Wyatt Frederick William, Al-Dadah Oday
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom.
Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom.
World J Orthop. 2024 May 18;15(5):444-456. doi: 10.5312/wjo.v15.i5.444.
Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis. However, which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate. Simultaneously, there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes, preoperatively and following HTO or UKA.
To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis: Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.
This longitudinal observational study assessed a total of 42 patients that had undergone UKA ( = 23) and HTO ( = 19) to treat medial compartment knee osteoarthritis. Patient-reported outcome measures (PROMs) were collected to evaluate clinical outcome. These included two disease-specific (Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score) and two generic (EQ-5D-5L, Short Form-12) PROMs. The radiographic parameters of knee alignment assessed were the: Hip-knee-ankle angle, mechanical axis deviation and angle of Mikulicz line.
Statistical analyses demonstrated significant ( < 0.001), preoperative to postoperative, improvements in the PROM scores of both groups. There were, however, no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group. Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively ( < 0.05). Postoperatively, two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters (hip-knee-ankle angle, mechanical axis deviation) within the HTO group; yet no such associations were observed within the UKA group.
UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis. Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively; however, a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
单髁膝关节置换术（UKA）和高位胫骨截骨术（HTO）是治疗膝关节骨关节炎的成熟手术干预措施。然而，哪种干预措施对膝关节骨关节炎患者更有益仍不明确，且是一个备受争议的话题。同时，术前以及HTO或UKA术后，评估膝关节对线的影像学参数与患者报告的临床结局之间关系的研究较少。
比较UKA和HTO作为内侧间室膝关节骨关节炎的干预措施：检查临床结局的差异并研究关节对线与此的关系。
这项纵向观察性研究共评估了42例接受UKA（n = 23）和HTO（n = 19）治疗内侧间室膝关节骨关节炎的患者。收集患者报告的结局指标（PROMs）以评估临床结局。这些指标包括两个疾病特异性指标（膝关节损伤和骨关节炎结局评分、牛津膝关节评分）和两个通用指标（EQ-5D-5L、简明健康调查量表12项版）。评估的膝关节对线影像学参数包括：髋-膝-踝角、机械轴偏移和米库利奇线角。
统计分析表明，两组患者术前至术后的PROM评分均有显著改善（P < 0.001）。然而，UKA组和HTO组术后的PROM评分在组间无显著差异。术前，米库利奇线向远端外侧倾斜角度越大，与膝关节功能和总体健康状况越差存在显著相关性（P < 0.05）。术后，HTO组内疾病特异性PROM评分与膝关节对线参数（髋-膝-踝角、机械轴偏移）之间观察到两组显著相关性；而UKA组内未观察到此类关联。
UKA和HTO都是有效的手术，为内侧间室膝关节骨关节炎患者提供了相当程度的临床益处。术后临床结局与膝关节对线的影像学参数之间的关联有限；然而，术前米库利奇线向远端外侧倾斜角度越大，似乎与膝关节功能/健康相关生活质量越差有关。
