Legnani Claudio, Parente Andrea, Parente Franco, Ventura Alberto
IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan Italy.
IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy.
EFORT Open Rev. 2022 Aug 4;7(8):569-575. doi: 10.1530/EOR-21-0133.
It is debatable whether or not previous high tibial osteotomy (HTO) has negative effects on the results of subsequent medial unicompartmental knee replacement (UKR). The purpose of this study is to report, through a systematic review of the literature, the outcomes of medial UKR after failed HTO. It was hypothesized that this procedure would be safe and effective in providing satisfactory postoperative functional outcomes.
A systematic review was performed by searching Pubmed/MEDLINE, Embase and CINAHL. Only studies in English pertaining to all levels of evidence reporting on subjects undergoing UKR following HTO were considered. Review articles and expert opinion or editorial pieces were excluded. Outcomes of interest included indications, surgical technique and associated procedures, type of prosthesis, clinical and functional outcomes, rate of complications, revision surgery and failure rate.
Overall, six studies met all the inclusion criteria for this review. All were published between 2006 and 2021. The search resulted in one prospective comparative study, four retrospective comparative cohort studies, and one retrospective cohort study. Average follow-up periods ranged from 1 to 13 years. From these studies, 115 patients (117 knees) were identified. Overall, most studies reported satisfying postoperative clinical and functional outcomes. Implant survivorship ranged from 66 to 97.6%. In 15 patients, revision surgery was performed due to persistent pain.
Medial UKR performed after failed HTO appears as a feasible procedure providing satisfying outcomes and limited complications in most cases. Further prospective comparative studies reporting long-term outcomes are needed, as high-level studies on this topic are lacking.
既往高位胫骨截骨术（HTO）是否会对随后的内侧单髁膝关节置换术（UKR）的结果产生负面影响，这一问题存在争议。本研究的目的是通过对文献的系统回顾，报告HTO失败后内侧UKR的结果。研究假设该手术在提供令人满意的术后功能结果方面将是安全有效的。
通过检索Pubmed/MEDLINE、Embase和CINAHL进行系统回顾。仅纳入以英文发表的、关于HTO后接受UKR受试者的所有证据水平的研究。排除综述文章、专家意见或社论文章。感兴趣的结果包括适应症、手术技术及相关手术、假体类型、临床和功能结果、并发症发生率、翻修手术和失败率。
总体而言，六项研究符合本综述的所有纳入标准。所有研究均发表于2006年至2021年之间。检索结果包括一项前瞻性对照研究、四项回顾性对照队列研究和一项回顾性队列研究。平均随访期为1至13年。从这些研究中，共确定了115例患者（117膝）。总体而言，大多数研究报告了令人满意的术后临床和功能结果。植入物生存率在66%至97.6%之间。15例患者因持续疼痛接受了翻修手术。
HTO失败后进行的内侧UKR似乎是一种可行的手术，在大多数情况下能提供令人满意的结果且并发症有限。由于缺乏关于该主题的高水平研究，需要进一步开展报告长期结果的前瞻性对照研究。
