Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes

doi:10.5312/wjo.v15.i5.444

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May 18, 2024 (publication date) through Jul 22, 2024

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World Journal of Orthopedics

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Orthop. May 18, 2024; 15(5): 444-456
Published online May 18, 2024. doi: 10.5312/wjo.v15.i5.444

Table 1 Demographics

	UKA group (n = 23)	HTO group (n = 19)
Age (years), mean (SD)	66.9 (8.6)	54.3 (10.8)
Sex (male:female)	12:11	18:1
Laterality (left:right)	15:8	11:8
Smoking, n (%)	1 (4.5)	1 (5.6)
Height (cm), mean (SD)	167.1 (10.0)	174.2 (9.1)
Weight (kg), mean (SD)	84.2 (18.4)	95.6 (16.8)
BMI (kg/m²), mean (SD)	30.0 (4.6)	31.5 (4.8)
ASA, median (range)	2 (1 to 3)	2 (1 to 2)
SCQ, median (range)	3.5 (0 to 12)	3 (0 to 10)

UKA: Unicompartmental knee arthroplasty; HTO: High tibial osteotomy; BMI: Body mass index; ASA: American Society of Anesthesiologists Physical Status Classification System; SCQ: Self-administered co-morbidity questionnaire.

Table 2 Between-group comparison of preoperative and postoperative patient reported outcome measures scores

	Preoperative				Postoperative
	UKA group mean (SD)	HTO group mean (SD)	P value¹	95%CI	UKA group mean (SD)	HTO group mean (SD)	P value¹	95%CI
KOOS:
Pain	32.5 (8.2)	35.2 (17.7)	0.530	-5.8 to 11.1	91.1 (12.7)	87.2 (12.4)	0.419	-13.5 to 5.8
Symptoms	42.3 (17.8)	38.2 (17.8)	0.462	-15.2 to 7.1	87.0 (12.9)	73.0 (17.3)	0.012^a	-24.6 to -3.3
ADLs	38.0 (9.1)	42.2 (17.3)	0.320	-4.2 to 12.6	90.6 (13.9)	90.2 (10.8)	0.936	-9.8 to 9.1
Sport/Rec	19.0 (21.3)	14.4 (12.4)	0.455	-16.9 to 7.7	78.7 (28.9)	71.8 (27.6)	0.549	-30.1 to 16.4
QoL	17.8 (11.9)	13.0 (11.9)	0.211	-12.5 to 2.9	80.1 (21.8)	67.8 (14.8)	0.107	-27.4 to 2.8
Overall	29.1 (7.9)	27.1 (13.1)	0.580	-9.3 to 5.3	85.2 (17.3)	78.4 (13.6)	0.295	-19.8 to 6.3
OKS	16.5 (5.6)	18.4 (7.8)	0.362	-2.3 to 6.1	42.4 (6.3)	42.1 (5.2)	0.872	-4.7 to 4.0
EQ-5D^Index	35.6 (24.0)	37.4 (29.7)	0.834	-15.4 to 19.0	84.7 (18.8)	80.8 (15.1)	0.557	-17.4 to 9.6
EQ-5D^VAS	72.4 (17.6)	64.8 (23.4)	0.237	-20.4 to 5.2	88.3 (12.7)	82.9 (9.6)	0.210	-14.0 to 3.2
SF-12 PCS	28.9 (5.8)	32.1 (7.7)	0.143	-1.1 to 7.5	50.9 (7.7)	50.0 (8.9)	0.983	-7.4 to 5.5
SF-12 MCS	51.0 (11.4)	42.9 (13.0)	0.043^a	-15.9 to -0.3	51.8 (9.7)	50.8 (10.5)	0.511	-8.8 to 6.9

¹Independent-sample Student’s t-test.

^aP < 0.05, statistically significant.

SD: Standard deviation; UKA: Unicompartmental knee arthroplasty; HTO: High tibial osteotomy; PROM: Patient reported outcome measures; KOOS: Knee injury and osteoarthritis outcome score; ADL: Activities of daily living; Sport/Rec: Sport and recreation; QoL: Quality of life ; OKS: Oxford knee score; EQ-5D^index: EuroQol–5 dimension descriptive component; EQ-5D^vas: EuroQol–5 dimension visual analogue scale; SF-12 PCS: 12 item Short Form survey physical component score; SF-12 MCS: 12 item Short Form survey mental component score.

