Arch Orthop Trauma Surg. 2013 Nov;133(11):1587-93. doi: 10.1007/s00402-013-1838-y.
Currently, there is no consensus as to whether total knee replacement(TKR) following high tibial osteotomy(HTO) provides similar postoperative outcomes as compared to TKR without previous HTO. Previous studies have provided limited evidence to small sample sizes and methodological inappropriateness.
A systematic search process was conducted utilising PRISMA guidelines. Electronic, peer reviewed and published literatures were searched. Databases searched include Embase, Medline, Cochrane Library, PubMed and cross references. Methodological appropriateness was assessed with Papadokastakis system and Critical Appraisal Skills questionnaire. Data were analysed for both clinical and statistical homogeneity. Meta analytic pooling was subsequently performed.
11 studies including 2170 TKR procedures were analysed for systematic review. The study (TKR following previous HTO) and control (TKR without previous HTO) groups were adequately matched for age, sex ratio and follow-up. Meta analysis of six studies utilising KSS system and four studies utilising HSS system showed no significant (p > 0.05) difference between the two groups. Complications also showed no significant difference between the two groups. At an average follow-up of 7.2 years, with revision arthroplasty for any cause as the endpoint, survivorship for the study and control groups was 95 and 97 %, respectively. For revision arthroplasty with aseptic loosening as the end point, the survivorship was 98 % for both groups.
Systematic review and meta analysis suggested that TKR following HTO provides similar outcomes as compared to TKR without previous HTO. Therefore, a previous HTO does not negatively influence a future TKR, though the conversion process of HTO to TKR is technically challenging. Systematic review also identified paucity in prospective and long term studies.
目前，对于全膝关节置换术（TKR）是否比没有先前高胫骨截骨术（HTO）的 TKR 提供相似的术后结果，尚未达成共识。先前的研究提供了有限的证据，样本量小且方法学不适当。
我们采用 PRISMA 指南进行了系统的搜索过程。检索了电子、同行评审和已发表的文献。搜索的数据库包括 Embase、Medline、Cochrane 图书馆、PubMed 和交叉引用。使用 Papadokastakis 系统和批判性评估技能问卷评估方法学的适当性。对临床和统计学的同质性进行了数据分析。随后进行了荟萃分析。
对 11 项包括 2170 例 TKR 手术的研究进行了系统评价。研究（先前有 HTO 的 TKR）和对照组（先前没有 HTO 的 TKR）在年龄、性别比例和随访方面匹配良好。使用 KSS 系统的 6 项研究和使用 HSS 系统的 4 项研究的荟萃分析显示两组之间没有显著差异（p>0.05）。两组的并发症也没有显著差异。平均随访 7.2 年，以任何原因进行翻修关节置换术作为终点，研究组和对照组的生存率分别为 95%和 97%。对于以无菌性松动为终点的翻修关节置换术，两组的生存率均为 98%。
系统评价和荟萃分析表明，HTO 后行 TKR 与无先前 HTO 的 TKR 相比提供了相似的结果。因此，先前的 HTO 不会对未来的 TKR 产生负面影响，尽管 HTO 转换为 TKR 的过程在技术上具有挑战性。系统评价还发现前瞻性和长期研究的缺乏。
