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Osteotomy vs. UNI: Therapeutic Dilemma in Middle-Aged Patients in Austria

Explore the competition between osteotomy and UNI procedures in active middle-aged patients facing knee issues like varus deformities, ACL insufficiency, and arthrosis in Austria. Understand the advantages, complications, outcomes, and new concepts associated with these treatments. Discover the latest research findings and comparison of clinical results to make informed decisions for optimal patient care.

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Osteotomy vs. UNI: Therapeutic Dilemma in Middle-Aged Patients in Austria

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  1. UNI vs OsteotomyIs there a competion ? • Vienna S. Hofmann Head Knee Training Centre General & Orthopaedic Hospital Stolzalpe – AUSTRIA Stolzalpe

  2. Therapeutic Dilemma(active middle aged 40-60) • Biological therapy ? NSAIDS, Suppl & Cartilage • Arthroscopy ? • Mechanical unloading Braces & Distraction • Osteotomy • Joint replacement Partial, UKA & TKA Waller et al, KSSTA 2011

  3. Indications for osteotomies & Unis Varus 8°, ACL & cartilage defect • Anteromedial arthrosis (AMA) • Lateral arthrosis with ACL • ACL insufficiency &single compartment arthrosis ? • Patient related factors  individual indications ACL, osteotomy & mosaic plasty ACL & MIS Uni

  4. Basic principles osteotomies • More than 30 years • Overcorrection of deformity • Offloading one compartment • Pain reduction • Gain time before TKA • 80 % Varus deformity Coventry, JBJS 1987

  5. Basic principles Unis • More than 20 years • Partial correction deformity • Resurfacing one compartment • Free of pain • Timewinning or defintive solution ? • > 90 % Varus deformities C 3 4 5 0 1 2 Kennedy CORR 1987

  6. Comparison patella osteotomy • Cartilgage damage  not main symptom • Biomechanics & clinics  • Advantage lenghtening lig. patellae (closed) Release soft tissues • Disatvantage Shortening Lig. Patellae (open) No patelloplasty Müller EFORT 2000

  7. Comparison patella Unis • Cartilage damage not main symptom • Biomechanics & clinics  • Advantage patelloplasty possible No sec. shortening • Disatvantage No lenghtening lig. patellae No release soft tissues

  8. Comparison complications osteotomies • Under- or overcorrection • Inclination joint line (3° Varus) • Loss of correction • Pseudarthrosis • Neural & vascular damage • Secoundary batella baja  All over rate 30 - 40 % Joint line 6° Valgusafter HTO

  9. Comparison complications Unis • Under- or Overcorrection • Malpositioning implants • Dislocation mobile bearings • Neural & vascular damages • Secoundary patella baja • Infection & Loosening  Overall rate 5 -10 % Malposition & chronic pain with mobile bearings

  10. Outcomes of osteotomy • No EBM data • Cochrane – Silver Evidence 70% benefit 10 years • Survivalrates 5 years 73 % 10 years 52 % • Selected patients Survival 10 y 90% • Results depend on risc factors Feeley et al, J Am Acad Orthop Surg 2010 Hofmann et al, European IC Lectures 2011

  11. Comparison clinical results • Retrospective studies • Unis Clinical results Complications  • Survival rate 10 years HTO / Uni 76 % / 90 % • Survival rate 15 years HTO / Uni 65 % / 88 % Weale CORR 1994

  12. Comparison revision to TKA • Worser after UnisGill et al, CORR 1995 • Worser after osteotomiesJackson et al, J Arthroplasty 1994 • No difference & comparable to primary TKAMcAuley et al, CORR 2001 OvercorrectionValgus 24° Uni & largebony defects

  13. SportingActivitiesTKA vs UNI vsOsteo Bonnin et al, KSSTA 2011

  14. New concept of osteotomies • Biomechanical understanding Alignment Slope & joint line Patellofemoral joint • Patient selection & planning • Safe & easy osteosynthesis • Early functional rehabiliation Hofmann et al, Orthopäde 2009 Hofmann et al, European IC Lectures 2011

  15. Results New Concept • Prospective multicenter (3) • 369 varus knees • FU 3.5 years (2-5) • 3.5% Complications • 98% Survival (3-5 years) • Oxford Score 41 (max 48) UKA 39 & TKA 35-40 Lobenhoffer et al, ESSKA 2010

  16. Cartilage Damage prior Surgery Lobenhoffer et al, ESSKA 2010

  17. Oxford Score Cartilage Damage Lobenhoffer et al, ESSKA 2010

  18. Oxford Score & Age Lobenhoffer et al, ESSKA 2010

  19. Patient SelectionsStolzalpe • „Golden rule age“ male < 65 female < 55 • Sporting activities • Occupation • Compliance & patients expections Adipositas per magna

  20. Summary advantages osteotomies • No artificial joint • No arthrotomy necessary • Combination with cartilage &ligament surgery • Less expensive

  21. Summary advantages MIS Uni’s • Significant shorter rehabiliation • Less complications • Better clinical results • Longer survival • Definite solution older patients 3 days post Op FL 0-100°

  22. Summary • New interest in Unis with MIS • Osteotomies increasing in combination with cartilage & ligament reconstructions • Pre OP clearing up, planning & extensive enlighment necessary • Clear differential indications • With new osteotomy conceptresults are probably comparable

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