1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Majeed A S, Thaha N, Varghese B. High tibial osteotomy in medial compartment osteoarthritis of knee: functional outcome of medial open wedge and lateral closing wedge osteotomies-How does the outliers fare in the medium term? Musculoskelet Surg 2023; 107:313-322. [PMID: 35986855 DOI: 10.1007/s12306-022-00756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Our study aimed to compare the functional outcome of HTO performed via lateral closing wedge osteotomy and medial open wedge osteotomy followed up for a mean period of 6 years using Lysholm knee score. Secondary objective was to find out whether an achievement of 2°-6° of mechanical axis had a significant impact in the outcome and how the outliers of 2°-6° (177°-182° (straight knees) and greater than 186° (overcorrection) performed in the medium term and how patients who lost correction to more than - 3° (persistent varus) performed in the medium term. STUDY DESIGN This is a prospective observational study. MATERIALS AND METHODS Sixty-two consecutive patients who had undergone HTO by a single surgeon from 2012 to 2015 were followed up. The final follow-up visit was from August 2019 to December 2019. Nine were lost to follow-up, and 53 presented for the follow-up visit. Case records were noted for the preoperative LKS scores, preoperative mechanical axis, ROM, and preoperative tibiofemoral angle. Post-operative mechanical axis in full-length weight bearing at 4 months was also noted. During the latest visit, patients underwent LKS scoring, full-length weight-bearing X-rays to assess mechanical axis, and assessment of tibiofemoral angle. The results were grouped into excellent, good, fair, and poor outcomes based on LKS scale. The mechanical axes attained at surgery and at the follow-up were grouped into less than 177° as varus, 177°-182° as straight 182°-186° as required correction, and more than 186° as overcorrection. Lysholm knee score was dichotomised using LKS 84 as the cut-off (LKS ≥ 84 high LKS; LKS 84 low LKS). RESULTS A total of 53 patients with a median age of 56 years (SD 4.23) were included in this study. There were 8 (15.1%) males and 45 (84.9%) females. The mean ± SD of BMI of patients was 28.10 ± 2.66 kg/m2. Medial opening wedge osteotomy was performed in 27 (50.9%) cases, and lateral closing wedge osteotomy was performed in 26 (49.1%). Median duration between the time of surgery and the follow-up was 72 months (IQR 32.5). Preoperatively, the mean LKS score of the patients was 50.25 ± 12.43 (88.68% had poor score and 11.32% had fair score), and the mean mechanical axis of the knee was 172.54 ± 3.78 (all had varus deformity). The mean (SD) preoperative LKS score of the 53 participants before the surgery was 50.25 (12.43). Poor score was reported by 47 (88.68%) and fair score by 6 (11.32%) patients, respectively. At the time of final follow-up, the mean (SD) LKS score of 53 patients was 77.81(17.11). At the time of final follow-up (when compared with the score before surgery), 41(77.36%) patients had improvement in the LKS score, 10 (18.87%) patients had no improvement in the score, and 2 (3.77%) patients worsened from fair to poor. The difference between the LKS score before surgery and at the final follow-up was significantly greater for patients who underwent medial opening wedge osteotomy [median (IQR)35 (26-38)] than for the patients who underwent lateral closing wedge osteotomy [median (IQR) 30 (23-34)], U226.5, p 0.026. Knees with desired valgus angle within 2°-6° and knees which remained straight at the final follow-up showed a good or excellent outcome at the final follow-up (23 out of 53 knees). Those knees with had varus HKA axis had a poor or fair outcome at the final follow-up (23 out of 53 knees). Those knees that were overcorrected also had poor outcomes. CONCLUSION Our study shows that both medial open wedge osteotomy and lateral closing wedge osteotomy are capable of improving knee function in medial compartment osteoarthritis of knee. Medial open wedge with locking plates is a biomechanically more stable construct compared with lateral closing wedge osteotomy. Irrespective of the two techniques chosen, the aim of the osteotomy should be to achieve an overcorrection of 2°-6° of valgus or at least to keep the knee straight (normal mechanical axis). This will give a satisfactory medium-term result. However, varus alignment and valgus alignment of more than 6° can result in a deterioration of function of knee. The results of the osteotomy are found to deteriorate with obesity, severe varus in preop mechanical axis and longer duration of follow-up.
