School of Medicine, Nankai University, Tianjin, 300071, China.
Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No.51 Fucheng Road, Haidian, Beijing, 100048, China.
J Orthop Surg Res. 2022 Sep 24;17(1):425. doi: 10.1186/s13018-022-03319-7.
The purpose of this study was to overview the findings of reported meta-analyses on unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO).
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 (PRISMA 2020) guidelines were followed. Two independent reviewers conducted a literature search of PubMed, Embase, the Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses comparing UKA and HTO that were published prior to September 2021. Literature screening, data extraction, and article quality appraisal were performed according to the study protocol registered online at PROSPERO (CRD42021279152).
A total of 10 meta-analyses were identified, and different studies reported different results. Five of the seven meta-analyses showed that the proportion of subjects with excellent or good functional results was higher for UKA than for HTO. All three meta-analyses showed that UKA was associated with lower pain levels, and all six of the studies that included an analysis of range of motion (ROM) reported that UKA was inferior to HTO. Four of the eight meta-analyses found that total complication rates were lower for UKA. Only 3 of the 10 meta-analyses found that UKA had lower revision rates. Moreover, in the subgroup analysis, the revision and complication rates of UKA were similar to those of opening-wedge HTO but much lower than those of closing-wedge HTO.
Compared to HTO, UKA was associated with lower pain levels but inferior postoperative ROM. The results were inconclusive regarding whether UKA yielded better knee function scores and lower revision or complication rates than HTO. Accurate identification of indications and appropriate patient selection are essential for treating individuals with OA.
本研究旨在综述有关单髁膝关节置换术（UKA）和胫骨高位截骨术（HTO）的已发表荟萃分析结果。
遵循系统评价和荟萃分析的首选报告项目 2020（PRISMA 2020）指南。两位独立评审员对 PubMed、Embase、Web of Science 和 Cochrane 系统评价数据库进行了文献检索，以查找 2021 年 9 月之前发表的比较 UKA 和 HTO 的荟萃分析。根据在 PROSPERO（CRD42021279152）在线注册的研究方案进行文献筛选、数据提取和文章质量评估。
共确定了 10 项荟萃分析，不同的研究报告了不同的结果。7 项荟萃分析中的 5 项表明，UKA 的优良功能结果比例高于 HTO。所有 3 项荟萃分析均表明 UKA 与较低的疼痛水平相关，而纳入运动范围（ROM）分析的 6 项研究中有 4 项报告 UKA 劣于 HTO。4 项荟萃分析发现 UKA 的总并发症发生率较低。10 项荟萃分析中只有 3 项发现 UKA 的翻修率较低。此外，在亚组分析中，UKA 的翻修和并发症发生率与开放式楔形 HTO 相似，但远低于闭合楔形 HTO。
与 HTO 相比，UKA 与较低的疼痛水平相关，但术后 ROM 较差。UKA 与 HTO 相比是否能获得更好的膝关节功能评分以及更低的翻修或并发症发生率，结果尚无定论。准确识别适应证并对患者进行适当选择对于治疗 OA 患者至关重要。
