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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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Guo H, Song B, Zhou R, Yu J, Chen P, Yang B, Pan N, Li C, Zhu Y, Wang J. Risk Factors and Dynamic Nomogram Development for Surgical Site Infection Following Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:2141-2153. [PMID: 38143487 PMCID: PMC10748744 DOI: 10.2147/cia.s436816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background As the worldwide population ages, the population receiving open wedge high tibial osteotomy (OWHTO) is growing, and surgical site infection (SSI) is a rare but fatal surgical complication. This study aimed to identify risk factors independently associated with SSI following OWHTO and develop a predictive nomogram. Methods Clinical data of patients who received OWHTO and followed up for more than 12 months in our hospital were retrospectively reviewed. Multivariable logistic regression was performed to determine independent risk factors for SSI and to construct predictive nomograms. The study further illustrated the predictive performance of the model by using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results A total of 1294 eligible patients were included in the study. Multivariate analysis revealed tobacco consumption (OR=3.44, p=0.010), osteotomy size ≥12 mm (OR=3.3, p=0.015), the use of allogeneic bone or artificial bone graft substitutes (allogeneic bone vs none, OR=4.08, p=0.037; artificial bone vs none, OR=5.16, p=0.047), Kellgren-Lawrence (K-L) grade IV (OR=2.5, p=0.046), systemic immune-inflammation index (SII) >423.62 (OR=6.2, p<0.001), high-sensitivity C-reactive protein (HCRP) >2.6 mg/L (OR=2.42, p=0.044), and a higher level of fasting blood glucose (FBG) (OR=1.32, p=0.022) were the independent predictors of SSI. The cutoff score of the model was 148, with a sensitivity of 76.0% and specificity of 81.0%. The concordance index (C-index) and Brier score of the nomogram were 0.856 and 0.017, and the corrected values after 1000 bootstrapping validations were 0.820 and 0.018, respectively. Furthermore, the ROC curve, calibration curve, and DCA exhibited excellent predictive accuracy and clinical applicability of the model. Conclusion This study developed a dynamic nomogram based on seven predictors, which allowed surgeons to individualize risk stratification of patients and intervene promptly to reduce SSI rates.
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Affiliation(s)
- Haichuan Guo
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Bixuan Song
- Division of Medical Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Ruijuan Zhou
- College of Education, Hebei Normal University, Shijiazhuang, Hebei, 050010, People’s Republic of China
| | - Jiahao Yu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Pengzhao Chen
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Bin Yang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Naihao Pan
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Chengsi Li
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China
| | - Juan Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China
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Abdelaal AM, Khalifa AA. Total knee arthroplasty post-high tibial osteotomy, results of an early experience from a North African arthroplasty unit, and a comprehensive review of the literature. J Orthop Surg Res 2023; 18:705. [PMID: 37730629 PMCID: PMC10510125 DOI: 10.1186/s13018-023-04199-1] [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: 08/06/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE To report an early experience after converting HTO to TKA by reporting the incidence of functional, radiological, and complications in a single surgeon case series from a North African specialized arthroplasty unit. METHODS Between 2010 and 2020, 33 knees in 31 patients (two bilateral) were operated upon, 24 females and seven males, had a mean age of 65 ± 4.5 years; 17 (51.5%) knees had medial wedge opening (WMO), while 16 (48.5%) had lateral wedge closure (LWC) osteotomies. The mean time from HTO to TKA was 8.1 ± 3.3 years. A posterior stabilized (PS) implant was used in 31 (93.9%), while in 2 (6.1%), a varus-valgus constrained (VVC) implant was used. A tibial stem was needed in 13 (39.4%) knees. The functional assessment was performed according to the Knee Society Scoring System (KSS). The radiographic assessment included the anatomical femorotibial angle (aFTA) for alignment, the medial proximal tibial angle (MPTA), and the tibial slope (TS). RESULTS After a mean follow-up of 4.3 ± 1.1 years, the KSS knee and function sub-scores improved from a preoperative mean of 41 ± 8.9 (26 to 57) and 37.7 ± 9.2 (25 to 55) points to 91.3 ± 3.8 (81 to 94) and 85.5 ± 5 (80 to 95) points at the last follow-up, respectively (P < 0.05). The preoperative knee flexion improved from a mean of 84.5° ± 15.9 (55 to 110) to 110.6° ± 9.3 (95 to 125) (P < 0.05). The aFTA improved from a preoperative mean of 182.2° ± 10.3 (164 to 205) to a postoperative mean of 186° ± 2.6 (179 to 190) (P < 0.05). The MPTA changed from a preoperative mean of 88.4° ± 6.7 (77 to 102) to a postoperative (tibial component alignment) mean of 90° ± 1.7 (85 to 94) (P < 0.05). The mean preoperative TS changed from 80.9° ± 7.3 (68 to 96) to a mean postoperative of 86.9° ± 1.3 (83 to 89) (P < 0.05). Non-progressive radiolucent lines were detected at the tibial component in four (12%) knees. Complications were reported in seven (21.2%) knees; no revision was needed in any knee. CONCLUSIONS The authors' early experience showed improved functional and radiological outcomes; however, the complication incidence was relatively high, but no knees required revision. A longer follow-up is mandatory to prove the consistency of the results.
