Comparison of joint awareness and functional outcomes following high tibial osteotomy and mobile-bearing medial unicompartmental knee arthroplasty

Introduction and Aim: Surgical treatment of gonarthrosis should be approached individually based on factors such as the patient's age, overall health condition, presence of other comorbidities, activity level, and treatment expectations. Particularly in the presence of deformity, proximal tibial osteotomies and unicompartmental knee arthroplasty (UKA) are among the preferred surgical methods. The aim of this study is to compare joint awareness and functional outcomes after High Tibial Osteotomy (HTO) and Mobile-bearing Medial Unicompartmental Knee Arthroplasty (UKA). Materials and Methods: A total of 208 patients (98 YTO and 110 UDA) who underwent High Tibial Osteotomy (HTO) and Unicondylar Knee Arthroplasty (UKA) with a diagnosis of OA and focal medial femoral condyle osteonecrosis between 2011 and 2022 in Ankara Atatürk Training and Research Hospital and Ankara City Hospital Department of Orthopedics and Traumatology were retrospectively screened. 52 YTO and 31 UDA patients who met the inclusion criteria were included in the study. Inclusion criteria were defined as patients who underwent YTO and cementless Biomet Oxford mobile-bearing UKA and had at least 1 year of follow-up data. Exclusion criteria were defined as patients who underwent cemented unicondylar knee arthroplasty, received a knee prosthesis other than the Biomet Oxford mobile-bearing prosthesis, had less than 1 year of follow-up, died during follow-up, or had any of the metal implants revised. Results: Patients were evaluated based on their preoperative level of arthritis (according to the Kellgren-Lawrence score) and postoperative Oxford Knee Score (OKS), Visual Analog Scale (VAS), Knee Society Scores (KSS), Knee Society Functional Score (KSS-F), and Forgotten Joint Score (FJS). Statistical analysis was performed using SPSS 20.0 (Chicago, IL). A p-value < 0.05 was considered statistically significant. A total of 83 patients with a mean age of 53.3 were included. It was found that 80.7% of the patients were female, and 57.8% underwent surgery on the left side. The mean age was higher in the UDA group (p < 0.001). In the UDA group, the level of arthritis was higher (p -0.005), and Knee Society Scores (KSS) (p -0.013), Knee Society Functional Score (KSS-F) (p -0.020), and Forgotten Joint Score (FJS) (p - 0.06) were significantly more favorable toward unicondylar knee arthroplasty. However, there was no significant difference in OKS (p -0.132 ). Conclusion: Based on the findings of our study, it is concluded that unicompartmental knee arthroplasty (UKA) yields better results in terms of functional scores compared to high tibial osteotomy (HTO) for older patients with advanced arthrosis levels. Key Words: High Tibial Osteotomy, Unicompartmental Knee Arthroplasty,FJS,KSS,KSS-F