Unicompartmental Knee Arthroplasty Has Lower Infection, Conversion, and Complication Rates Compared to High Tibial Osteotomy

Abstract

Introduction Isolated medial knee osteoarthritis can be surgically treated with either unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO). Proponents of UKA suggest superior survivorship, while HTO offers theoretically improved alignment and joint preservation delaying total knee arthroplasty (TKA). Therefore, we compared complications in a large population of patients undergoing UKAs or HTOs. We specifically assessed 90 days, 1 year, and 2 years: (1) periprosthetic joint infection (PJI) rates, (2) conversion to TKA rates, as well as (3) complication rates.

Methods A review of an administrative claims database was used to identify patients undergoing primary UKA (n = 13,674) or HTO (n = 1,096) from January 1, 2010 to December 31, 2019. Complication rates at 90 days, 1 year, and 2 years were compared between groups using unadjusted odds ratios (ORs) with 95% confidence intervals. Subsequently, multivariate logistic regressions were performed for PJI and conversion to TKA rates.

Results At all time points, patients who underwent UKA were associated with lower rates of infection compared with those who underwent HTOs (all OR ≤ 0.51, all p ≤ 0.010). After 1 year, patients who received UKAs were found to have lower risk of requiring a conversion to a TKA versus those who received HTOs (all OR ≤ 0.55, all p < 0.001). Complications such as dislocations, periprosthetic fractures, and surgical site infections were found at lower odds in UKA compared with HTO patients.

Conclusion This study provides large-scale analyses demonstrating that UKA is associated with lower infection rates and fewer conversions to TKA compared with patients who have undergone HTO. Dislocations, periprosthetic fractures, and surgical site infections were also found to be lower among UKA patients. However, with careful patient selection, good results and preservation of the native knee are achieved with HTOs. Therefore, UKA versus HTO may be an important discussion to have with patients in an effort to lower the incidence of postoperative infections and complications.

Keywords

unicompartmental knee arthroplasty - infection - conversion - complication - high tibial osteotomy