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Affiliation(s)
- Ahmed M Abdelaal
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
- Hospital for Advanced Orthopaedics, Assiut, Egypt
| | - Ahmed A Khalifa
- Hospital for Advanced Orthopaedics, Assiut, Egypt.
- Orthopedics Department, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523, Egypt.
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Xu H, Tu H, Zhao T, Xu D, Yu Q, Liao L, Tang S, Shi B. Comparison of the clinical effects for different positions of the weight-bearing axis after high tibial osteotomy. J Orthop Surg Res 2023; 18:423. [PMID: 37301834 DOI: 10.1186/s13018-023-03912-4] [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: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To analyze the clinical effects of different positions of the weight-bearing axis (WBA) after high tibial osteotomy (HTO). METHODS The clinical data of 90 patients who underwent HTO in the Department of Orthopedics at our hospital from June 2018 to June 2021 were retrospectively analyzed. Patients were divided into groups A and B (n = 45 per group) according to different post-HTO WBA positions of the affected side. WBAs in both groups were at 50-60% and 62-66% of the tibial plateau, from inside to outside, respectively. American Hospital for Special Surgery Knee Score (HSS), visual analog scale (VAS) score, femorotibial angle (FTA), and medial proximal tibial angle (MPTA) were recorded and analyzed. RESULTS All patients were followed up with for 12 months. HSS scores increased gradually and VAS scores decreased gradually in both groups preoperatively, and at 3 months, 6 months, and 1 year postoperatively (P < 0.05). Compared to group A, group B had better HHS scores at 6 months and 1 year postoperatively (P < 0.05). There was no significant between-group difference in VAS scores at all aforementioned timepoints (P > 0.05). Postoperative MPTA and FTA were 89.56° ± 2.18° and 177.11° ± 2.63° in group A, and 89.07° ± 1.98° and 177.07° ± 2.36° in group B, respectively, with no significant between-group difference (P > 0.05). CONCLUSION Patients with post-HTO WBA ranges of 50-60% and 62-66% achieved knee joint function improvement and pain relief. Half a year later, those with a WBA range of 62-66% had better knee joint function scores. However, a comparison of long-term effects warrants further investigation.
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Affiliation(s)
- Han Xu
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Huali Tu
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Tianzuo Zhao
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Daofei Xu
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Qinglong Yu
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Long Liao
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Shitian Tang
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China
| | - Bo Shi
- Department of Orthopedics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 12, Changjia Lane, Jingzhong Street, Mianyang, 621000, China.
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Sakai M, Akasaki Y, Akiyama T, Horikawa T, Okazaki K, Hamai S, Tsushima H, Kawahara S, Kurakazu I, Kubota K, Mizu-Uchi H, Nakashima Y. Similar short-term KOOS between open-wedge high tibial osteotomy and total knee arthroplasty in patients over age 60: A propensity score-matched cohort study. Mod Rheumatol 2023; 33:623-628. [PMID: 35652607 DOI: 10.1093/mr/roac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/28/2022] [Accepted: 05/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade. METHODS Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups. RESULTS After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA groups. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score. CONCLUSIONS In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.
