Meta-analysis Of Proximal Fibular Osteotomy Versus Unicompartmental Knee Arthroplasty In The Treatment Of Unicompartmental Knee Osteoarthritis

Objective: A systematic review and quantitative meta analysis of the literature on the treatment of osteoarthritis of the knee joint with proximal fibula osteotomy and unicompartmental knee arthroplasty.The clinical efficacy of proximal fibula osteotomy and unicompartmental knee arthroplasty were evaluated comprehensively.Methods: the clinical efficacy of computer retrieval system of Cochrane controlled trials register,PubMed,Wanfang database,China HowNet database retrieved December 20,2017 proximal fibular osteotomy and unicompartmental knee arthroplasty for the treatment of unicompartmental knee osteoarthritis research literature,the language was English and Chinese.According to the Cochrane system evaluation method,two researchers independently included trials,extracted data,evaluated the bias risk of the included studies,and extracted effective data for systematic review.Results: a total of 6 clinical trials were included,including 312 patients,including 155 proximal fibular osteotomy and 157 unicompartmental knee arthroplasty.Comparison of proximal fibula osteotomy and unicompartmental knee arthroplasty,Meta analysis results: fibula osteotomy in operation time is shorter than unicompartmental knee arthroplasty,the difference was statistically significant(WMD=-64.12,95%CI[-75.45,-52.80],p < 0.00001);Fibular osteotomy compared with unicompartmental knee arthroplasty,less bleeding during the operation,the difference was statistically significant(WMD=-33.90,95%CI[-40.18,-27.62],p<0.00001);fibular osteotomy compared with unicompartmental knee arthroplastyt,shorter hospitalization time,the difference was statistically significant(WMD=-7.58,95%CI[-9.12,-6.04],p<0.00001);The cost of the fibular osteotomy was less than that of unicompartmental knee arthroplastyt,and the difference was statistically significant(WMD=-2.79,95%CI[-3.18,-2.39],p<0.00001);The difference of VAS score of the last follow-up after operation between the fibula osteotomy and unicompartmental knee arthroplastyt was statisticallysignificant(WMD=-0.29,95%CI[-0.49,-0.10],p=0.003);There was no significant difference in the knee joint activity of the last follow-up after operation between the fibula osteotomy and unicompartmental knee arthroplastyt(WMD=-1.06,95%CI[-3.95,1.83,p=0.47);There was no significant difference in HSS score of the last follow-up after operation between the fibula osteotomy and unicompartmental knee arthroplastyt(WMD=-0.40,95%CI[-2.24,3.05,p=0.76);There was no significant difference in KSS score of the last follow-up after operation between the fibula osteotomy and unicompartmental knee arthroplastyt(WMD=-0.31,95%CI[-1.6,-0.97,p=0.63);There was no significant difference in the incidence of postoperative complications between the fibula osteotomy group and the unicompartmental knee arthroplastyt group(RR=0.30,95%CI[0.07,1.31,p=0.11).Conclusion: In terms of postoperative efficacy,the VAS score of the proximal fibula group was better than that of the unicompartmental knee arthroplasty.However,there were no significant differences in the range of motion of the knee,HSS and KSS scores between the two operative methods.In terms of operative effectiveness,operative time,intraoperative blood loss,hospitalization time and hospitalization expenses were significantly different.Proximal fibula osteotomy was more economical than unicompartmental knee arthroplasty.There was no significant difference in postoperative complication rate between the two in the postoperative safety.