Summary
UKA appears to be as effective and as safe and produces better functional results than HTO in the treatment of medial knee arthritis.
Abstract
Introduction
Surgical treatment of unicompartmental knee osteoarthritis is still a controversial issue. Therapeutic options are either: medical or surgical such as arthroscopy,high tibial osteotomy, unicompartmental arthroplasty and TKA. The debate remains as to whether (HTO) or (UKA) is more beneficial for the treatment of unicompartmental knee osteoarthritis. The aim of this study was to compare functional outcomes, knee scores, activity levels and complications between the two procedures.
Materials And Methods
This is a prospective, comparative, randomized, double-blind clinical study with different observators conducted on 70 patients divided into two groups: HTO and UKA equally. The inclusion criteria were: Age: 50-70 years; BMI less than 30; Varus minus 15°, Integrity of ligaments, AHLBACK: 2 to 3. All osteotomies were performed by lateral closed wedge procedures. UKA (fixed metal-back, cemented). No significant differences between the two groups were noted regarding demographic characteristics: age (HTO: 61; UKA: 60), sex (p=0.130), BMI: HTO: 27.8 and UKA: 26.9. No significant differences regarding clinical or functional characteristics; mean preoperative mobility is 97°: HTO and 99°: UKA; mean HSS (60-69) in both groups; 97.1% of patients in the HTO group and 85.7% in the UKA group have a moderate KOOS (60-69). The Oxford HTO score is 28.6 (25-31) and the UKA score is 28.7 (26-31); 82.9% of patients in the HTO group and 85.7% of UKA have Ahlback grade III osteoarthritis. The mean follow-up is 38 (24-46) months.
Results
Postoperatively and at the last follow-up, there is no significant difference between the two groups regarding the Charneley score, the Oxford score and postoperative complications, no deterioration of the contralateral or patellofemoral compartment in both groups. However, UKA produces better results compared to HTO in terms of functional results, regarding the Devane score, postoperative mobility, flexion contracture, HSS and KOOS, on the other hand the survival rate is 100% in HTO and 97% for UKA, but this difference is not significant.
Discussion
UKAs provide better functional results and allow faster rehabilitation. Their disadvantages lie in a demanding surgical technique for implant positioning with the risk of rapid degradation of the prosthesis or the opposite compartment. Our study allowed us to introduce modern functional scores comparing HTO and UKA and to specify the indications for each of the two techniques.
Conclusion
We believe that both techniques are effective provided that their respective specifications are respected. Based on our results and the analysis of recent studies, UKA appears to be as effective and as safe and produces better functional results than HTO in the treatment of medial knee arthritis.