2023, Vol. 27 ›› Issue (4): 632-639

Medial open-wedge tibial osteotomy versus lateral closed-wedge tibial osteotomy for unicompartmental knee osteoarthritis: a meta-analysis

Yu Jiaan, Liu Xinwei, Lian Hongyu, Liu Kexin, Li Zitao   

Abstract: OBJECTIVE: High tibial osteotomy is an effective treatment for medial compartment knee osteoarthritis, and the commonly used clinical procedures are medial open-wedge high tibial osteotomy and lateral closed-wedge high tibial osteotomy. There are some controversies about the basis of the two surgical choices. The article evaluated the clinical efficacy and imaging results of medial open-wedge high tibial osteotomy and lateral closed-wedge high tibial osteotomy by meta-analysis.
METHODS: PubMed, Ovid, CNKI, Wanfang, VIP, Cochrane Library, and EMbase databases were searched for articles on the comparison of medial open-wedge tibial osteotomy and lateral closed-wedge tibial osteotomy for osteoarthritis of the knee. The retrieval period was from the database inception to October 2021. Literature screening and data compilation were conducted according to the specified inclusion and exclusion criteria. Randomized controlled trials were evaluated using Cochrane Handbook criteria to assess risk of bias, and cohort studies were evaluated using the NOS scale. RevMan 5.3 software was used for meta-analysis.
RESULTS: (1) A total of 13 publications were included, of which 8 were randomized controlled trials, and 5 were cohort studies. The overall quality of the literature was high. (2) Meta-analysis results showed that medial tibial open-wedge osteotomy and lateral tibial closed-wedge osteotomy presented significant differences in postoperative posterior tibial plateau inclination (MD=2.82, 95%CI:1.31-4.33, P=0.000 2), patellar height BPI (MD=-0.09, 95%CI:-0.11 to -0.07, P < 0.000 01), and operative time (MD=-19.48, 95%CI:-31.02 to -7.94, P=0.000 9). Postoperative mechanical axis angle (MD=-0.01, 95%CI:-0.51-0.48, P=0.96), angle of correction (MD=-0.16, 95%CI:-0.75-0.43, P=0.60), HSS score (MD=-0.46, 95%CI:-1.47-0.55, P=0.37), visual analogue scale score (MD=0.12, 95%CI:-0.24-0.48, P=0.51), Lysholm score (MD=-0.17, 95%CI:-2.53-2.19, P=0.89), and complications (OR=0.68, 95%CI:0.25-1.82, P=0.44) were similarly effective.
CONCLUSION: The overall clinical outcomes of the two procedures are similar, and the medial tibial open-wedge osteotomy has the advantage of being easier to perform, but is prone to increased posterior tibial plateau tilt and patellar drop, so adequate preoperative imaging evaluation and individualized selection of the procedure are needed for patients with unicompartmental knee osteoarthritis.
Key words: high tibial osteotomy, knee, osteoarthritis, medial, lateral, open, closed, meta-analysis