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Affiliation(s)
- Mamiko Sakai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Tomohiro Horikawa
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Kumamoto Saishun Medical Center, Koshi, Kumamoto, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Ichiro Kurakazu
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Kenji Kubota
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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Guarino A, Farinelli L, Iacono V, Cozzolino A, Natali S, Zorzi C, Mariconda M. Long-Term Survival and Predictors of Failure of Opening Wedge High Tibial Osteotomy. Orthop Surg 2023; 15:1002-1007. [PMID: 36782306 PMCID: PMC10102285 DOI: 10.1111/os.13674] [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: 10/14/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE High tibial valgus osteotomy (HTO) is a widely accepted procedure indicated for varus knee with symptomatic osteoarthritis of the medial compartment. However, there is a lack of studies evaluating long term results of this procedure. The primary aim of this study was to evaluate the long-term survival of opening wedge high tibial osteotomy (HTO) for isolated osteoarthritis in the medial compartment of the knee. The secondary objective was to identify independent predictors of conversion to total knee arthroplasty (TKA). METHODS This is a long term retrospective study of 296 cases of open wedge HTOs performed at a single center (level of evidence IV) between January 2005 and August 2015. Opening wedge medial HTO was always performed after diagnostic arthroscopy. Eighty-three percent of the population (233 patients, 247 procedures) was followed up at a mean 11.6 years (6-17) by telephone interview, to evaluate the possible conversion to TKA. Mean age at the index operation was 42.8 years (range 15-70) and most patients were male (70%). Associated procedures (e.g., platelet rich plasma supplementation, microfractures, meniscectomy, etc.) were carried out at the time of the HTO in 80 (32%) cases. Survival of HTO and its association with age, sex, body mass index, smoking habit, preoperative severity of varus deformity, cartilage status at surgery, and associated procedures were evaluated. Kaplan-Meier and Cox regression analyses were performed. RESULTS Thirty-three of the 247 HTOs (13.4%) were converted to knee replacement, with 86.6% of the original procedures surviving at a mean 12-year follow-up. Kaplan-Meier survival estimates at 17 years for HTO were 75.5% (95% confidence interval [CI] 66.7-84.3). There was significant difference (P < 0.001) in the 17-year survival rate between obese (55.5%; 95% CI 35.3-75.6) and non-obese (79.7%; 95% CI 70.1-89.2) patients. The determinants of conversion to knee arthroplasty detected at multivariate Cox regression analysis were body mass index, severity of cartilage degeneration in the medial compartment (Outerbridge grade), and age. CONCLUSION The long-term survival of open wedge HTO for osteoarthritis in the medial compartment of the knee is satisfactory. The risk of conversion to TKA is significantly increased in obese patients. Advanced age and severity of pre-existing cartilage damage may also contribute to the risk of conversion to TKA.
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Affiliation(s)
- Amedeo Guarino
- Department of Public Health, Section of Orthopaedics, Federico II University, Naples, Italy
| | - Luca Farinelli
- Orthopaedic Clinic, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Venanzio Iacono
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore-Don Calabria in Negrar (VE), Negrar di Valpolicella VR, Italy
| | - Andrea Cozzolino
- Department of Public Health, Section of Orthopaedics, Federico II University, Naples, Italy
| | - Simone Natali
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore-Don Calabria in Negrar (VE), Negrar di Valpolicella VR, Italy
| | - Claudio Zorzi
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore-Don Calabria in Negrar (VE), Negrar di Valpolicella VR, Italy
| | - Massimo Mariconda
- Department of Public Health, Section of Orthopaedics, Federico II University, Naples, Italy
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Nakayama H, Kanto R, Onishi S, Amai K, Ukon R, Tachibana T, Yoshiya S, Iseki T, Morimoto S, Iseki T. Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. J Exp Orthop 2023; 10:5. [PMID: 36695905 PMCID: PMC9877267 DOI: 10.1186/s40634-023-00573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the relationship between preoperative Ahlbäck radiographic classification grade and the clinical outcomes of double level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. METHODS The study population comprised a consecutive series of 99 knees (68 patients) for which DLO was performed and follow-up results for a minimum of two years were available. The Ahlbäck radiographic classification system was used to determine the osteoarthritic grade. The following radiological parameters for alignment and bone geometry were measured: mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line convergence angle (JLCA), and mechanical tibiofemoral angle (mTFA). Clinical results were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 2 years after surgery. Difference between preoperative and postoperative measurements as well as relationship between Ahlbäck grade and radiological/clinical results were statistically assessed. RESULTS The average age of the study participants was 60.9 ± 6.2 years and the mean follow-up period was 45.4 ± 15.2 months. Each of the radiological parameters exhibited preoperative abnormal values. Knees with Ahlbäck grade 3 and 4 osteoarthritis exhibited significantly greater JLCA and mTFA than grade 1 knees. Two years post-surgery, all radiological parameter values measured within a normal range. Clinical evaluation showed significant improvement in KOOS after surgery. Analysis of the relationship between Ahlbäck grade and clinical score showed that the 2-year postoperative KOOS scores in grade 3 and 4 osteoarthritic knees were significantly lower than grade 1 knees (with the mean 2-year KOOS scores of 350.0 ± 79.9, 317.9 ± 78.3, and 420.2 ± 42.9, respectively). CONCLUSIONS While DLO may produce significant radiological and clinical improvement in knees with joint space obliteration, Ahlbäck grade 3 and 4 osteoarthritic knees associated with larger JLCA and mTFA showed less satisfactory clinical results compared to grade 1 knees. LEVEL OF EVIDENCE IV case series.
