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Jung WH, Sahu V, Seo M, Takeuchi R. Cartilage regeneration and long term survival in medial OA knee patients treated with HTO and OATS. J Orthop 2024; 57:120-126. [PMID: 39021587 PMCID: PMC11250883 DOI: 10.1016/j.jor.2024.06.024] [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: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Background Osteoarthritis (OA) of the knee, in most instances primarily, affects medial compartment of knee. Combining Osteochondral Autologous Transfer System (OATS) with Medial Open-Wedge High Tibial Osteotomy (MOWHTO) may represent an integrated approach to sustaining long-term knee functionality in OA patients. Materials and methods From 2009 to 2016, combined OATS and MOWHTO was performed in 66 knees of 63 patients with medial compartment knee OA. Cartilage regeneration was assessed by 2nd look arthroscopy and Knee function was assessed by knee society scoring (KSS) pre-operatively and post-operatively. The survival rate of MOWHTO plus OATS was assessed. Failure is characterized by the need to convert into total knee replacement. Results The KSS knee score (from 48.3 to 90.4) and function score (from 42.6 to 88.7) showed a statistically significant improvement (p-value of <0.0001) at a mean follow-up period of 9.49 years. Second look arthroscopy done at the time of implant removal showed 100 % cartilage regeneration with even hyaline cartilage regeneration in 49 out of 57 knees assessed and partial regeneration in 8 knees. The Kaplan Meier survivorship analysis was 96.7 % at the mean 9.49 years after surgery. Only 2 patients needed TKA conversion in follow-up. Conclusion Combining OATs and valgus MOWHTO provides good option to successfully manage patients of OA and varus malalignment. This resulted in significant improvement in knee function, lowering pain intensity, good cartilage regeneration, and a high survivorship rate for 10 years postoperatively.
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Affiliation(s)
- Woon-Hwa Jung
- Department of Orthopaedic Surgery, Murup Hospital, Changwon, South Korea
| | - Vaibhav Sahu
- Department of Orthopaedic Surgery, Murup Hospital, Changwon, South Korea
| | - Minseok Seo
- Department of Orthopaedic Surgery, Murup Hospital, Changwon, South Korea
| | - Ryohei Takeuchi
- Department of Orthopaedic Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
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Matache BA, Jean PO, Pelet S, Roger MÈ, Dartus J, Belzile EL. Lateral knee laxity increases the risk of excessive joint line obliquity after medial opening-wedge high tibial osteotomy. Orthop Traumatol Surg Res 2024; 110:103717. [PMID: 37863189 DOI: 10.1016/j.otsr.2023.103717] [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] [Received: 02/14/2022] [Revised: 06/04/2023] [Accepted: 07/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Medial opening-wedge high tibial osteotomy (HTO) is a well-recognized treatment for patient with varus knee osteoarthritis. Joint line obliquity has recently been suggested to negatively impact clinical outcomes following HTO, but little is known about what factors lead to increased joint line obliquity. The purpose of the current study was (1) to evaluate whether increased preoperative lateral knee laxity, represented by the joint line convergence angle, results in increased joint line obliquity in a consecutive series of patients treated with HTO and (2) to determine the effect of advanced arthritic changes on joint line obliquity. HYPOTHESIS Increased joint line convergence angle would be associated with increased joint line obliquity. PATIENTS AND METHODS All HTOs performed at our center between 2010-2017 were retrospectively reviewed. Patients were excluded if pre- and postoperative standing alignment radiographs were not available. Varus-producing osteotomies were excluded. Patients were subdivided according to their preoperative joint line convergence angle (≤3° or >3°) and the degree of radiographic arthritic change. The primary outcome measure was the postoperative joint line obliquity. Categorical variables were compared using the paired samples t-test. Survival analysis was performed for failure and overall rate of reoperation. RESULTS During the study period, 90 HTO were performed, and 38 patients (42 knees; M/F: 32/6; mean age: 41.6; mean follow-up: 4.72 years) met the inclusion criteria. The most common surgical indications were varus knee osteoarthritis (n=27, 64.3%) and osteochondritis dissecans (n=7, 8.2%). Patients with a preoperative joint line convergence angle >3° demonstrated significantly greater joint line obliquity postoperatively as compared to those with a joint line convergence angle ≤3° (6.4°±4.6° vs. 2.5°±5.7°, respectively; p=0.02). Patients with advanced arthritic changes had significantly lower preoperative (-3°±3.4° vs. -5.6°±4.1°; p=0.03) and greater postoperative (5.8°±4° vs. 2.2°±6.4°; p=0.04) joint line obliquity as compared to those with minimal arthritic changes. There were 12 complications among the 42 procedures: one conversion to total knee replacement (TKR), one hardware failure (fixation revised), one infection, and 9 hardware removals. Overall survival using conversion to TKR was 96.23% (95% CI 0.92-1.0) at 10 years. DISCUSSION Lateral knee laxity, as defined by a preoperative joint line convergence angle >3°, and advanced arthritic changes are associated with increased postoperative joint line obliquity following medial opening-wedge high tibial osteotomy. Soft-tissue adaptation should be accounted for in order to avoid excessive joint line obliquity following high tibial osteotomy, and the planned correction should be reduced by 25% in patients with a preoperative joint line convergence angle >3° when templating using standing alignment radiographs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bogdan A Matache
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada.
