Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review

Mingliang He, Xihong Zhong, Zhong Li, Kun Shen, Wen Zeng, Mingliang He, Xihong Zhong, Zhong Li, Kun Shen, Wen Zeng

Abstract

Background: High tibial osteotomy (HTO) has been used for over 60 years in clinical practice and mainly comprises two major techniques: closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). However, these have been gradually replaced by total knee arthroplasty (TKA), due to inconsistent clinical results and many complications. With the concept of knee-protection and ladder treatment of osteoarthritis, as an effective minimally invasive treatment for knee osteoarthritis, HTO has once again received attention.

Methods: A systematic literature search was conducted in PubMed, Embase, ClinicalKey, CNKI, and the China Wanfang database. The search terms relating to osteoarthritis and high tibial osteotomy were used. Studies were considered eligible if the participants were adults with knee osteoarthritis (KOA) who had undergone HTO. A total of two reviewers participated in the selection of the studies. Reviewer 1 was assigned to screen titles and abstracts, and reviewer 2 to screen full-text data. Data extraction was completed by reviewer 2, and 30% were checked by the research team. Potential conflicts were resolved through discussion. The methodological quality was assessed using a risk of bias, based on the Cochrane handbook and Newcastle-Ottawa assessment scale. The outcome indicators are (1) posterior slope of tibial plateau, (2) the height of the patella, (3) fracture in the osteotomy plane, (4) survival rate, (5) special surgery knee score (HSS), and (6) the recurrence of varus deformity of the included studies were evaluated according to the guidelines of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) working group (Atkins et al., BMJ 328:1490, 2004).

Results: Among the 18 articles included, 10 were prospective cohort studies, five were randomized controlled trial (RCT) studies, one was prospective comparative study (PCS), one was retrospective comparative study (RCS), and one was retrospective cohort. The earliest publication year was 1999, and the most recent was 2018. A total of 6555 eligible cases were included, comprised of 3351 OWHTO patients and 3204 CWHTO patients. Five RCT were assessed using risk of bias, based on the Cochrane handbook. Eleven cohort studies and two case-control studies were assessed using the Newcastle-Ottawa assessment scale. These six outcome indicators for a total of twenty-four evidence individuals were evaluated separately, among which the GRADE classification of 1, 2, and 6 was medium quality, and 3, 4, and 5 were low quality. Based on our systematic review, regardless of whether the chosen procedure was OWHTO or CWHTO, both HSS scores increased significantly as compared with the preoperative scores. Compared with CWHTO, the height of the patella and tibial posterior slope angle increased following OWHTO. Additionally, OWHTO has a better long-term survival rate and lower fracture rate, supporting OWHTO as the first treatment choice.

Conclusions: For young patients with knee osteoarthritis (KOA), high tibial osteotomy (HTO) can be considered as a treatment option to replace total knee arthroplasty (TKA) to reduce the economic burden and promote the reasonable allocation of medical resources. This study shows that compared with CWHTO, OWHTO has certain advantages in long-term survival rate and lower fracture rate, but the level of evidence is lower. In the future, we will need larger sample sizes and longer follow-up randomized controlled trials to improve our research.

Keywords: CWHTO; HTO; Knee osteoarthritis; OWHTO.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PubMed and Embase search strategy
Fig. 2
Fig. 2
ClinicalKey search strategy
Fig. 3
Fig. 3
CNKI and the China Wanfang database search strategy
Fig. 4
Fig. 4
Literature screening flow chart
Fig. 5
Fig. 5
Proximal tibiofibular joint