Table 3 Within-group comparison of preoperative vs postoperative patient reported outcome measures scores

	UKA Group				HTO Group
	Pre-op mean (SD)	Post-op mean (SD)	P value¹	95%CI	Pre-op mean (SD)	Post-op mean (SD)	P value¹	95%CI
KOOS:
Pain	32.5 (8.2)	91.1 (12.7)	< 0.001^a	51.8 to 63.3	35.2 (17.7)	87.2 (12.4)	< 0.001^a	37.5 to 63.0
Symptoms	42.3 (17.8)	87.0 (12.9)	< 0.001^a	37.3 to 52.1	38.2 (17.8)	73.0 (17.3)	< 0.001^a	25.7 to 49.5
ADLs	38.0 (9.1)	90.6 (13.9)	< 0.001^a	47.6 to 57.1	42.2 (17.3)	90.2 (10.8)	< 0.001^a	32.9 to 53.9
Sport/Rec	19.0 (21.3)	78.7 (28.9)	< 0.001^a	44.9 to 76.5	14.4 (12.4)	71.8 (27.6)	< 0.001^a	39.7 to 71.2
QoL	17.8 (11.9)	80.1 (21.8)	< 0.001^a	53.9 to 71.6	13.0 (11.9)	67.8 (14.8)	< 0.001^a	40.9 to 62.6
Overall	29.1 (7.9)	85.2 (17.3)	<0.001^a	47.8 to 63.6	27.1 (13.1)	78.4 (13.6)	< 0.001^a	37.7 to 58.1
OKS	16.5 (5.6)	42.4 (6.3)	< 0.001^a	23.0 to 28.6	18.4 (7.8)	42.1 (5.2)	< 0.001^a	16.4 to 27.8
EQ-5D^Index	35.6 (24.0)	84.7 (18.8)	< 0.001^a	38.8 to 57.2	37.4 (29.7)	80.8 (15.11)	< 0.001^a	23.8 to 48.9
EQ-5D^VAS	72.4 (17.6)	88.3 (12.7)	< 0.001^a	8.6 to 23.0	64.8 (23.4)	82.9 (9.6)	0.069	-1.2 to 27.0
SF-12 PCS	28.9 (5.8)	50.9 (7.7)	< 0.001^a	16.3 to 25.4	32.1 (7.7)	50.0 (8.9)	0.001^a	9.1 to 25.8
SF-12 MCS	51.0 (11.4)	51.8 (9.7)	0.476	-3.0 to 6.2	42.9 (13.0)	50.8 (10.5)	0.115	-1.8 to 14.1

¹Paired Student’s t-test.

^aP < 0.05, statistically significant.

SD: Standard deviation; UKA: Unicompartmental knee arthroplasty; HTO: High tibial osteotomy; Pre-op: Preoperative; Post-op: Postoperative; PROM: Patient reported outcome measures; KOOS: Knee Injury and osteoarthritis outcome score; ADL: Activities of daily living; Sport/Rec: Sport & recreation; QoL: Quality of life; OKS: Oxford knee score; EQ-5D^index: EuroQol–5 dimension descriptive component; EQ-5D^vas: EuroQol–5 dimension visual analogue scale; SF-12 PCS: 12 item Short Form survey physical component score; SF-12 MCS: 12 item Short Form survey mental component score.

Table 4 Correlation analysis: Preoperative radiographic parameters and preoperative patient reported outcome measures

	Angle of Mikulicz line	HKA	MAD
	r (P value¹)	r (P value¹)	r (P value¹)
KOOS:
Pain	-0.18 (0.290)	-0.12 (0.484)	-0.01 (0.938)
Symptoms	-0.36 (0.022^a)	0.15 (0.352)	0.16 (0.336)
ADLs	-0.37 (0.020^a)	0.06 (0.707)	0.10 (0.534)
Sport/Rec	-0.04 (0.839)	0.06 (0.737)	0.16 (0.357)
QoL	-0.34 (0.040^a)	-0.23 (0.169)	-0.14 (0.415)
Overall	-0.38 (0.026^a)	-0.04 (0.844)	0.07 (0.698
OKS	-0.41 (0.010^a)	0.13 (0.422)	0.21 (0.201)
EQ-5D^Index	-0.45 (0.005^a)	-0.07 (0.670)	-0.02 (0.896)
EQ-5D^VAS	-0.29 (0.071)	0.03 (0.843)	0.06 (0.709)
SF-12 PCS	-0.23 (0.158)	0.26 (0.112)	0.34 (0.035^a)
SF-12 MCS	-0.23 (0.173)	-0.05 (0.773)	-0.08 (0.641)

¹Pearson’s product-moment correlation analysis.

^aP < 0.05, statistically significant.

r: Correlation co-efficient; UKA: Unicompartmental knee arthroplasty; HTO: High tibial osteotomy; PROM: Patient reported outcome measures; HKA: Hip knee ankle angle; MAD: Mechanical axis deviation; KOOS: Knee injury and osteoarthritis outcome score; ADL: Activities of daily living; Sport/Rec: Sport & recreation; QoL: Quality of life; OKS: Oxford knee score; EQ-5D^index: EuroQol–5 dimension descriptive component; EQ-5D^vas: EuroQol–5 dimension visual analogue scale; SF-12 PCS: 12 item Short Form survey physical component score; SF-12 MCS: 12 item Short Form survey mental component score.