Collapse
Affiliation(s)
- Shiju Majeed A
- Department of Orthopedics, Government Medical College, Thiruvananthapuram, India.
| | - Nabeel Thaha
- Department of Orthopedics, Government Medical College, Thiruvananthapuram, India
| | - Betsy Varghese
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Przystalski K, Paleczek A, Szustakowski K, Wawryka P, Jungiewicz M, Zalewski M, Kwiatkowski J, Gądek A, Miśkowiec K. Automated correction angle calculation in high tibial osteotomy planning. Sci Rep 2023; 13:12876. [PMID: 37553353 PMCID: PMC10409734 DOI: 10.1038/s41598-023-39967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023] Open
Abstract
High tibial osteotomy correction angle calculation is a process that is usually performed manually or in a semi-automated way. The process, according to the Miniaci method, is divided into several stages to find specific points: the center of the femoral head, the edges of the tibial plateau, the Fujisawa point, the center of the ankle joint, and the Hinge point. In this paper, we proposed an end-to-end approach that consists of different techniques for finding each point. We used YOLOv4 to detect regions of interest. To identify the center of the femoral head, we used the YOLOv4 and the Hough transform. For the other points, we used a combined method of YOLOv4 with the ASM/AAM algorithm and YOLOv4 with image processing algorithms. Our fully-automated method achieved a mean error rate of 0.5[Formula: see text] (0[Formula: see text]-2.76[Formula: see text]) ICC 0.99 (0.98-0.99) 95% CI on our own dataset of standing long-leg Anterior Posterior view X-rays. This might be the first method that automatically calculates the correction angle of high tibial osteotomy.
Collapse
Affiliation(s)
- Karol Przystalski
- Medtransfer, Na Zjeździe 11, 31353, Kraków, Poland.
- Department of Information Technologies, Jagiellonian University, Łojasiewicza 11, 30348, Kraków, Poland.
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland.
| | - Anna Paleczek
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Karol Szustakowski
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Piotr Wawryka
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Michał Jungiewicz
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Mateusz Zalewski
- Ortotop, Ludwinowska 11/9, 30331, Kraków, Poland
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
| | - Jakub Kwiatkowski
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
| | - Artur Gądek
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
- Department of Orthopedics and Physiotherapy, Jagiellonian University Medical College, Jakubowskiego 2, 30688, Kraków, Poland
| | - Krzysztof Miśkowiec
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
- Department of Orthopedics and Physiotherapy, Jagiellonian University Medical College, Jakubowskiego 2, 30688, Kraków, Poland
| |
Collapse
|
6
|
Katagiri H, Nakagawa Y, Amano Y, Shirakawa Y, Ozeki N, Nakamura T, Sekiya I, Koga H. Decision regret following opening wedge high tibial osteotomy: Older age as a risk factor. Knee 2023; 43:62-69. [PMID: 37271073 DOI: 10.1016/j.knee.2023.05.007] [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: 10/19/2022] [Revised: 02/09/2023] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Understanding risk factors that can predict decision regret after surgical procedures can potentially increase the quality of patient decision making and reduce decision regret after opening wedge high tibial osteotomy (OWHTO). The purpose of the present study was to identify the risk factors that predict the likelihood of decision regret after OWHTO. METHOD Questionnaires were administered to 98 eligible OWHTO recipients more than one year post-operatively. They answered "Yes" or "No" to the question "Would you go for the same choice (OWHTO) if you had to do it over again?" Univariate and multivariate logistic regression analyses were conducted using the decision regret questionnaire as the dependent variable against patient characteristics and surgery related factors. A receiver operating characteristic curve and area under the curve were constructed and calculated for age at surgery. Cut-off values were determined using the Youden principle and receiver operating characteristic curves. RESULTS Among the 98 respondents, 18 (18%) reported regretting their decision. Older age at surgery was the only predictive risk factor for decision regret (P < 0.01). The area under the curve for the model using age to predict failure was 0.722. The cut-off value was 71 years. Patients aged 71 years or more had a 7.841 odds ratio for decision regret (P < 0.01). CONCLUSIONS Older age emerged as a predictive risk factor for decision regret after OWHTO. Patients aged 71 years or older had a higher decision regret rate after OWHTO than younger patients and should more carefully weigh the suitability of OWHTO against other options.
Collapse
Affiliation(s)
- Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Japan
| | - Yusuke Amano
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Japan
| | - Yoshiko Shirakawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan; Department of Orthopaedic Surgery, Medical Corporation Jinseikai Takagi Hospital, Japan
| | - Nobutake Ozeki
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), Japan.
| |
Collapse
|
7
|
Goodell PB, Johansen PM, Bartels DW, Sherman SL, Amanatullah DF. Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS Rev 2023; 11:01874474-202303000-00004. [PMID: 36930742 DOI: 10.2106/jbjs.rvw.22.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
» Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) allow for compartment-specific intervention on an arthritic knee joint that preserves bone stock and native soft tissue compared to a total knee arthroplasty (TKA). Both operations give a more natural feeling with native proprioception compared with a TKA. » HTO is better suited in patients who are younger (<55 years-of-age), have a body mass index (BMI) <30 kg/m2, high activity requirements, mechanical malalignment, asymmetric varus, isolated anterior cruciate ligament insufficiency, need for multiplanar correction, and a preference for joint preserving interventions. Recent data suggest that age (>55 years-of-age) should not solely contraindicate a HTO. » UKA may be chosen in patients who are older (>55 years-of-age), low activity requirements, have a BMI <40 kg/m2, severe osteoarthritis with significant joint space narrowing, acceptable coronal alignment, symmetric varus, and patient preference for arthroplasty.
