Seo Seung-Suk, Nha Kyung-Wook, Kim Tae-Yeong, Shin Young-Soo
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan.
Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Goyang.
Medicine (Baltimore). 2019 Jul;98(30):e16609. doi: 10.1097/MD.0000000000016609.
Theoretical considerations suggest that total knee arthroplasty (TKA) is technically more challenging after high tibial osteotomy (HTO), resulting in inferior results compared to primary TKA. However, several studies on this issue have shown contradictory results. The purpose of this meta-analysis to compare survivorship and clinical outcomes between TKA with and without previous HTO.
We reviewed studies that evaluated pain and function scores, range of motion (ROM), operation time, Insall-Salvati (IS) ratio, complications, and survival rates in patients treated with TKA with previous HTO or with primary TKA with short- to midterm (<10 years) or long-term (>10 years) follow-up.
Fifteen studies were included in the meta-analysis. There were no significant differences between TKA with and without previous HTO in pain score (95% CI: -0.27 to 0.29; P = .94), function score (95% CI: -0.08 to 0.24; P = .32), operation time (95% CI: -5.43 to 26.85; P = .19), IS ratio (95% CI: -0.03 to 0.08; P = .40), complication rates (TKA with previous HTO, 62/1717; primary TKA, 610/31386; OR 1.31, 95% CI: 0.97-1.77; P = .08), and short- to midterm survival rates (TKA with previous HTO, 1860/2009; primary TKA, 37848/38765; OR 0.55, 95% CI: 0.28-1.10; P = .09). Conversely, ROM (95% CI: -7.40 to -1.26; P = .006) and long-term survival rates (TKA with previous HTO, 1426/1523; primary TKA, 29810/31201; OR 0.71, 95% CI: 0.57-0.89; P = .003) were significantly different between the two groups. In addition, both groups had substantial proportions of knees exhibiting short- to midterm survivorship (92.6% by TKA with previous HTO and 97.6% by primary TKA) and long-term survivorship (93.6% by TKA with previous HTO and 95.5% by primary TKA).
This meta-analysis suggests that a previous HTO affected ROM or survival of TKA in the long-term even though both groups have equivalent clinical outcomes and complications. Thus, orthopedic surgeons should offer useful information regarding the advantages and disadvantages of both procedures to patients, and should provide advice on the generally higher risk of revision after TKA with previous HTO at long-term follow-up when counseling patients.
理论上认为，与初次全膝关节置换术（TKA）相比，胫骨高位截骨术（HTO）后进行TKA在技术上更具挑战性，结果也较差。然而，关于这个问题的几项研究结果相互矛盾。本荟萃分析的目的是比较既往有HTO和无HTO的TKA患者的假体生存率和临床结局。
我们回顾了评估既往有HTO的TKA患者或初次TKA患者的疼痛和功能评分、活动范围（ROM）、手术时间、Insall-Salvati（IS）比值、并发症及生存率的研究，随访时间为短期至中期（<10年）或长期（>10年）。
15项研究纳入了该荟萃分析。既往有HTO和无HTO的TKA患者在疼痛评分（95%CI：-0.27至0.29；P = 0.94）、功能评分（95%CI：-0.08至0.24；P = 0.32）、手术时间（95%CI：-5.43至26.85；P = 0.19）、IS比值（95%CI：-0.03至0.08；P = 0.40）、并发症发生率（既往有HTO的TKA患者，62/1717；初次TKA患者，610/31386；OR 1.31，95%CI：0.97 - 1.77；P = 0.08）及短期至中期生存率（既往有HTO的TKA患者，1860/2009；初次TKA患者，37848/38765；OR 0.55，95%CI：0.28 - 1.10；P = 0.09）方面无显著差异。相反，两组间ROM（95%CI：-7.40至-1.26；P = 0.006）和长期生存率（既往有HTO的TKA患者，1426/1523；初次TKA患者，29810/31201；OR 0.71，95%CI：0.57 - 0.89；P = 0.003）存在显著差异。此外，两组中均有相当比例的膝关节表现出短期至中期生存率（既往有HTO的TKA患者为92.6%，初次TKA患者为97.6%）和长期生存率（既往有HTO的TKA患者为93.6%，初次TKA患者为95.5%）。
本荟萃分析表明，既往HTO即使在两组临床结局和并发症相当的情况下，长期来看仍会影响TKA的ROM或假体生存率。因此，骨科医生应向患者提供两种手术方式优缺点的有用信息，并在为患者提供咨询时，就既往有HTO的TKA患者在长期随访中翻修风险普遍较高提供建议。