Table 5 Correlation analysis: Post-operative radiographic parameters and post-operative patient reported outcome measures

	UKA Group			HTO Group
	Angle of Mikulicz line, r (P value¹)	HKA, r (P value¹)	MAD, r (P-value¹)	Angle of Mikulicz line, r (P-value¹)	HKA, r (P-value¹)	MAD, r (P-value¹)
KOOS:
Pain	-0.17 (0.483)	-0.15 (0.518)	-0.07 (0.760)	0.13 (0.716)	0.41 (0.238)	0.53 (0.119)
Symptoms	-0.17 (0.450)	-0.07 (0.772)	0.02 (0.922)	0.26 (0.436)	0.65 (0.032^a)	0.62 (0.040^a)
ADLs	-0.22 (0.328)	-0.05 (0.837)	0.01 (0.961)	0.09 (0.790)	0.59 (0.055)	0.62 (0.041^a)
Sport/Rec	-0.21 (0.459)	0.15 (0.584)	0.28 (0.317)	0.46 (0.178)	0.5 (0.103)	0.53 (0.113)
QoL	-0.27 (0.249)	-0.11 (0.635)	-0.03 (0.898)	0.14 (0.693)	0.58 (0.080)	0.60 (0.065)
Overall	-0.26 (0.357)	-0.01 (0.959)	0.12 (0.676)	0.32 (0.373)	0.65 (0.041^a)	0.68 (0.031^a)
OKS	-0.34 (0.137)	-0.02 (0.950)	0.03 (0.884)	0.24 (0.481)	0.65 (0.032^a)	0.61 (0.045^a)
EQ-5D^Index	-0.23 (0.334)	-0.70 (0.768)	0.01 (0.974)	-0.13 (0.724)	0.47 (0.175)	0.45 (0.191)
EQ-5D^VAS	-0.23 (0.304)	-0.02 (0.942)	0.03 (0.881)	0.10 (0.776)	0.21 (0.534)	0.21 (0.544)
SF-12 PCS	-0.14 (0.584)	-0.13 (0.615)	-0.02 (0.929)	-0.07 (0.850)	0.15 (0.680)	0.18 (0.616)
SF-12 MCS	-0.49 (0.041^a)	-0.24 (0.341)	-0.19 (0.455)	-0.02 (0.953)	0.38 (0.279)	0.29 (0.422)

¹Pearson’s product-moment correlation analysis.

^aP < 0.05, statistically significant.

r: Correlation co-efficient; UKA: Unicompartmental knee arthroplasty; HTO: High tibial osteotomy; PROM: Patient reported outcome measures; HKA: Hip knee ankle angle; MAD: Mechanical axis deviation; KOOS: Knee injury and osteoarthritis outcome score; ADL: Activities of daily living; Sport/Rec: Sport & recreation; QoL: Quality of Life; OKS: Oxford knee score; EQ-5D^index: EuroQol–5 dimension descriptive component; EQ-5D^vas: EuroQol–5 dimension visual analogue scale; SF-12 PCS: 12 Item Short Form Survey Physical Component Score; SF-12 MCS: 12 Item Short Form survey mental component score.

Table 6 Within-group comparison of preoperative vs post-operative radiographic parameters of joint alignment

	UKA Group				HTO Group
	Pre-op mean (SD)	Post-op mean (SD)	P value¹	95%CI	Pre-op mean (SD)	Post-op mean (SD)	P value¹	95%CI
Angle of Mikulicz line (°)	0.3 (2.6)	-0.2 (1.8)	0.326	-1.6 to 0.6	0.7 (2.0)	0.2 (1.5)	0.951	-1.5 to 1.6
HKA (°)	174.5 (2.7)	180.2 (3.3)	< 0.001^a	4.3 to 7.1	173.9 (4.0)	182.5 (2.8)	< 0.001^a	5.2 to 12.0
MAD (%)	23.5 (10.8)	48.9 (13.6)	< 0.001^a	20.7 to 30.0	22.3 (14.5)	59.9 (12.0)	< 0.001^a	24.2 to 51.0

¹Paired Student’s t-test.

^aP < 0.05, statistically significant.

SD: Standard deviation; UKA: Unicompartmental knee arthroplasty; HTO: High tibial osteotomy; Pre-op: Preoperative; Post-op: Postoperative; HKA: Hip knee ankle angle; MAD: Mechanical axis deviation.

Citation: Wyatt FW, Al-Dadah O. Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes. World J Orthop 2024; 15(5): 444-456
URL: https://www.wjgnet.com/2218-5836/full/v15/i5/444.htm
DOI: https://dx.doi.org/10.5312/wjo.v15.i5.444