Publikationsverlauf

Eingereicht: 26. Juli 2022

Angenommen: 26. August 2022

Artikel online veröffentlicht:
20. Dezember 2022

• References

• 1 Stoddart JC, Dandridge O, Garner A, Cobb J, van Arkel RJ. The compartmental distribution of knee osteoarthritis – a systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29 (04) 445-455
• 2 Wang WJ, Sun MH, Palmer J. et al. Patterns of compartment involvement in end-stage knee osteoarthritis in a Chinese orthopedic center: implications for implant choice. Orthop Surg 2018; 10 (03) 227-234
• 3 Deng M, Hu Y, Zhang Z, Zhang H, Qu Y, Shao G. Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141 (08) 1361-1372
• 4 Beard DJ, Davies LJ, Cook JA. et al; TOPKAT Study Group. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 2019; 394 (10200): 746-756
• 5 Argenson JA, Jacquet C, Ollivier M. Medial femorotibial osteoarthritis of the knee: total or partial knee replacement?. Ann Transl Med 2020; 8 (11) 721
• 6 Weber KL, Jevsevar DS, McGrory BJ. AAOS clinical practice guideline: surgical management of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg 2016; 24 (08) e94-e96
• 7 McGrory BJ, Weber KL, Jevsevar DS, Sevarino K. Surgical management of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg 2016; 24 (08) e87-e93
• 8 Manner PA, Tubb CC, Levine BR. AAOS Appropriate Use Criteria: surgical management of osteoarthritis of the knee. J Am Acad Orthop Surg 2018; 26 (09) e194-e197
• 9 Quinn RH, Murray JN, Pezold R, Sevarino KS. Surgical management of osteoarthritis of the knee. J Am Acad Orthop Surg 2018; 26 (09) e191-e193
• 10 Kim MS, Koh IJ, Sohn S, Jeong JH, In Y. Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. Int Orthop 2019; 43 (11) 2493-2501
• 11 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 (01) 50
• 12 Belsey J, Yasen SK, Jobson S, Faulkner J, Wilson AJ. Return to physical activity after high tibial osteotomy or unicompartmental knee arthroplasty: a systematic review and pooling data analysis. Am J Sports Med 2021; 49 (05) 1372-1380
• 13 Han SB, Kyung HS, Seo IW, Shin YS. Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy. Medicine (Baltimore) 2017; 96 (50) e9268
• 14 Lee SH, Kim HR, Seo HY, Seon JK. A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea. BMC Musculoskelet Disord 2022; 23 (01) 127
• 15 Rodkey DL, McMillan LJ, Slaven SE, Treyster DA, Dickens JF, Cody JP. Unicompartmental knee arthroplasty: more conversions, fewer complications than proximal tibial osteotomy in a young population. J Arthroplasty 2021; 36 (12) 3878-3882
• 16 Koh IJ, Kim MS, Sohn S. et al. Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis. Orthop Traumatol Surg Res 2019; 105 (01) 77-83
• 17 Jin QH, Lee WG, Song EK, Jin C, Seon JK. Comparison of long-term survival analysis between open-wedge high tibial osteotomy and unicompartmental knee arthroplasty. J Arthroplasty 2021; 36 (05) 1562-1567.e1
• 18 Liu TW, Chiu CH, Chen ACY, Chang SS, Chan YS. Risk factor analysis for infection after medial open wedge high tibial osteotomy. J Clin Med 2021; 10 (08) 1727
• 19 Lee CS, Su EP, Cross MB, Carli AV, Landy DC, Chalmers BP. Unicompartmental knee arthroplasty is associated with a lower rate of periprosthetic joint infection compared to total knee arthroplasty. Arthroplast Today 2021; 10: 117-122
• 20 Kawata M, Jo T, Taketomi S. et al. Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database. Knee Surg Sport Traumatol Arthrosc 2021; 29 (02) 429-436
• 21 Berger RA, Meneghini RM, Jacobs JJ. et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am 2005; 87 (05) 999-1006
• 22 Bini S, Khatod M, Cafri G, Chen Y, Paxton EW. Surgeon, implant, and patient variables may explain variability in early revision rates reported for unicompartmental arthroplasty. J Bone Joint Surg Am 2013; 95 (24) 2195-202
• 23 van der List JP, Zuiderbaan HA, Pearle AD. Why do medial unicompartmental knee arthroplasties fail today?. J Arthroplasty 2016; 31 (05) 1016-1021
• 24 Chatellard R, Sauleau V, Colmar M, Robert H, Raynaud G, Brilhault J. Société d'Orthopédie et de Traumatologie de l'Ouest (SOO). Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival?. Orthop Traumatol Surg Res 2013; 99 (4, Suppl): S219-S225
• 25 Roemhildt ML, Beynnon BD, Gauthier AE, Gardner-Morse M, Ertem F, Badger GJ. Chronic in vivo load alteration induces degenerative changes in the rat tibiofemoral joint. Osteoarthritis Cartilage 2013; 21 (02) 346-357
• 26 Vakharia RM, Sodhi N, Cohen-Levy WB, Vakharia AM, Mont MA, Roche MW. Comparison of patient demographics and utilization trends of robotic-assisted and non-robotic-assisted unicompartmental knee arthroplasty. J Knee Surg 2021; 34 (06) 621-627
• 27 Cobb J, Henckel J, Gomes P. et al. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the Acrobot system. J Bone Joint Surg Br 2006; 88 (02) 188-197
• 28 Kayani B, Haddad FS. Robotic unicompartmental knee arthroplasty: current challenges and future perspectives. Bone Joint Res 2019; 8 (06) 228-231
• 29 Iturriaga C, Salem HS, Ehiorobo JO, Sodhi N, Mont MA. Robotic-assisted versus manual unicompartmental knee arthroplasty: a systematic review. Surg Technol Int 2020; 37: 275-279
• 30 Cool CL, Needham KA, Khlopas A, Mont MA. Revision analysis of robotic arm-assisted and manual unicompartmental knee arthroplasty. J Arthroplasty 2019; 34 (05) 926-931
• 31 Gilmour A, MacLean AD, Rowe PJ. et al. Robotic-arm-assisted vs conventional unicompartmental knee arthroplasty. The 2-year clinical outcomes of a randomized controlled trial. J Arthroplasty 2018; 33 (7S): S109-S115
• 32 Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S. Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg 2018; 138 (12) 1765-1771
• 33 Cavinatto L, Bronson MJ, Chen DD, Moucha CS. Robotic-assisted versus standard unicompartmental knee arthroplasty-evaluation of manuscript conflict of interests, funding, scientific quality and bibliometrics. Int Orthop 2019; 43 (08) 1865-1871