Collapse
Affiliation(s)
- Parker B Goodell
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, California
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Douglas W Bartels
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| |
Collapse
|
8
|
Unicompartmental knee arthroplasty in patients under the age of 60 years provides excellent clinical outcomes and 10-year implant survival: a systematic review : A study performed by the Early Osteoarthritis group of ESSKA-European Knee Associates section. Knee Surg Sports Traumatol Arthrosc 2023; 31:922-932. [PMID: 35763042 DOI: 10.1007/s00167-022-07029-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the present study was to systematically review the clinical and functional outcomes following medial unicompartmental knee arthroplasty (UKA) in patients under the age of 60 years old. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies between 2012 and April 2022, on patients 18-60 years old who have had a unicompartmental knee replacement evaluating patient-reported outcomes measures (PROMs), were included. The Knee Society Scores (KSS) clinical score was considered the primary outcome. Pre- and post-operative range of motion (ROM), PROMs, complications and survival were recorded. Paired sample t testing was performed to compare the pre-operative with post-operative KSS. RESULTS Seventeen articles comprising 2083 unicompartmental arthroplasties were included. The follow-up range was between 1 and 15 years. In eligible studies, all reported outcomes were improved following UKA. The mean KSS clinical was significantly improved from 45.5 (SD: 9.6) pre-operatively to 89.4 (SD: 4.4) post-operatively (p = 0.0001). Mean implant survival ranged 86-96.5% at 10 years follow-up. There was no significant difference between mobile and fixed bearing in terms of ROM and KSS clinical. In total, 92 revisions and 7 re-operations with implant retention were reported. CONCLUSION Unicompartmental knee arthroplasty for medial osteoarthritis is a safe, reliable and effective treatment option for patients of 60 years or younger. It provides pain relief, satisfactory activity level, excellent clinical outcomes, and up to 96.5% implant survival at 10-year follow-up. LEVEL OF EVIDENCE IV.
Collapse
|
9
|
Uçan V, Aliyev O, Demirkiran CB, Yildiz F, Elmali N, Uzer G. Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:51-56. [PMID: 34781390 DOI: 10.1055/a-1611-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO). METHODS From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL). RESULTS No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (- 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01). CONCLUSION SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.
Collapse
Affiliation(s)
- Vahdet Uçan
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | | | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Nurzat Elmali
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| |
Collapse
|
10
|
Kucirek NK, Anigwe C, Zhang AL, Ma CB, Feeley BT, Lansdown DA. Complications after high tibial osteotomy and distal femoral osteotomy are associated with increasing medical comorbidities and tobacco use. Knee Surg Sports Traumatol Arthrosc 2022; 30:4029-4045. [PMID: 35112179 DOI: 10.1007/s00167-022-06865-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to assess complications, reoperations, and their risk factors at 90 days and 2 years after high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) in a national cohort. METHODS The PearlDiver Mariner Dataset was queried using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for HTO and DFO, complications, and subsequent surgery. Minimum follow-up was 2 years and complications were assessed at 90 days and 2 years. Hospital readmission in the first 90 days was also assessed. Univariate and multiple logistic regression were utilized to identify risk factors for complications and re-operation. RESULTS The 90-day and 2-year complication rates after HTO (n = 1780) were 11.6% and 31.7%, compared to 21.5% (p < 0.0001) and 41.5% (p = 0.0001) after DFO (n = 446). Infection was the most frequent early (90-day) complication for both HTO and DFO cohorts, while hardware problems were most common at 2 years. Increasing Elixhauser Comorbidity Index (ECI) was associated with increased odds of infection, readmission, and hardware-associated complications in both cohorts. Gender and tobacco use were also associated with various complications after HTO. At 2 years, 23.7% of HTO patients and 26.2% of DFO patients had undergone subsequent surgery. Hardware removal occurred in 16.4% of HTO and 18.4% of DFO patients (n.s.), while 4.5% of HTO and 5.2% of DFO patients underwent total knee arthroplasty (TKA) within 2 years (n.s.). CONCLUSION HTO and DFO have substantial complication rates in the short and mid term, with a higher rate of overall complications observed after DFO as compared to the HTO cohort. After both procedures, roughly one quarter of patients will undergo subsequent surgery within 2 years. Patients with tobacco use and numerous medical co-morbidities may not be optimal candidates due to increased complication rates. Elixhauser Comorbidity Index (ECI) may be an useful tool for risk assessment prior to surgery. LEVEL OF EVIDENCE Retrospective cohort study, III.