| | - Pierre-Olivier Jean
- Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
| | - Stéphane Pelet
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
| | - Marie-Ève Roger
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
| | - Julien Dartus
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada; Lille University School of Medicine, 1, avenue Eugène Avinée, 59120 Lille, France
| | - Etienne L Belzile
- Hôpital Enfant-Jésus, CHU de Québec-Université Laval, 1401, 18(e) rue, Québec, QC, G1J 1Z4, Canada; Faculty of Medicine, université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Québec, QC, QC G1V 0A6, Canada
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Avellan S, Mabrouk A, Taillebot V, Pithioux M, Ollivier M. Using a patient-specific cutting guide enables identical knee osteotomies: An evaluation of accuracy on sawbones. Orthop Traumatol Surg Res 2024:103813. [PMID: 38218221 DOI: 10.1016/j.otsr.2024.103813] [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: 01/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE It was hypothesized that using a Patient-Specific Cutting Guide (PSCG) would allow the creation of sawbones model osteotomies, identical in the 3 planes and the hinge parameters, that can be used for biomechanical studies. The aim of the study was to evaluate the accuracy of the PSCG system and to introduce and assess the new hinge parameter; the hinge area. METHODS Six identical sawbones tibia models were identically set up for identical osteotomy cuts by the same surgeon in the same session and with identical instruments. A medical scanner was used to evaluate the 3D configuration of all the specimens. The analyzed parameters included the cutting angles in both the coronal and sagittal planes (degrees) and the hinge and the slicing areas (cm2), and the hinge thickness (mm). The values were statistically evaluated for average, standard deviation, 95% confidence index, and delta to the expected values were calculated. RESULTS The mean values for the coronal and sagittal angles were 110.5̊±1̊ and 89.8̊±0.8̊, respectively. The 95% confidence index level ranged between 0.1̊, and 0.8̊ in both the coronal & the sagittal planes. The mean values for the hinge thickness, the hinge area, and the slicing area were 12.7±1.5mm, 4.2±0.9 cm2, and 18.3±1.2 cm2, respectively. CONCLUSION In the presented study, it can be demonstrated that mechanically identical osteotomy specimens, with regard to the cutting planes and hinge parameters, can be reliably created using the PSCG. The identical specimens can be used for biomechanical research purposes to further expand our knowledge of the factors affecting osteotomy outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sébastien Avellan
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France; BIOBank®, Tissue Bank, Lieusaint, France
| | - Ahmed Mabrouk
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France; Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Virginie Taillebot
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France.
