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Bafor A, Iobst CA. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2024:00004623-990000000-01133. [PMID: 38896731 DOI: 10.2106/jbjs.24.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Anirejuoritse Bafor
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio
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Yang HY, Shin YG, Shin HH, Choi JH, Seon JK. Factors to improve odds of success following medial opening-wedge high tibial osteotomy: a machine learning analysis. BMC Musculoskelet Disord 2024; 25:323. [PMID: 38658876 PMCID: PMC11040853 DOI: 10.1186/s12891-024-07441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Although high tibial osteotomy (HTO) is an established treatment option for medial compartment osteoarthritis, predictive factors for HTO treatment success remain unclear. This study aimed to identify informative variables associated with HTO treatment success and to develop and internally validate machine learning algorithms to predict which patients will achieve HTO treatment success for medial compartmental osteoarthritis. METHODS This study retrospectively reviewed patients who underwent medial opening-wedge HTO (MOWHTO) at our center between March 2010 and December 2015. The primary outcomes were a lack of conversion to total knee arthroplasty (TKA) and achievement of a minimal clinically important difference of improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) at a minimum of five years postoperatively. Recursive feature selection was used to identify the combination of variables from an initial pool of 25 features that optimized model performance. Five machine learning algorithms (XGBoost, multilayer perception, support vector machine, elastic-net penalized logistic regression, and random forest) were trained using five-fold cross-validation three times and applied to an independent test set of patients. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS A total of 231 patients were included, and 200 patients (86.6%) achieved treatment success at the mean of 9 years of follow-up. A combination of seven variables optimized algorithm performance, and the following specific cutoffs increased the likelihood of MOWHTO treatment success: body mass index (BMI) ≤ 26.8 kg/m2, preoperative KOOS for pain ≤ 46.0, preoperative KOOS for quality of life ≤ 33.0, preoperative International Knee Documentation Committee score ≤ 42.0, preoperative Short-Form 36 questionnaire (SF-36) score > 42.25, three-month postoperative hip-knee-ankle angle > 1.0°, and three-month postoperative medial proximal tibial angle (MPTA) > 91.5° and ≤ 94.7°. The random forest model demonstrated the best performance (F1 score: 0.93; AUC: 0.81) and was transformed into an online application as an educational tool to demonstrate the capabilities of machine learning. CONCLUSIONS The random forest machine learning algorithm best predicted MOWHTO treatment success. Patients with a lower BMI, poor clinical status, slight valgus overcorrection, and postoperative MPTA < 94.7 more frequently achieved a greater likelihood of treatment success. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea
| | | | - Hyun Ho Shin
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea
| | - Ji Hoon Choi
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea
| | - Jong Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea.
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Dal Fabbro G, Grassi A, Agostinone P, Lucidi GA, Fajury R, Ravindra A, Zaffagnini S. High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05254-0. [PMID: 38430233 DOI: 10.1007/s00402-024-05254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA. METHODS A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score. RESULTS A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up. CONCLUSION HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population. LEVEL OF EVIDENCE IV; systematic review of level III-IV studies.
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Affiliation(s)
- Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy.
- Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Bologna, Italy.
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Raschid Fajury
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Abhijit Ravindra
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
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Ahrend MD, Petzold D, Schuster P, Herbst M, Ihle C, Mayer P, Schröter S. Higher conversion rate to knee arthroplasty in female patients following medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38415780 DOI: 10.1002/ksa.12083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Most studies about medial open-wedge high tibial osteotomy (HTO) reported outcomes without focusing on gender differences. Therefore, the study compared the long-term survival rate and postoperative subjective knee function after HTO in female versus male patients with symptomatic medial compartment knee osteoarthritis. METHODS The data of three cohorts with long-term outcomes were analysed (n = 245; 32% females; age: 49 ± 7 years; Kellgren Lawrence Grade I 6.1%, II 32.7%, III 42.4%; IV 18.8%). The minimum follow-up was at least 6 years or an earlier conversion to total knee arthroplasty (TKA). The gender-specific survival rate after HTO was calculated after 5 and 10 years and compared using Kaplan-Meier analysis and the logrank test. Baseline characteristics and subjective knee function (International Knee Documentation Committee [IKDC]/Lysholm) were analysed between both genders. RESULTS Forty of 78 (51.3%) women and 41 of 167 men (24.5%) underwent TKA. HTO survival in females was significantly lower (p = 0.0010). The 5- and 10-year survival rates were 85.9% and 62.6% for females and 93.4% and 77.7% for males. In females and males, from preoperative to the last follow-up, the IKDC (43 ± 15 to 58 ± 17; 47 ± 14 to 67 ± 18) and the Lysholm (42 ± 18 to 72 ± 18; 55 ± 22 to 77 ± 23) improved significantly (all p < 0.0001). Females had significantly lower preoperative and postoperative IKDC (p = 0.0438; p = 0.0035) and Lysholm scores (p = 0.0002; p = 0.0323). But the absolute improvements of the IKDC and Lysholm were not significantly different between genders. CONCLUSIONS Females had higher conversion rates to TKA and lower knee function at the last follow-up. However, preoperative knee function was lower in females and the absolute improvement following HTO was similar for both genders. In general, females benefit from HTO to treat medial knee arthritis, and TKA could be postponed for half of female patients for more than 10 years. However, surgeons must be aware of the described inferior outcomes in females for realistic patient expectation management. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany
| | - Daniel Petzold
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Philipp Schuster
- Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Christoph Ihle
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Philipp Mayer
- Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
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Constantin H, Salmon LJ, Russell V, Sundaraj K, Roe JP, Pinczewski LA. 20-Year Outcomes of High Tibial Osteotomy: Determinants of Survival and Functional Outcome. Am J Sports Med 2024; 52:344-351. [PMID: 38243788 DOI: 10.1177/03635465231217742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a successful joint-preserving procedure for the treatment of medial compartment osteoarthritis. Long-term survivorship of HTO ranges from 40% to 85%. There are consistent factors that predict failure. PURPOSE To determine the 20-year survival of HTO and identify predictors of failure. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 100 consecutive patients with medial bone-on-bone arthritis were prospectively studied to provide long-term patient-reported outcome measures after lateral closing-wedge HTO and determine the time to failure. Failure was defined as conversion to arthroplasty (total knee arthroplasty or unicompartmental knee arthroplasty) or revision HTO. RESULTS At 20 years, HTO survival was determined in 95 patients, and 5 were lost to follow-up. The overall survivorship of HTO at 20 years was 44%. The significant factors that were associated with better survivorship were age <55 years, body mass index <30, and Western Ontario and McMaster Universities Osteoarthritis Index pain score >45. These factors were used to define the favorable candidates. In the favorable candidates, survivorship was 100% at 5 years, after which there was a gradual decline to 62% survival at 20 years. Of those with HTO survival, 32 of 33 (97%) reported satisfaction with surgery, with a mean Knee injury and Osteoarthritis Outcome Score Pain score of 91 and Activities of Daily Living score of 97. CONCLUSION HTO is a successful surgical option to treat medial compartment osteoarthritis and prevent the need for arthroplasty in young patients. The most suitable candidates for HTO are aged <55 years, are not obese, and have not progressed to severe symptomatic disability.
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Affiliation(s)
- Harry Constantin
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | | | - Keran Sundaraj
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
| | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Leo A Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
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