Collapse
Affiliation(s)
- Natalie K Kucirek
- University of California, San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Christopher Anigwe
- University of California, San Francisco School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens St, San Francisco, CA, 94158, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens St, San Francisco, CA, 94158, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens St, San Francisco, CA, 94158, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens St, San Francisco, CA, 94158, USA
| |
Collapse
|
11
|
Batailler C, Gicquel T, Bouguennec N, Steltzlen C, Tardy N, Cartier JL, Mertl P, Pailhé R, Rochcongar G, Fayard JM. A predictive score of high tibial osteotomy survivorship to help in surgical decision-making: the SKOOP score. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04694-w. [PMID: 36418609 DOI: 10.1007/s00402-022-04694-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The high tibial osteotomy (HTO) survival rate is strongly correlated with surgical indications and predictive factors. This study aims to assess HTO survival in the long term, to determine the main predictive factors of this survival, to propose a predictive score for HTO based on those factors. METHODS This multicentric study included 481 HTO between 2004 and 2015. The inclusion criteria were all primary HTO in patients 70 years old and younger, without previous anterior cruciate ligament injury, and without the limitation of body mass index (BMI). The assessed data were preoperative clinical and radiological parameters, the surgical technique, the complications, the HKA (hip knee ankle angle) correction postoperatively, and the surgical revision at the last follow-up. RESULTS The mean follow-up was 7.8 ± 2.9 years. The HTO survival was 93.1% at 5 years and 74.1% at 10 years. Age < 55, female sex, BMI < 25 kg/m2 and incomplete narrowing were preoperative factors that positively impacted HTO survival. A postoperative HKA angle greater than 180° was a positive factor for HTO survival. The SKOOP (Sfa Knee OsteOtomy Predictive) score, including age (threshold value of 55 years), BMI (threshold values of 25 and 35 kg/m2), and the presence or absence of complete joint line narrowing, have been described. If the scale was greater than 3, the survival probability was significantly lower (p < 0.001) than if the scale was less than 3. CONCLUSION A predictive score including age, BMI, and the presence or absence of joint line narrowing can be a helpful in making decisions about HTO, particularly in borderline cases. LEVEL OF EVIDENCE Retrospective cohort study.
Collapse
Affiliation(s)
- Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France. .,IFSTTAR, Univ Lyon, Claude Bernard Lyon 1 University, LBMC UMR_T9406, F69622, Lyon, France.
| | - Thomas Gicquel
- Clinique Mutualiste de La Porte de L'Orient, 3, Rue Robert de La Croix, 56100, Lorient, France
| | - Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 2, Rue Georges-Nègrevergne, 33700, Mérignac, France
| | - Camille Steltzlen
- Service de Chirurgie Orthopédique, Hôpital Mignot, 177, Rue de Versailles, 78150, Le Chesnay, France
| | - Nicolas Tardy
- Centre Ostéo-Articulaire Des Cèdres, Clinique Des Cèdres, 5, Rue Des Tropiques, 38130, Echirolles, France
| | - Jean-Loup Cartier
- , Clinique Des Alpes Du Sud, 3, Rue Antonin Coronat, 05000, Gap, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique, CHU Amiens-Picardie Site Sud, 1, Rond-Point du Professeur Christian-Cabrol, 80054, Amiens Cedex 1, France
| | - Régis Pailhé
- Service de Chirurgie de L'Arthrose Et du Sport, Urgences Traumatiques Des Membres, Hôpital Sud - CHU de Grenoble, Laboratoire TIMC-GMCAO UMR 5525 UGA/CNRS, 38000, Grenoble, France
| | - Goulven Rochcongar
- Département de Chirurgie Orthopédique et Traumatologique, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue de la Côte de Nacre, 14033, Caen, France
| | - Jean Marie Fayard
- Centre Orthopédique Santy-Hopital Privé Jean Mermoz-Ramsay Générale de Santé, 69008, Lyon, France
| | | |
Collapse
|
12
|
Yoo JD, Huh MH, Shin YS. Risk of revision in UKA versus HTO: a nationwide propensity score-matched study. Arch Orthop Trauma Surg 2022; 143:3457-3469. [PMID: 36264509 DOI: 10.1007/s00402-022-04658-0] [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: 03/31/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Our study aims to investigate the incidence rate and risk factors for subsequent revision in patients treated with UKA compared with those treated with HTO. METHODS In this retrospective nationwide cohort study, we used data from the Korean National Health Insurance claims database from January 1, 2009 to December 31, 2017. We compared patients who had undergone UKA or HTO as the primary surgical procedure longer than two years prior. We used multivariable logistic regression models to compare risk of revision between the groups after propensity matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to total knee arthroplasty (TKA) after primary UKA or HTO. RESULTS In this study, 73,902 patients with UKA and 72,215 patients with HTO were identified after applying IPTW. The risk of revision during the entire study period was higher for patients with HTO than for patients with UKA (adjusted hazard ratio [HR] = 1.42). Kaplan-Meier 8-years survival was 96.8% in the UKA group and 95.1% in the HTO group. Patients with HTO who were at higher risk of revision had advanced age (60-69 years [HR = 2.17, 95% CI 1.76-2.67] and 70-79 years [HR = 2.89, 95% CI 1.81-4.62]), female sex (HR = 1.41, 95% CI 1.19-1.66), CHF (HR = 3.12, 95% CI 1.25-7.78), COPD (HR = 1.68, 95% CI 1.34-2.10), PVD (HR = 1.75, 95% CI 1.10-2.78), and CVA or TIA (HR = 1.87, 95% CI 1.13-3.08) compared with those with UKA. CONCLUSION Risk of revision was higher for patients with HTO than for patients with UKA. Risk factors for subsequent revision in patients with HTO were advanced age (60-69, 70-79), female sex, and comorbidities such as CHF, COPD, PVD, CVA, or TIA. However, orthopedic surgeons should also consider that TKA conversion from UKA has higher risk of revision than TKA conversion from HTO before choosing between UKA and HTO.
