Evidence map›Paper›PMID 40095117›Full record

SynthesisEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025

Total knee arthroplasty after prior high tibial osteotomy results in comparable survival and clinical outcomes but significantly higher complication rates compared to primary total knee arthroplasty: a systematic review and meta-analysis of 550,000 patients.

Ryan Wai Keong Loke, Barry Wei Loong Tan, Erel Yun En Kane Tan, James H P Hui

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Publisher
In one paragraph

Synthesis in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Ryan Wai Keong Loke *Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. ryanwk212@gmail.com.
Barry Wei Loong TanDepartment of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore. barry_wl_tan@nuhs.edu.sg.
Erel Yun En Kane Tan *Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
James H P HuiDepartment of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHigh Tibial Osteotomy (HTO) is an effective surgical option in managing medial compartment knee osteoarthritis in the relatively younger population group but most will eventually require conversion to Total Knee Arthroplasty (TKA). TKA post-HTO is considered more complex than a primary TKA, given the numerous factors that increase the difficulty of the surgery-skin and soft tissue scarring, patella baja, limited knee motion, anatomical deformity or bony distortion of the proximal tibial metaphysis after HTO.

methodsA random-effects meta-analysis of comparative studies between TKA post-HTO and primary TKA was performed. We searched MEDLINE, EMBASE, Cochrane Library and SCOPUS from inception to August 1, 2024. Survivorship outcomes in terms of revision rates were analyzed. Where possible, further subgrouping to assess the impact of different techniques was performed. Secondarily, associated complications, surgical duration and clinical outcomes (Hospital for Special Surgery (HSS) Scores and Knee Society Scores (KSS) (Knee & Function)) were pooled.

resultsAt short-term follow-up, pooled revision rate for TKA post-HTO was 2.9% (95%CI 1.7-5.1) while that for primary TKA was 1.9% (95%CI 1.2-2.9). At mid-term follow-up, the pooled revision rate was 4.8% (95%CI 2.8-8.2) compared to 3.0% (95%CI 1.9-4.8) in primary TKA. At long-term follow-up, the pooled revision rate for TKA post-HTO was 7.2% (95%CI 1.3-30.9), while that of primary TKA was 4.1% (95%CI 1.6-10.2). No significant differences were noted between both groups at each follow-up. Pooled complication rate for TKA post-HTO was 15.8% (95%CI 12.3-20.0%), while that for primary TKA group was 6.1% (95%CI3.5-10.4). TKA post-HTO had significantly greater complication rates than in primary TKA (WMD: 2.6, 95%CI 2.2-3.1, p < 0.01). Pooled mean postoperative HSS scores were 83.5 (95% CI 80.1-86.8) in the TKA post-HTO group, compared to 86.1 (95% CI 82.3-90.0) in the primary TKA group. Pooled mean postoperative KSS (Knee) scores were 85.9 (95% CI 83.6-88.2) in the TKA post-HTO group, and 88.1 (95% CI 84.4-91.7) in the primary TKA group. Pooled mean postoperative KSS (Function) scores were 77.1 (95% CI 72.1-82.1) in the TKA post-HTO group and 78.4 (95% CI 74.5-82.5) in the primary TKA group. No significant differences were noted between both groups.

conclusionTKA post-HTO has comparable survival but significantly higher complication rates than primary TKA.

Indexed as

Arthroplasty, Replacement, KneeOsteoarthritis, KneeOsteotomyPostoperative ComplicationsTibiaHumansReoperationTreatment OutcomeHigh tibial osteotomyMeta-analysisRevision total knee arthroplastyTotal knee arthroplasty

Identifiers

PMID40095117

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.