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
| | - Matthieu Ollivier
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
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Mabrouk A, Ollivier M, Fayard JM, Batailler C, Bouguennec N, Tardy N, Rochcongar G. High tibial osteotomy is equally effective for varus malaligned knees with either virgin or wrecked medial meniscus: An age and gender-matched secondary analysis of a Francophone Arthroscopy Society Symposium. Orthop Traumatol Surg Res 2023; 109:103650. [PMID: 37364820 DOI: 10.1016/j.otsr.2023.103650] [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] [Received: 04/16/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Despite the growing concept of meniscal preservation, partial meniscectomy could be the definitive procedure in specific scenarios. And total meniscectomy was once before a frequent procedure, with current sequelae of degenerate knees. High tibial osteotomy (HTO) is an effective treatment for patients suffering from unicompartmental degenerative changes, and substantial deformities. However, it is yet to be answered, whether HTO is similarly effective in both post-meniscectomy knees and knees with not previously operated meniscus. HYPOTHESIS Outcomes of HTO is similar with or without previous history of total or subtotal meniscectomy. METHODS This study compared the clinical and radiological outcomes of 41 patients who received HTO and had no previous history of surgery in the ipsilateral knee (group I), and 41 age, and gender-matched patients who had meniscectomy surgery in the ipsilateral knee (group II). Preoperatively and postoperatively, all patients were clinically evaluated; the visual analogue scale scores, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including hip-knee-ankle angle, femoral mechanical angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were reported. RESULTS A total of 82 patients were included; group I (n=41) and group II (n=41). The mean age was 51.18±8.64 (27-68) and 90.24% were male. The duration since the onset of symptoms was longer in group II vs. group I, 43.34±41.03 versus 38.07±36.11months respectively. No significant differences in the clinical evaluation between the two groups with a greater proportion of patients demonstrating moderate degenerative changes. Similar preoperative and postoperative radiographic parameters were reported, in group I, Δ HKA was 7.19±4.14 versus 7.65±3.16 in group II. Preoperative pain VAS scores were slightly higher in group II vs. group I, 79.23±26.35 vs. 76.31±24.45, respectively. However, postoperatively, the pain scores significantly improved in group I vs. group II, 22.84±3.65 vs. 41.69±17.33, respectively. Tegner activity scores and WOMAC scores were comparable between both groups preoperatively and postoperatively. Only the WOMAC function scores were better in group I when compared to group II, 26.13±25.84 versus 20.01±17.98. All patients returned to work at an average of 0.82±0.38months. CONCLUSION Knee preservation with high tibial osteotomy is equally effective in managing unicompartmental degenerative changes in varus malaligned knees with either no previous history of meniscal surgeries or where a meniscal sacrifice was inevitable, either with subtotal or total meniscectomy. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Ahmed Mabrouk
- Leeds Teaching Hospitals, Department of trauma and Orthopaedics, Leeds, United Kingdom; Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France.
| | | | - Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | | | - Nicolas Tardy
- Centre Ostéo-Articulaire Des Cèdres, Clinique Des Cèdres, 5, rue des Tropiques, 38130 Échirolles, France
| | - Goulven Rochcongar
- Orthopaedics and Traumatology Department, Normandie University, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
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An JS, Bouguennec N, Batailler C, Tardy N, Rochcongar G, Frayard JM, Ollivier M. Better clinical outcomes and faster weight bearing after medial opening-wedge high tibial osteotomy using allogeneic than synthetic graft: A secondary analysis of a Francophone Arthroscopy Society Symposium. Orthop Traumatol Surg Res 2023; 109:103700. [PMID: 37813331 DOI: 10.1016/j.otsr.2023.103700] [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] [Received: 06/21/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Although an autogenous graft has the highest rate of bone union to fill the void created in medial opening wedge high tibial osteotomy (MOWHTO), it also has some disadvantages, such as prolonged surgical time, donor site pain and morbidity. Two possible candidates for ideal grafts to replace autogenous grafts are allogeneic and synthetic graft, which are free from donor site pain and morbidity. However, previous reports comparing the clinical results of allogeneic to synthetic graft have been limited and controversial. The purpose of this study is to compare radiological findings and clinical outcomes of using synthetic versus allogenic graft to fill the void created in MOWHTO. HYPOTHESIS The present clinical study hypothesized that allogenic graft to fill the void would allow the higher rate of bone union and better clinical outcomes. MATERIAL AND METHODS This study compared the clinical and radiological outcomes of 95 patients who received MOWHTO to fill the void with either synthetic or allogenic graft (44 in Syn group, 51 in Allo group). Preoperatively and postoperatively, all patients were clinically evaluated; Return to work, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including Hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were also reported. RESULTS Mean follow-up (months) were 24.0±1.3 in Syn group and 26.8±1.2 in Allo group (p=0.13). The postoperative improvement of pain and global WOMAC scores in Allo group were significantly better than in Syn group (ΔPain of WOMAC: Syn group 27.8±4.4, Allo group 49.3±3.8, p value <0.001*) (ΔGlobal score of WOMAC: Syn group 16.7±3.2, Allo group 37.4±4.9, p value=0.002*). The risk of hinge fracture in Syn group was significantly higher than in Allo group (Hinge fracture by Takeuchi grade (0/1/2/3): Syn group 37/3/3/1, Allo group 43/8/0/0, p value=0.04*). The timing of full weight bearing in Allo group was significantly earlier than in Syn group (Weight Bearing (1=FWB, 2=PWB 3wk, 3=PWB 6wk): Syn group 2.7±0.1, Allo group 2.3±0.1, p value=0.01*). DISCUSSION The use of allogenic graft to fill the void in MOWHTO does not show superiority in bone union compared to synthetic graft, however it improves pain, function, decreases the risk of hinge fracture and allows faster weight bearing than synthetic graft. LEVEL OF PROOF III; Case-control study.