Collapse
Affiliation(s)
- Jae-Doo Yoo
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Yangchuan Anyangchun-Ro, Seoul, 07985, Republic of Korea
| | - Min-Hwan Huh
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Yangchuan Anyangchun-Ro, Seoul, 07985, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Mokdong Hospital, Ewha Womans University School of Medicine, 1071 Yangchuan Anyangchun-Ro, Seoul, 07985, Republic of Korea.
| |
Collapse
|
13
|
Ishibashi K, Sasaki E, Wijaya E, Yamauchi S, Sasaki S, Kimura Y, Yamamoto Y, Shimbo T, Tamai K, Ishibashi Y. A Novel Quantitative Evaluation of Bone Formation After Opening Wedge High Tibial Osteotomy Using Tomosynthesis. J Digit Imaging 2022; 35:1373-1381. [PMID: 35419665 PMCID: PMC9582182 DOI: 10.1007/s10278-022-00630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to establish and validate a novel evaluation method using digital tomosynthesis to quantify bone formation in the gap after opening wedge high tibial osteotomy (OW-HTO). We retrospectively analyzed bone formation in the gap in 22 patients who underwent OW-HTO using digital tomosynthesis at 1, 2, 3, 6, 9, and 12 months postoperatively. Bone formation was semi-quantitatively assessed using the modified van Hemert's score and density measurements on digital tomosynthesis images. The gap filling value (GFV) was calculated as the ratio of the intensities of the opening gap and the tibial shaft. In addition, the relationship between the modified van Hemert's score and GFV was evaluated. The reproducibility of GFV had an interclass correlation coefficient (ICC [1,2]) of 0.958 for intraobserver reliability and an ICC (2,1) of 0.975 for interobserver reliability. The GFV increased in a time-dependent manner and was moderately correlated with the modified van Hemert's score (r = 0.630, p < 0.001). The GFV plateaued at 6 months postoperatively. In addition, the GFV was higher in patients with a modified van Hemert's score of 2 than in patients with a modified van Hemert's score of 3 (p = 0.008). The GFVs obtained using digital tomosynthesis can be used to assess postoperative bone formation in the opening gap after OW-HTO with high accuracy and reproducibility.