References

    1. Chang CB, Koh IJ, Seo ES, Kang YG, Seong SC, Kim TK. The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity. Knee. 2011;18(6):456–460. doi: 10.1016/j.knee.2010.08.010.
    1. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41:1343–1355. doi: 10.1002/1529-0131(199808)41:8<1343::AID-ART3>;2-9.
    1. Yelin E. The economics of osteoarthrits. In: Brandt K, Doherty M, Lohmander LS, editors. Osteoarthrits. New York: Oxford University Press; 1998. pp. 23–30.
    1. Jacobs CA, Christensen CP, Karthikeyan T. An intact anterior cruciate ligament at the time of posterior cruciate ligament-retaining total knee arthroplasty was associated with reduced patient satisfaction and inferior pain and stair function. J Arthroplasty. 2016;31(8):1732–1735. doi: 10.1016/j.arth.2016.01.026.
    1. Riddle DL, Perera RA, Jiranek WA, et al. Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample. Arthritis Care Res (Hoboken) 2015;67(3):349–357. doi: 10.1002/acr.22428.
    1. Walker P, Arno S, Bell C, et al. Function of the medialmeniscus in force transmission and stability. J Biomech. 2015;2048:1383–1388. doi: 10.1016/j.jbiomech.2015.02.055.
    1. Santoso MB, Wu L. Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. J Orthop Surg Res. 2017;12(1):50. doi: 10.1186/s13018-017-0552-9.
    1. Smith WB, Steinberg J, Scholtes S. Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2017;25:924–933. doi: 10.1007/s00167-015-3821-3.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–341. doi: 10.1016/j.ijsu.2010.02.007.
    1. Shizheng L, Jifang W. Campbell orthopaedic surgery. 10. Jinan: Shandong Science and Technology Press; 2005. pp. 870–881.
    1. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490.
    1. Chiu KY, Zhang SD, Zhang GH. Posterior slope of tibial plateau in Chinese. J Arthroplasty. 2000;15(2):224–227. doi: 10.1016/S0883-5403(00)90330-9.
    1. Kuwano T, Urabe K, Miura H, et al. Importance of the lateral anatomic tibial slope as a guide to the tibial cut in total knee arthroplasty in Japanese patients. J Orthop Sci. 2005;10(1):42–47. doi: 10.1007/s00776-004-0855-7.
    1. Nha KW, Kim HJ, Ahn HS, et al. Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy: a meta-analysis. Am J Sports Med. 2016;44(11):3006–3013. doi: 10.1177/0363546515626172.
    1. Hohmann E, Bryant A, Imhoff AB. The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc. 2006;14(5):454–459. doi: 10.1007/s00167-005-0700-3.
    1. Giffin JR, Vogrin TM, Zantop T, et al. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376–382. doi: 10.1177/0363546503258880.
    1. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med. 2005;33(3):378–387. doi: 10.1177/0363546504269034.
    1. Van Raaij TM, Brouwer RW, de Vlieger R, et al. Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop. 2008;79(4):508–514. doi: 10.1080/17453670710015508.
    1. Turkmen F, Kacira BK, Ozkaya M, et al. Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2914–2920. doi: 10.1007/s00167-016-4049-6.
    1. Nakamura R, Komatsu N, Fujita K, et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J. 2017;99-B(10):1313–1318. doi: 10.1302/0301-620X.99B10.BJJ-2017-0103.R1.
    1. Hao C. Changes of patella joint pressure after high tibial osteotomy with different correction angles: Hebei Medical University; 2012. 10.7666/d.y2105940.
    1. Ozkaya U, Kabukçuoğlu Y, Parmaksizoğlu AS, Yeniocak S, Ozkazanli G. Açik kama yüksek tibia osteotomisi sonrasinda patella yüksekliği ve tibial eğim açisindaki değişiklikler [Changes in patellar height and tibia inclination angle following open-wedge high tibial osteotomy] Acta Orthop Traumatol Turc. 2008;42(4):265–271. doi: 10.3944/aott.2008.265.
    1. Lee OS, Ahn S, Lee YS. Changes of sagittal and axial alignments of patella after open- and closed-wedge high-tibial osteotomy: a systematic review and meta-analysis. J Knee Surg. 2018;31(7):625–634. doi: 10.1055/s-0037-1605561.
    1. Altay MA, Ertürk C, Altay N, et al. Clinical and radiographic outcomes of medial open-wedge high tibial osteotomy with Anthony-K plate: prospective minimum five year follow-up data. Int Orthop. 2016;40(7):1447–1454. doi: 10.1007/s00264-015-2919-z.
    1. Terauchi M, Shirakura K, Katayama M, et al. Varus inclination of the distal femur and high tibial osteotomy. J Bone Joint Surg Br. 2002;84(2):223–226. doi: 10.1302/0301-620X.84B2.0840223.
    1. El-Assal MA, Khalifa YE, Abdel-Hamid MM, Said HG, Bakr HM. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):961–966. doi: 10.1007/s00167-010-1104-6.
    1. Park H, Kim HW, Kam JH, Lee DH. Open wedge high tibial osteotomy with distal tubercle osteotomy lessens change in patellar position. Biomed Res Int. 2017;2017:4636809. doi: 10.1155/2017/4636809.
    1. Bae DK, Song SJ, Kim KI, Hur D, Jeong HY. Mid-term survival analysis of closed wedge high tibial osteotomy: a comparative study of computer-assisted and conventional techniques. Knee. 2016;23(2):283–288. doi: 10.1016/j.knee.2015.10.005.
    1. Kim JH, Kim HJ, Lee DH. Survival of opening versus closing wedge high tibial osteotomy: a meta-analysis. Sci Rep. 2017;7(1):7296. doi: 10.1038/s41598-017-07856-8.
    1. Trieb K, Grohs J, Hanslik-Schnabel B, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):149–152. doi: 10.1007/s00167-005-0638-5.
    1. Billings A, Scott DF, Camargo MP, et al. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg Am. 2000;82(1):70–79. doi: 10.2106/00004623-200001000-00009.
    1. Flamme CH, Ruhmann O, Schmolke S, et al. Long-term outcome following high tibial osteotomy with tension bend principle. Arch Orthop Trauma Surg. 2003;123(1):12–16. doi: 10.1007/s00402-002-0446-z.
    1. Matsuda S, Miura H, Nagamine R, et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg. 1999;12(3):165–168.
    1. Savarese E, Bisicchia S, Romeo R, et al. Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner. J Orthop Traumatol. 2011;12(1):1–17. doi: 10.1007/s10195-010-0120-0.

Source: PubMed

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