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Affiliation(s)
- Jae-Sung An
- Tokyo Medical and Dental University, Tokyo, Japan; Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | | | - Cécile Batailler
- Service de chirurgie orthopédique, hôpital de la Croix-Rousse, Lyon, France
| | - Nicolas Tardy
- Centre Ostéo-Articulaire des Cèdres, Clinique des Cèdres, Echirolles, France
| | - Goulven Rochcongar
- Département de chirurgie orthopédique et traumatologique, université de Caen, Basse-Normandie, CHU de Caen, Caen cedex, France
| | | | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France.
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Fitoussi A, Dartus J, Erivan R, Pasquier G, Migaud H, Putman S, Chazard E. Management of medial femorotibial osteoarthritis: Epidemiology, and survival of unicompartmental knee arthroplasty versus valgus high tibial osteotomy in France. Study of 108,007 cases from the French National Hospitals Database. Orthop Traumatol Surg Res 2023; 109:103692. [PMID: 37776952 DOI: 10.1016/j.otsr.2023.103692] [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] [Received: 10/24/2022] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) and valgus high tibial osteotomy (HTO) are two options for isolated medial femorotibial osteoarthritis in genu varum. In the absence of registries for osteotomies and for arthroplasty in the knee, epidemiological data are hard to obtain in France. We therefore performed a retrospective study, with the aims of: 1) estimating UKA and HTO survival without revision by total knee arthroplasty (TKA), and 2) assessing risk factors for revision according to treatment group. HYPOTHESIS Medium-term survival is better with HTO than UKA in under-70-year-olds. MATERIALS AND METHOD All elderly patients undergoing HTO or UKA in the French National Hospitals Database for the period 2011-2020 were included: i.e., 108,007 patients; 43,537 HTO (29,330 male, 14,207 female; mean age 49.7 years, 95% CI 49.6-49.8) and 64,470 UKA (31,181 male, 33,289 female; mean age 60.5 years, 95% CI 60.5-60.6). RESULTS Survival free of revision by TKA was 75.8% (95% CI=75.2-76.4) for UKA and 80.6% (95% CI=80.0-81.3) for HTO (p<0.00001). In UKA, revision risk factors comprised: low annual center volume (<17 UKAs per year) (HR=1.50; 95% CI=1.41-1.59), obesity (HR=1.25; 95% CI=1.18-1.32), and age <60years, with maximum risk for 50-59years (HR=2.41; 95% CI=1.83-3.16 in 50-59 year-olds). In HTO, revision risk factors comprised: obesity (HR=1.42; 95% CI=1.31-1.53), rheumatoid arthritis (HR=2.75; 95% CI=1.37-5.51), joint chondrocalcinosis (HR=2.01; 95% CI=1.18-3.39), and age >60years (HR=8.81; 95% CI=7.23-19.73 in 60-69-year-olds). Male gender was a protective factor against revision in both groups: UKA, HR=0.75 (95% CI=0.72-0.79); HTO, HR=0.73 (95% CI=0.69-0.77). The number of UKAs increased over the years, matching the increase in arthroplasty in France, with a decrease in HTOs until 2019. CONCLUSION HTO showed better medium-term survival than UKA in under-70-year-olds in France. Even so, indications decreased in favor of UKA, although the respective risk factors differ. These findings suggest that conservative surgery still has a role, depending on osteoarthritis stage. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Allison Fitoussi
- Service de chirurgie orthopédique, hôpital Roger-Salengro, centre hospitalier universitaire (CHU) de Lille, place de Verdun, 59000 Lille, France.