Collapse
Affiliation(s)
- Kyota Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
- Department of Stem Cell Therapy Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | | | - Shohei Yamauchi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shizuka Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuka Kimura
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Takashi Shimbo
- Department of Stem Cell Therapy Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- StemRIM Institute of Regeneration-Inducing Medicine, Osaka University, Suita, Japan
| | - Katsuto Tamai
- Department of Stem Cell Therapy Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| |
Collapse
|
14
|
Ihle C, Dorn J, Ateschrang A, Baumgartner H, Herbst M, Döbele S, Histing T, Schröter S, Ahrend MD. Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 31:1546-1555. [PMID: 35267048 PMCID: PMC10049930 DOI: 10.1007/s00167-022-06909-4] [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: 10/10/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to assess changes in health-related quality of life (HRQL) and work intensity following double-level knee osteotomy (DLO). It was hypothesized that postoperative HRQL would be comparable to that of the general population and that work intensity can be restored in the short term. METHODS Twenty-four patients (28 varus knees; mechanical tibiofemoral angle: -11.0 ± 3.0° (-6.0 to -17.0), age: 49.1 ± 9.5 (31-65) years) who underwent DLO were included. The duration the patients were unable to work was evaluated. HRQL was measured with the SF-36 questionnaire, which consists of a physical (PCS) and mental component summary score (MCS). The pre- to postoperative changes in the PCS and MCS were analysed. The PCS and MCS were also compared to those of the general population, who has a reference score value of 50 points. The work intensity measured with the REFA classification and the Tegner activity scale were assessed preoperatively and at the final postoperative follow-up examination (18.0 ± 10.0 (5-43) months). RESULTS The duration that the patients were unable to work was 12.2 ± 4.4 (6-20) weeks. The PCS improved from 32.1 ± 11.3 (14.5-53.3) preoperatively to 54.6 ± 8.5 (25.2-63.7) (p < 0.001) at the final follow-up, and the MCS improved from 53.9 ± 11.1 (17.1-67.7) to 57.2 ± 3.1 (47.3-61.7) (n.s). The preoperative PCS was significantly lower than the reference score of the general population (p < 0.001), whereas the preoperative MCS was similar between the two groups (n.s.). At follow-up, no significant differences were observed between the PCS and the MCS of the patient group and those of the general population. Five patients who were unable to work prior to surgery due to knee symptoms returned to work with moderate (four patients) or even very heavy (one patient) workloads. The Tegner activity scale increased significantly from a median of 2.0 (0.0-5.0) to 4.0 (2.0-7.0) (p < 0.001). CONCLUSION Our results demonstrate an improvement in quality of life and return to working activity following DLO in the short term. The HRQL can be improved by DLO in patients with varus knee osteoarthritis to the level of the general population. These results can assist surgeons in discussing realistic expectations when considering patients for DLO. LEVEL OF EVIDENCE Study type: therapeutic, IV.
Collapse
Affiliation(s)
- Christoph Ihle
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Julia Dorn
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Atesch Ateschrang
- Evangelisches Stift St. Martin Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Heiko Baumgartner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Stefan Döbele
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Steffen Schröter
- Komitee Osteotomie der Deutschen Kniegesellschaft (DKG), Munich, Germany.,Department of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
| | - Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.,Komitee Osteotomie der Deutschen Kniegesellschaft (DKG), Munich, Germany.,AO Research Institute Davos, Davos, Switzerland
| |
Collapse
|
15
|
Bode L, Eberbach H, Brenner AS, Kloos F, Niemeyer P, Schmal H, Suedkamp NP, Bode G. 10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy. Orthop J Sports Med 2022; 10:23259671221078003. [PMID: 35224123 PMCID: PMC8873560 DOI: 10.1177/23259671221078003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Good-to-excellent midterm results after high tibial osteotomy (HTO) to treat
medial compartment cartilage defects or osteoarthritis (OA) have been
published, but little is known about long-term survival rates in terms of
conversion to total knee arthroplasty (TKA) using angular stable internal
plate fixation. Purpose: To determine TKA-free survival rates and functional and radiological outcomes
at 10 years after HTO. A subgroup analysis of patients who underwent
combined HTO and autologous cartilage implantation (ACI) was also
performed. Study Design: Case series; Level of evidence, 4. Methods: Included were 125 patients with a mean follow-up of 9.90 ± 2.25 years; 90
patients underwent HTO for medial OA, and 35 patients underwent ACI and HTO
for medial focal cartilage defects. Functional outcome measures included
visual analog scale (VAS) for pain, Lysholm, International Knee
Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome
Score (KOOS) subscales and KOOS4 (average of 4 KOOS subscales:
Pain, Symptoms, Sport, and Quality of Life). Radiological outcomes included
lateral distal femoral angle, medial proximal tibial angle, and joint line
convergence angle. Results: Overall, 16 patients required conversion to TKA at a mean 86.75 ± 25.73
months (10-year survival rate, 87.2%). Only 2 patients in the HTO+ACI
subgroup required a conversion to TKA (10-year survival rate, 94.3%). The
complication rate for all patients was 8.8%. In both the HTO and HTO+ACI
subgroups, VAS pain levels decreased and Lysholm scores increased
significantly from pre- to postoperatively (P < .001). A
higher preoperative Tegner score led to a significantly lower risk for
conversion to TKA (P = .001), and a preoperative body mass
index of ≥35 was associated with a significantly higher risk
(P = .019), as was female sex (P =
.046). Radiological parameters remained within physiological ranges. The
postoperative joint line conversion angle did correlate with postoperative
functional outcome but not with TKA conversion. Conclusion: Long-term results of HTO for medial compartment OA or cartilage defects with
underlying varus deformity were good to excellent. In particular, patients
who underwent HTO+ACI presented excellent long-term survival rates. HTO,
therefore, delays or prevents TKA implantation, especially in young, active
patients with medial compartment damage.
