Center of Trauma and Orthopaedic Surgery Eisenach, Sophienstr. 16, 99817, Eisenach, Germany.
Knee Surg Sports Traumatol Arthrosc. 2013 Jan;21(1):96-112. doi: 10.1007/s00167-011-1751-2. Epub 2011 Nov 11.
Both high tibial valgus osteotomy (HTO) and unicompartmental medial knee arthroplasty (UKA) are established methods for the treatment for moderate stages of OA. This is the first global meta-analysis to compare the long-term effects of both methods regarding survival, outcomes and complications of total arthroplasty.
Literature research was performed using established medical databases: MEDLINE (via PubMed), EMBASE (via OVID) and the Cochrane register. Criteria for inclusion were as follows: English or German papers, a clinical trial with a clear description of survival, an outcome evaluation using a well-described knee score and a follow-up >5 years. Statistical analysis was performed using the special meta-analysis software called "Comprehensive Meta Analysis" (version 2.0; Biostat, Englewood, NJ, USA).
Final meta-analysis after the full-text review included 46 studies about valgus HTO and 43 studies about medial UKA. There were no significant differences between valgus HTO and medial UKA in terms of the number of total required replacements. After a 5- to 8-year follow-up, 91.0% of the valgus HTO patients and 91.5% of medial UKA patients did not need a total replacement. This value was 84.4% for valgus HTOs and 86.9% for medial UKAs after a 9- to 12-year follow-up. Mean survival time to TKA was 9.7 years after valgus HTO and 9.2 years after medial UKA. Clinical outcome was significantly better after medial UKA in a 5- to 12-year follow-up. After more than 12 years, results were comparable in both groups. No significant differences were seen in the complication rates.
This meta-analysis aimed to find the advantages and disadvantages of two established methods for the treatment for medial compartment knee osteoarthritis. Valgus HTO is more appropriate for younger patients who accept a slight decrease in their physical activity. Medial UKA is appropriate for older patients obtaining sufficient pain relief but with reduced physical activity.
II.
胫骨高位截骨术（HTO）和单髁膝关节置换术（UKA）都是治疗中重度膝关节骨关节炎的成熟方法。这是首次对这两种方法的长期疗效进行全球荟萃分析，比较了全膝关节置换术的生存率、疗效和并发症。
使用已建立的医学数据库（MEDLINE[通过 PubMed]、EMBASE[通过 OVID]和 Cochrane 登记处）进行文献检索。纳入标准如下：英文或德文论文、具有明确生存率描述的临床试验、使用描述明确的膝关节评分进行的疗效评估以及随访时间＞5 年。使用名为“综合荟萃分析”（Comprehensive Meta Analysis）的特殊荟萃分析软件（版本 2.0；Biostat，恩格尔伍德，新泽西州，美国）进行统计分析。
全文审查后的最终荟萃分析纳入了 46 项关于外翻 HTO 的研究和 43 项关于内侧 UKA 的研究。在需要进行全膝关节置换术的数量方面，外翻 HTO 与内侧 UKA 之间没有显著差异。在 5 至 8 年的随访后，91.0%的外翻 HTO 患者和 91.5%的内侧 UKA 患者不需要进行全膝关节置换术。在 9 至 12 年的随访中，外翻 HTO 为 84.4%，内侧 UKA 为 86.9%。外翻 HTO 的平均生存时间至 TKA 为 9.7 年，内侧 UKA 为 9.2 年。在 5 至 12 年的随访中，内侧 UKA 的临床疗效明显更好。超过 12 年后，两组结果相当。并发症发生率无显著差异。
本荟萃分析旨在确定两种治疗内侧间室膝关节骨关节炎的成熟方法的优缺点。外翻 HTO 更适合接受活动量轻微减少的年轻患者。内侧 UKA 更适合获得足够疼痛缓解但活动量减少的老年患者。
II 级。
