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Longer survivorship seen with HTO vs. UKA, TKA in younger patients with medial OA
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CHICAGO — French investigators found that at 30 years minimum follow-up, high tibial osteotomy proved a more durable treatment for medial compartment knee osteoarthritis than the two most popular arthroplasty options when performed in patients aged 50 years or younger at the time of the procedure.
Philippe Hernigou, PhD, and colleagues analyzed reoperations performed for high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) during their extended follow-up of 51 men and 40 women (123 knees) who had a mean age of 42 years at the time of surgery. The index surgeries in the study were performed before 1982.
Hernigou, of Creteil, France, presented the findings here at the American Academy of Orthopaedic Surgeons Annual Meeting.
Philippe Hernigou
Using revision as an endpoint, survivorship at 20 years was 50% in the HTO group vs. 0% in the UKA cohort and 35% in the TKA group.
He noted that when patients can survive 30 years or more after knee arthroplasty surgery then orthopedic surgeons should perhaps more carefully consider which primary operation they initially select for this young patient population with medial knee osteoarthritis.
According to the results that Hernigou presented, there was 6% survivorship of HTOs — including four knees in the HTO group that were never revised — at 30-years follow-up. By comparison, survivorship was 0% for the UKA and TKA groups.
From a review of the causes of failure with the three procedures that Hernigou and colleagues did, loosening of the tibial plateau over time impacted TKA survivorship, but infection often led to a need to re-revise the knees.
“Osteolysis was not a problem until after 17 years,” Hernigou said.
Most of his patients aged younger than 65 years now get a HTO.
“When arthroplasty is performed first in a young patient, loosening is the most common cause of revision surgery while infection appears to be the greatest risk for re-revision or re-re-revision operations,” Hernigou said. “Beginning first by an HTO remains the safest way to reach 30 years of follow-up with only one total knee arthroplasty following HTO.”
Reference:
Hernigou P. Paper #108. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.
Disclosure: Hernigou has no relevant financial disclosures.