Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years
Abstract Background Spacer-type tibial osteotomy have been proven a novel and effective osteotomy to treat osteoarthritis, while lack of comparison with other surgical methods in younger patients. This study aims to evaluate the short-term clinical outcomes of spacer-type tibial osteotomy versus ope...
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BMC
2025-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05533-5 |
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| author | Yi Zhang Xiangzhi Yin Jinli Chen Yingze Zhang Tengbo Yu |
| author_facet | Yi Zhang Xiangzhi Yin Jinli Chen Yingze Zhang Tengbo Yu |
| author_sort | Yi Zhang |
| collection | DOAJ |
| description | Abstract Background Spacer-type tibial osteotomy have been proven a novel and effective osteotomy to treat osteoarthritis, while lack of comparison with other surgical methods in younger patients. This study aims to evaluate the short-term clinical outcomes of spacer-type tibial osteotomy versus open wedge high tibial osteotomy (OWHTO) and unicompartmental knee arthroplasty (UKA) for Kellgren-Lawrence (K-L) grade 3–4 osteoarthritis (OA) in patients younger than 65 years. Methods This retrospective study analyzed a total of 224 patients with K-L grade 3–4 knee OA treated from March 2018 to November 2020. Three groups were created according to the operation type. The clinical outcomes recorded preoperatively and at 6, 12 and 24 months postoperatively were the range of motion (ROM), visual analogue scale (VAS), American Knee Society Score (KSS), Western Ontario and McMaster Universities Global (WOMAC) score, operation time, length of incision, relevant complications and failures. Radiographic parameters were measured to evaluate the correction of varus deformity. Results The cohort comprised 224 patients; 70 underwent spacer-type tibial osteotomy, 73 underwent OWHTO, and 81 underwent UKA. The spacer group had the shortest incision (P = 0.000), least amount of bleeding (P = 0.000), and shortest operation time (P = 0.000). UKA achieved the most significant pain relief based on VAS (P = 0.014), KSS pain score (0.030), and WOMAC score (P = 0.000) at 6 months postoperatively, but there were no differences between three groups at 12 and 24 months postoperatively. The spacer and OWHTO groups achieved significantly greater ROM changes compared with the UKA group (all P = 0.000). The complication rate did not significantly differ between the three groups. No surgical failures were identified in HTO but two spacer dislocations in spacer group and three polyethylene dislocations in UKA. Conclusion For younger patients with K-L grade 3–4 OA, OWHTO seems to be the most appropriate method through clinical comparisons. Although spacer-type tibial osteotomy offers shorter operation time and comparable clinical outcomes, it also has extended recovery phase, additional fibular incision and the risk of spacer dislocation, which did not appear to be superior to OWHTO and UKA under the indications outlined in this study. Trial registration Retrospectively registered, QYFY WZLL 27,021. |
| format | Article |
| id | doaj-art-ccb895c191f04f878477c84f6f1e442a |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-ccb895c191f04f878477c84f6f1e442a2025-02-02T12:34:14ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-01-0120111110.1186/s13018-025-05533-5Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 yearsYi Zhang0Xiangzhi Yin1Jinli Chen2Yingze Zhang3Tengbo Yu4Department of Sports Medicine, Affiliated Hospital of Qingdao UniversityDepartment of Orthopedic Surgery, Affiliated Hospital of Qingdao UniversityDepartment of Sports Medicine, Affiliated Hospital of Qingdao UniversityTraumatic Orthopedics Institute of Shandong, Affiliated Hospital of Qingdao UniversityDepartment of Orthopedics, Qingdao Municipal HospitalAbstract Background Spacer-type tibial osteotomy have been proven a novel and effective osteotomy to treat osteoarthritis, while lack of comparison with other surgical methods in younger patients. This study aims to evaluate the short-term clinical outcomes of spacer-type tibial osteotomy versus open wedge high tibial osteotomy (OWHTO) and unicompartmental knee arthroplasty (UKA) for Kellgren-Lawrence (K-L) grade 3–4 osteoarthritis (OA) in patients younger than 65 years. Methods This retrospective study analyzed a total of 224 patients with K-L grade 3–4 knee OA treated from March 2018 to November 2020. Three groups were created according to the operation type. The clinical outcomes recorded preoperatively and at 6, 12 and 24 months postoperatively were the range of motion (ROM), visual analogue scale (VAS), American Knee Society Score (KSS), Western Ontario and McMaster Universities Global (WOMAC) score, operation time, length of incision, relevant complications and failures. Radiographic parameters were measured to evaluate the correction of varus deformity. Results The cohort comprised 224 patients; 70 underwent spacer-type tibial osteotomy, 73 underwent OWHTO, and 81 underwent UKA. The spacer group had the shortest incision (P = 0.000), least amount of bleeding (P = 0.000), and shortest operation time (P = 0.000). UKA achieved the most significant pain relief based on VAS (P = 0.014), KSS pain score (0.030), and WOMAC score (P = 0.000) at 6 months postoperatively, but there were no differences between three groups at 12 and 24 months postoperatively. The spacer and OWHTO groups achieved significantly greater ROM changes compared with the UKA group (all P = 0.000). The complication rate did not significantly differ between the three groups. No surgical failures were identified in HTO but two spacer dislocations in spacer group and three polyethylene dislocations in UKA. Conclusion For younger patients with K-L grade 3–4 OA, OWHTO seems to be the most appropriate method through clinical comparisons. Although spacer-type tibial osteotomy offers shorter operation time and comparable clinical outcomes, it also has extended recovery phase, additional fibular incision and the risk of spacer dislocation, which did not appear to be superior to OWHTO and UKA under the indications outlined in this study. Trial registration Retrospectively registered, QYFY WZLL 27,021.https://doi.org/10.1186/s13018-025-05533-5Knee osteoarthritisSpacer implantationHigh tibial osteotomyUnicompartmental knee arthroplasty |
| spellingShingle | Yi Zhang Xiangzhi Yin Jinli Chen Yingze Zhang Tengbo Yu Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years Journal of Orthopaedic Surgery and Research Knee osteoarthritis Spacer implantation High tibial osteotomy Unicompartmental knee arthroplasty |
| title | Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years |
| title_full | Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years |
| title_fullStr | Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years |
| title_full_unstemmed | Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years |
| title_short | Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3–4 medial unicompartmental knee osteoarthritis in patients younger than 65 years |
| title_sort | spacer type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for kellgren lawrence grade 3 4 medial unicompartmental knee osteoarthritis in patients younger than 65 years |
| topic | Knee osteoarthritis Spacer implantation High tibial osteotomy Unicompartmental knee arthroplasty |
| url | https://doi.org/10.1186/s13018-025-05533-5 |
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