Collapse
Affiliation(s)
- Lisa Bode
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Helge Eberbach
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Anna-Sophie Brenner
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Ferdinand Kloos
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- OCM Clinic, Munich, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Orthopaedic Surgery, University Hospital Odense, Odense, Denmark
| | - Norbert P. Suedkamp
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Sporthopaedicum, Straubing, Straubing, Germany
| |
Collapse
|
16
|
Wang H, Ma B. Healthcare and Scientific Treatment of Knee Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5919686. [PMID: 35126931 PMCID: PMC8816538 DOI: 10.1155/2022/5919686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 01/08/2022] [Indexed: 01/22/2023]
Abstract
Knee osteoarthritis is a chronic degenerative disease companied with chronic knee pain and dysfunction. However, the etiology and pathogenesis of knee osteoarthritis were unclear. Currently, age, diet, trauma, obesity, and inheritance are the main risk factors. The major pathological hallmarks of knee osteoarthritis included subchondral bone sclerosis, articular cartilage degeneration, arthrosynovitis, and osteophyte. With the acceleration of the aging process in China, the treatment of knee arthritis and the methods to improve the quality of life have become the focus of medical staff. Currently, therapies in clinical practice include surgery and nonoperative treatment; however, the clinical effects of different individuals at different stages will still be very different. This article reviews the recent advances in the treatment of knee osteoarthritis from three aspects: nonsurgical treatment, surgical treatment, and modern new medical means.
Collapse
Affiliation(s)
- Huan Wang
- Orthopedics, The Second Affiliated Hospital of the Air Military Force Military Medical University, Xi'an, Shanxi Province 710000, China
| | - Baoan Ma
- Orthopedics, The Second Affiliated Hospital of the Air Military Force Military Medical University, Xi'an, Shanxi Province 710000, China
| |
Collapse
|
17
|
Kanakamedala AC, Hurley ET, Manjunath AK, Jazrawi LM, Alaia MJ, Strauss EJ. High Tibial Osteotomies for the Treatment of Osteoarthritis of the Knee. JBJS Rev 2022; 10:01874474-202201000-00002. [PMID: 35020711 DOI: 10.2106/jbjs.rvw.21.00127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» A high tibial osteotomy (HTO) is a joint-preserving procedure that can be used to treat symptomatic unicompartmental cartilage disorders in the presence of limb malalignment. » Appropriate patient selection and careful preoperative planning are vital for optimizing outcomes. » Based on past literature, correction of varus malalignment to 3° to 8° of valgus appears to lead to favorable results. Recently, there has been growing awareness that it is important to consider soft-tissue laxity during preoperative planning. » Although there has been a recent trend toward performing opening-wedge rather than closing-wedge or dome HTOs for unicompartmental osteoarthritis, current data suggest that all 3 are acceptable techniques with varying complication profiles. » Based on current evidence, an HTO provides pain relief, functional improvement, and a high rate of return to sport, with reported survivorship ranging from 74.7% to 97.6% and 66.0% to 90.4% at 10 and 15 years, respectively.
Collapse
Affiliation(s)
- Ajay C Kanakamedala
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | | | | | | | | | | |
Collapse
|
18
|
Lee SH, Seo HY, Kim HR, Song EK, Seon JK. Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis. Sci Rep 2021; 11:24340. [PMID: 34934052 PMCID: PMC8692610 DOI: 10.1038/s41598-021-03259-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022] Open
Abstract
Among various patient risk factors affecting survival after high tibial osteotomy (HTO), the ideal age limit for HTO is unclear. This study was performed to evaluate the effect of age on survival rate and complications after HTO for medial unicompartmental osteoarthritis. Among of 61,145 HTO patients from Korean National Health Insurance database, 41,112 patients underwent the procedure before the age of 60 years (Group A), 13,895 patients between the age of 60 and 65 years (Group B), and 6138 patients after the age of 65 years (Group C). We compared the survival rate in person-years among the three groups from the date of primary surgery until subsequent total knee arthroplasty. Perioperative complications were also recorded. The adjusted hazard ratio (HR) were calculated using the multivariable Cox proportional hazard regression model, adjusting for the potential confounders: age, sex, type of medical insurance, region of residence, hospital type, comorbidities, and Charlson comorbidity index score. The total number of HTO increased 6.5-fold, especially in patients aged > 65 years (by 8.2-fold) from 2008 to 2018. The overall revision rate was 4.2% in Group A, 6.4% in Group B, and 7.3% in Group C. The 5- and 10-year revision rate was significantly lower in Group A (p < 0.001), but no difference between Groups B and C. After adjusting for potential confounders, multivariable regression analysis revealed that revision rate was significantly lower in Group A than Group B (HR: 0.57; p < 0.0001), but no difference between Groups B and C. The incidence of complications was also significantly lower in Group A than in other groups. The inferior survival rate and more perioperative complications after HTO was found in old patients (aged ≥ 60 years) than in young patients. Therefore, the patient age is one of the predicting factors for a high risk of failure after HTO.