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Affiliation(s)
- Hiroshi Nakayama
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Ryo Kanto
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Shintaro Onishi
- Nishinomiya Kaisei Hospital, Ohama-Cho Nishinomiya City, Hyogo, 662-0957 Japan
| | - Kenta Amai
- grid.510255.60000 0004 0631 9872Osaka Kaisei Hospital, Miyahara Yodogawa Ward, Osaka City, Osaka, 532-0003 Japan
| | - Ryosuke Ukon
- grid.510255.60000 0004 0631 9872Osaka Kaisei Hospital, Miyahara Yodogawa Ward, Osaka City, Osaka, 532-0003 Japan
| | - Toshiya Tachibana
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Shinichi Yoshiya
- Nishinomiya Kaisei Hospital, Ohama-Cho Nishinomiya City, Hyogo, 662-0957 Japan
| | - Takuya Iseki
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Shota Morimoto
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Tomoya Iseki
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
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Ma X, Hu Y, Wang K. Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy. Orthop Surg 2022; 14:789-806. [PMID: 35509153 PMCID: PMC9087466 DOI: 10.1111/os.13281] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1-5 are indications and contraindications for PKO for lower extremity alignment correction, items 6-21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23-25 address the perioperative period, follow-up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction.
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Affiliation(s)
- Xin‐long Ma
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Yong‐cheng Hu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Kun‐zheng Wang
- Department of Orthopaedic SurgeryThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an ShaanxiChina
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Bin Abd Razak HR, Campos JP, Khakha RS, Wilson AJ, van Heerwaarden RJ. Role of joint distraction in osteoarthritis of the knee: Basic science, principles and outcomes. J Clin Orthop Trauma 2022; 24:101723. [PMID: 34938647 PMCID: PMC8654974 DOI: 10.1016/j.jcot.2021.101723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/25/2022] Open
Abstract
The burden of knee osteoarthritis (OA) is increasing worldwide. Advanced tibiofemoral joint OA in young patients is particularly a problem with inferior results seen with total knee arthroplasty in this patient population. Knee joint distraction (KJD) has been evaluated recently as a joint preserving procedure for young patients with advanced tibiofemoral osteoarthritis, to delay the need for a primary total knee arthroplasty (TKA). This will decrease the risk for revision TKA later in life. KJD temporarily unloads the knee joint and keeps the tibia and femur separated over a course of 6 weeks. Outcomes of KJD appear promising. Through this article, the authors hope to share from their collective experience as well as the available literature on the basic science, principles of surgery and outcomes of KJD.
