the two groups. In addition, both groups had substantial proportions of knees exhibiting short- to midterm survivorship (92.6% by TKA with previous HTO and 97.6% by primary TKA) and long-term survivorship (93.6% by TKA with previous HTO and 95.5% by primary TKA).

Conclusions: This meta-analysis suggests that a previous HTO affected ROM or survival of TKA in the long-term even though both groups have equivalent clinical outcomes and complications. Thus, orthopedic surgeons should offer useful information regarding the advantages and disadvantages of both procedures to patients, and should provide advice on the generally higher risk of revision after TKA with previous HTO at long-term follow-up when counseling patients.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
A flow diagram of preferred reporting items for systemic reviews and meta-analyses (PRISMA).
Figure 2
Figure 2
Funnel plot showing asymmetric data on (A) pain score between patients with TKA after HTO and primary TKA, suggesting some publication bias among included studies. However, funnel plot relatively symmetric data on (B) function score between patients with TKA after HTO and primary TKA, suggesting lack of publication biases.
Figure 3
Figure 3
Results of aggregate analysis for comparison of pain scores between patients with TKA after HTO and primary TKA.
Figure 4
Figure 4
Results of aggregate analysis for comparison of function scores between patients with TKA after HTO and primary TKA.
Figure 5
Figure 5
Results of aggregate analysis for comparison of postoperative range of motion (ROM) between patients with TKA after HTO and primary TKA.
Figure 6
Figure 6
Results of aggregate analysis for comparison of operation time between patients with TKA after HTO and primary TKA.
Figure 7
Figure 7
Results of aggregate analysis for comparison of Insall-Salvati ratio between patients with TKA after HTO and primary TKA.
Figure 8
Figure 8
Results of aggregate analysis for comparison of complication rate between patients with TKA after HTO and primary TKA.
Figure 9
Figure 9
Results of aggregate analysis for comparison of short- to midterm and long-term survival rates between patients with TKA after HTO and primary TKA.
See this image and copyright information in PMC

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