| | - Julien Dartus
- Service de chirurgie orthopédique, hôpital Roger-Salengro, centre hospitalier universitaire (CHU) de Lille, place de Verdun, 59000 Lille, France
| | - Roger Erivan
- SIGMA Clermont, ICCF, université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, 63000 Clermont-Ferrand, France
| | - Gilles Pasquier
- Service de chirurgie orthopédique, hôpital Roger-Salengro, centre hospitalier universitaire (CHU) de Lille, place de Verdun, 59000 Lille, France
| | - Henri Migaud
- Service de chirurgie orthopédique, hôpital Roger-Salengro, centre hospitalier universitaire (CHU) de Lille, place de Verdun, 59000 Lille, France
| | - Sophie Putman
- Service de chirurgie orthopédique, hôpital Roger-Salengro, centre hospitalier universitaire (CHU) de Lille, place de Verdun, 59000 Lille, France; ULR 2694 METRICS, université de Lille, CHU de Lille, 59000 Lille, France
| | - Emmanuel Chazard
- ULR 2694 METRICS, université de Lille, CHU de Lille, 59000 Lille, France
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Schröter S, Klink J, Ihle C, Gueorguiev BG, Herbst M, Maiotti M, Histing T, Ahrend MD. Long-term Outcomes after Medial Open Wedge High Tibial Osteotomy - A Retrospective Study of 69 Patients. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37647923 DOI: 10.1055/a-2120-0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
High tibial osteotomy (HTO) is a widespread option to avoid or delay total knee arthroplasty (TKA). The present study aimed to assess the long-term survival rate and postoperative subjective knee function after isolated medial open wedge HTO in patients with symptomatic medial compartment knee osteoarthritis (OA) and varus malalignment.Sixty-nine patients (48.8 ± 6.7, 35-66 years; preoperative mechanical tibiofemoral angle [mTFA] -5.3 ± 3.4; -14.9-0.0° varus) treated with medial open wedge HTO using a TomoFix plate were included in this retrospective study, with a follow-up of at least 10 years (11.8 ± 1.0 years). The survival rate after HTO was calculated after 5 and 10 years. Subjective knee function was assessed using Hospital for Special Surgery (HSS), Oxford knee, Lequesne, and Lysholm scores.Thirty-three patients underwent conversion to TKA, on average, 7.0 ± 3.4 (1.3-13.7) years after HTO. Five- and ten-year survival rates were 84.1 and 60.9%, respectively. Patients without conversion to TKA showed a Lysholm score of 64.5 (35-92), Lequesne score of 7 (1-13), HSS score of 71 (56-86), and Oxford knee score of 38.5 (25-44) at the last follow-up (more than 10 years). Significantly higher scores were registered at the last follow-up compared to the preoperative state regarding the Lysholm score (preoperative: 43.5 [12-95]; follow-up: 64.5 [35-92]; p < 0.001). The HSS score (preoperative: 69.5 [43-93]; follow-up: 71 [56-86]; p = 0.6941) showed no statistically significant change during the 10-year follow-up period. The Lequesne score was significantly lower than the preoperative score (preoperative: 11.5 [0.5-22]; follow-up: 7 [1-13]; p < 0.001), indicating a lower handicap.The majority of patients with a valgus medial compartmental knee OA treated with HTO with fixation using the TomoFix plate can expect no conversion to TKA for more than 10 years. Furthermore, patients without conversion to TKA after 10 years still had a significantly higher subjective knee function than preoperatively. Further research is needed to identify risk factors for conversion to TKA. This helps to guide surgeons in selecting patients who will benefit most from HTO.
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Affiliation(s)
- Steffen Schröter
- Klinik für Unfall- und Wiederherstellungschirurgie, Diakonie Klinikum GmbH Jung-Stilling, Siegen, Germany
- Mitglied Osteotomie Komitee der Deutschen Kniegesellschaft
| | - Julian Klink
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Christoph Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | | | - Moritz Herbst
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Marco Maiotti
- Orthopedics, Shoulder Unit Villa Stuart Clinic (Rome), Rome, Italy
| | - Tina Histing
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Tübingen, Germany
- Mitglied Osteotomie Komitee der Deutschen Kniegesellschaft
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