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Affiliation(s)
- Hamid Rahmatullah Bin Abd Razak
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - João Pedro Campos
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Serviço de Ortopedia e Traumatologia, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Matosinhos, Portugal
| | - Raghbir S. Khakha
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Department of Orthopaedics, Guys & St Thomas's Hospital, Great Maze Pond, SE1 9RT, United Kingdom
| | - Adrian J. Wilson
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester, SO22 4NR, United Kingdom
| | - Ronald J. van Heerwaarden
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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许 康, 童 也, 赵 鹏, 周 烨, 石 少. [Comparison of two osteotomies in the treatment of medial compartment osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1440-1448. [PMID: 34779171 PMCID: PMC8586778 DOI: 10.7507/1002-1892.202107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effectiveness of modified distal tibial tubercle-high tibial osteotomy (DTT-HTO) and open-wedge HTO (OWHTO) in the treatment of medial compartment osteoarthritis. METHODS A clinical data of 80 patients with medial compartment osteoarthritis treated with HTO between January 2016 and January 2019 was retrospectively analyzed, including 40 patients treated with DTT-HTO (DTT-HTO group) and 40 patients treated with OWHTO (OWHTO group). There was no significant difference in gender, age, body mass index, affected side, disease duration, Kellgren-Lawrence grading of osteoarthritis, and preoperative knee society score (KSS), Hospital for Special Surgery (HSS) score, knee joint visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), posterior tibial slope (PTS), weight-bearing line ratio (WBL), Blackburne-Peel index (BPI), Caton-Deschamps index (CDI), and Insall-Salvati index (ISI) between the two groups ( P>0.05). The operation time, incision length, bleeding volume, hospital stay, and complications in both groups were recorded. The KSS, HSS, and VAS scores were used to evaluated the effectiveness. A self-made questionnaire was used to evaluate the recovery of low-impact sports ability of the knee. X-ray films were used to observe the osteotomy healing and measure the HKA, PTS, WBL, and the patellar height indexes (BPI, CDI, ISI). RESULTS All operations successfully completed in both groups. The OWHTO group operated longer than the DTT-HTO group ( P<0.05). There was no significant difference in the incision length, bleeding volume, and hospital stay between the two groups ( P>0.05). All incisions healed by first intention in both groups. There were 2 cases of lateral hinge fractures in the OWHTO group, and 1 case of lateral hinge fracture and 2 cases of tibial plateau fractures in the DTT-HTO group. No other complications occurred. The patients in both groups were followed up 2-4 years with an average of 2.8 years. The HSS, KSS, and VAS scores in both groups significantly improved after operation when compared with preoperative scores ( P<0.05). All scores gradually improved with the time and there were significant differences between different time points ( P<0.05). The HSS, KSS, and VAS scores were significantly better in the DTT-HTO group than in the OWHTO group at 3 months after operation ( P<0.05). There was no significant difference between the two groups at 6 months, 1 year, and 2 years ( P>0.05). At 1 year, the low-impact sports ability of the OWHTO group was rated as excellent in 8 cases, general in 25 cases, and poor in 7 cases, and as excellent in 7 cases, general in 26 cases, and poor in 7 cases of the DTT-HTO group. There was no significant difference between the two groups ( Z=-0.715, P=0.475). X-ray film reexamination showed that the osteotomies healed in both groups. The healing time was (4.52±1.23) months in the OWHTO group, and (4.23±1.56) months in the DTT-HTO group, showing no significant difference ( t=0.923, P=0.359). At immediate after operation, the HKA and WBL of the two groups significantly improved when compared with the preoperative values ( P<0.05). However, the pre- and post-operational difference was not significant between the two groups ( P>0.05). The PTS of the OWHTO group was significantly higher than preoperative value ( P<0.05), while the PTS of the DTT-HTO group was lower than preoperative value ( P>0.05). The pre- and post-operational difference between the two groups was significant ( P<0.05). BPI and CDI in the OWHTO group were significantly lower than preoperative values ( P<0.05), but there was no significant difference in ISI when compared with preoperative value ( P>0.05). There was no significant difference in the BPI, CDI, and ISI of the DTT-HTO group between pre- and post-operation ( P>0.05). The pre- and post-operational differences of BPI and CDI between the two groups were significant ( P<0.05), and there was no significant difference in the pre- and post-operational difference of ISI ( P>0.05). CONCLUSION The two osteotomies in the treatment of medial compartment osteoarthritis can significantly change the varus deformity and achieve satisfactory effectiveness. The early functional recovery of DTT-HTO is faster, which can avoid the increased PTS and patellar baja of traditional OWHTO. However, neither of the two surgical procedures can restore the patient's ideal low-impact sports ability of the knee.
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Affiliation(s)
- 康永 许
- 安徽医科大学附属宿州医院骨科(安徽宿州 234000)Department of Orthopedics, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou Anhui, 234000, P.R.China
| | - 也 童
- 安徽医科大学附属宿州医院骨科(安徽宿州 234000)Department of Orthopedics, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou Anhui, 234000, P.R.China
| | - 鹏 赵
- 安徽医科大学附属宿州医院骨科(安徽宿州 234000)Department of Orthopedics, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou Anhui, 234000, P.R.China
| | - 烨 周
- 安徽医科大学附属宿州医院骨科(安徽宿州 234000)Department of Orthopedics, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou Anhui, 234000, P.R.China
| | - 少辉 石
- 安徽医科大学附属宿州医院骨科(安徽宿州 234000)Department of Orthopedics, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou Anhui, 234000, P.R.China
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