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Osteotomies and Total Knee Arthroplasty: Systematic Review and Meta-Analysis
Kulinski Krzysztof1, Ewa Trams1, Stanislaw Pomianowski1
1Department of Orthopaedics and Trauma Surgery, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
Life (Basel, Switzerland)
|July 27, 2022
Summary
This meta-analysis reviewed osteotomies combined with total knee replacement (TKA) for osteoarthritis. While secondary outcomes improved, primary outcomes showed no significant difference, highlighting a need for more research.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Osteoarthritis (OA) frequently necessitates total knee replacement (TKA).
- Complex cases, including deformities or stiffness, may require additional procedures like osteotomy.
- The combination of osteotomy and TKA presents unique surgical challenges.
Purpose of the Study:
- To conduct a meta-analysis and systematic review of osteotomies performed concurrently with TKA.
- To evaluate the efficacy and outcomes of combined osteotomy and TKA procedures.
- To identify evidence gaps in managing complex knee osteoarthritis cases.
Main Methods:
- A systematic literature search was performed in June 2022 across PubMed, Embase, Cochrane, and Clinicaltrials databases.
- The search adhered to PRISMA guidelines, utilizing keywords such as "osteotomy" and "total knee arthroplasty".
- Included studies were analyzed, with meta-analysis conducted on two subgroups: tibial tubercle osteotomy (TTO) and medial femoral condyle osteotomy.
Main Results:
- The meta-analysis included two subgroups: tibial tubercle osteotomy and medial femoral condyle osteotomy.
- No significant difference was found in the primary outcome favoring TTO.
- Secondary outcomes demonstrated improvements across all presented subgroups when compared to preoperative status.
Conclusions:
- A significant deficit of randomized controlled trials exists for osteotomies combined with TKA.
- There is a lack of evidence-based surgical guidelines for treating complex OA cases requiring osteotomy and TKA.
- Further research is needed to establish best practices for patients with posttraumatic deformities, stiff knees, severe axis deviations, or patella disorders.
