Higher risk of revision in total knee arthroplasty after high tibial osteotomy: A systematic review and updated meta-analysis

Background: High tibial osteotomy is commonly performed in young patients with high activity demand. It is reported up to 30% of HTO need subsequent conversion to TKA. Primary TKA now provides satisfactory long-term outcome in terms of function and survival. Researches have been conducted to compare clinical outcome between primary TKA and TKA after HTO to see if primary should be the prior treatment rather than HTO in some cases. But the results were inconsistent. This study aims to compare the risk of revision and other parameters of total knee arthroplasty after high tibial osteotomy and primary total knee arthroplasty. Methods: Thorough searches and screens of the relevant literature were conducted, after which data were extracted and pooled analysis was performed to compare the clinical outcomes between the two groups. Results: A total of 14 studies with 144,692 cases were included. Pooled analysis showed significantly more revisions and complications and more tibial component loosening and impingement in postoperative X-ray in the HTO-TKA group. Surgical complexity during conversion to total knee arthroplasty was summarised and listed in a table. Conclusion: Total knee arthroplasty after tibial osteotomy is a technically challenging procedure and provide inferior clinical outcomes than primary TKA. Given the success of primary TKA, it may be considered as the first choice in young patients with high activity demand.