High tibial osteotomy compared with unicompartmental arthroplasty for the treatment of medial compartment osteoarthritis: a meta-analysis

ABSTRACT Background The objective of our meta-analysis was to compare the clinical outcomes of high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) for the treatment of isolated medial compartment osteoarthritis (OA). Methods We searched the major medical databases for randomized trials and observational studies comparing HTO and UKA. After testing for publication bias and heterogeneity, the data were aggregated by fixed-effects modeling. Our primary outcome was the percentage of good or excellent outcomes in each group. Our secondary outcomes were implant survivorship and change in gait velocity. Results Six studies met our inclusion criteria for review. We found no evidence of publication bias or heterogeneity between studies for all outcome measures. The combined odds ratio for a good or excellent outcome in the UKA group was 2.03 (95% CI: 1.16 to 3.6) P = 0.01. The combined odds ratio for survival from aseptic loosening for the UKA group was 2.14 (95% CI: 0.93 to 4.93) P = 0.07. The pooled mean difference for gait velocity was 0.39 (95% CI: −0.12 to 0.90), P = 0.14. Conclusion UKA yields a greater percentage of good or excellent outcomes and a strong trend towards improved survivorship over HTO for medial compartment OA. Level of Evidence: Therapeutic Level II.