Chen Xi, Yang Zhen, Li Hairui, Zhu Shibai, Wang Yiou, Qian Wenwei
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Department of Orthopedic Surgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
BMC Musculoskelet Disord. 2020 Mar 6;21(1):153. doi: 10.1186/s12891-020-3177-9.
High tibial osteotomy is commonly performed in young patients with high activity demand. Several studies have reported outcome of HTO. The reported 10-year survival ranged from 79 to 97.6%. The reported 15-year survival ranged from 56 to 65.5%, resulting in the need for conversion to TKA. Primary TKA now provides satisfactory long-term outcome in terms of function and survival. Researches have been conducted to compare clinical outcome between primary TKA and TKA after HTO to see if TKA should be the prior treatment rather than HTO in some cases. But the results were inconsistent. This study aims to compare the risk of revision and other parameters between total knee arthroplasty after high tibial osteotomy and primary total knee arthroplasty.
Searches and screens of the relevant literature were conducted, after which data were extracted and pooled analysis was performed to compare the clinical outcomes between the two groups.
A total of 14 studies with 144,692 cases were included. Pooled analysis showed significantly more revisions and complications, and more tibial component loosening and impingement in postoperative X-ray in the HTO-TKA group. Surgical complexity during conversion to total knee arthroplasty was summarised and listed in table.
High tibial osteotomy offers satisfactory pain relief and functional outcome in selected patients with high activity demand. However, the need for subsequent TKA should be noted, which might be a technically challenging procedure with significantly higher risk of revision comparing to primary TKA.
高位胫骨截骨术常用于对活动需求较高的年轻患者。多项研究报告了高位胫骨截骨术的结果。报告的10年生存率在79%至97.6%之间。报告的15年生存率在56%至65.5%之间，这导致需要转换为全膝关节置换术（TKA）。目前，初次全膝关节置换术在功能和生存率方面提供了令人满意的长期结果。已经开展了研究来比较初次全膝关节置换术和高位胫骨截骨术后全膝关节置换术的临床结果，以确定在某些情况下全膝关节置换术是否应作为优先治疗而非高位胫骨截骨术。但结果并不一致。本研究旨在比较高位胫骨截骨术后全膝关节置换术和初次全膝关节置换术之间的翻修风险及其他参数。
进行相关文献的检索和筛选，之后提取数据并进行汇总分析，以比较两组的临床结果。
共纳入14项研究，涉及144,692例病例。汇总分析显示，高位胫骨截骨术后全膝关节置换术（HTO-TKA）组的翻修和并发症明显更多，术后X线检查中胫骨组件松动和撞击更多。汇总并列出了转换为全膝关节置换术期间的手术复杂性。
对于有较高活动需求的特定患者，高位胫骨截骨术可提供令人满意的疼痛缓解和功能结果。然而，应注意后续进行全膝关节置换术的必要性，与初次全膝关节置换术相比，这可能是一个技术上具有挑战性的手术，且翻修风险明显更高。