Collapse
Affiliation(s)
- Sun-Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hyoung-Yeon Seo
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Republic of Korea
| | - Eun-Kyoo Song
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
| |
Collapse
|
19
|
Suh DW, Han SB, Yeo WJ, Cheong K, So SY, Kyung BS. Human umbilical cord-blood-derived mesenchymal stem cell can improve the clinical outcome and Joint space width after high tibial osteotomy. Knee 2021; 33:31-37. [PMID: 34536766 DOI: 10.1016/j.knee.2021.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/30/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited study about the human umbilical cord-blood derived mesenchymal stem cell (hUCB-MSC) cartilage regeneration procedures combined with high tibial osteotomy (HTO). We compared the clinical and radiological results of hUCB-MSC cartilage regeneration procedures combined with HTO to those of microfracture with HTO. METHODS From August 2017 to December 2018, HTO patients with International Cartilage Regeneration and Joint Preservation Society (ICRS) grade IV cartilage defects over 200 mm2 on medial femoral condyle (MFC) were enrolled. For comparison, all participants were divided into two groups: those who had undergone an hUCB-MSC induced cartilage regeneration procedure (group MSC) and those with microfractures only (group C, controls). Clinically, Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), and Lysholm scores were evaluated post-operatively at 18 months. Radiologically, mechanical axis (MA) and joint space width (JSW) were evaluated. RESULTS A total of 100 knees were enrolled (43 in group MSC, 57 in group C). The IKDC score in group MSC (69) was better than that in group C (62; P < 0.05). The JSW increment in the MSC group (0.6 mm) was more than that in group C (0.1 mm; P < 0.05). No patient developed nonunion, correction loss, or arthroplasty conversion. CONCLUSION hUCB-MSCs can improve clinical outcome and JSW better than microfracture only in HTO patients.
Collapse
Affiliation(s)
- Dong Won Suh
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Seung Beom Han
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Woo Jin Yeo
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Kuhoang Cheong
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Sang-Yeon So
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Bong Soo Kyung
- Joint Center, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea.
| |
Collapse
|
20
|
Otsuki S, Wakama H, Ikeda K, Okuno N, Okamoto Y, Okayoshi T, Matsuyama J, Neo M. Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients. J Exp Orthop 2021; 8:65. [PMID: 34409519 PMCID: PMC8374014 DOI: 10.1186/s40634-021-00376-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years. Methods Our retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis. Results The preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01). Conclusion Age at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.
Collapse
Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| |
Collapse
|
21
|
Kyun-Ho S, Hyun-Jae R, Ki-Mo J, Seung-Beom H. Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:623. [PMID: 34266424 PMCID: PMC8283898 DOI: 10.1186/s12891-021-04499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension. This study aimed to evaluate the efficacy of concurrent MMPRT repair during high tibial osteotomy (HTO) compared to HTO alone in patients with medial osteoarthritis and MMPRTs. METHODS The MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting on concurrent MMPRT repair during HTO. Pre- and postoperative data were pooled to investigate the treatment effects of concurrent MMPRT repair during HTO, and compare postoperative clinical, radiological, and arthroscopic outcomes including cartilage status and healing event rates according to the arthroscopic classification of MMPRT healing (complete, partial [lax or scar tissue], or failed healing) between HTO patients with and without concurrent MMPRT repair. The random-effect model was used to pool the standardized mean differences, odds ratios (ORs), 95% confidence intervals (CIs), and event rates. RESULTS Seven patient subgroups in six articles divided according to meniscal repair techniques were included in the final analysis. Concurrent MMPRT repair during HTO significantly improved the Lysholm score, while no intergroup differences were observed in the postoperative Lysholm and WOMAC scores, as well as radiological and arthroscopic outcomes. Those who underwent concurrent MMPRT repair showed a higher rate of complete meniscal healing (OR: 4.792, 95% CI, 1.95-11.79), with a pooled rate of complete meniscal healing of 0.327 (95% CI, 0.19-0.46). CONCLUSION Concurrent MMPRT repair during HTO for medial osteoarthritis with MMPRTs has little benefits on the clinical, radiological, and arthroscopic outcomes during short-term follow-up. Further accumulation of evidence is needed for long-term effects.
Collapse
Affiliation(s)
- Shin Kyun-Ho
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Ryoo Hyun-Jae
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Jang Ki-Mo
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Han Seung-Beom
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
| |
Collapse
|
22
|
Imhoff FB, Fucentese SF, Harrer J, Tischer T. [The influence of axial deformities and their correction on the development and progression of osteoarthritis]. DER ORTHOPADE 2021; 50:378-386. [PMID: 33844033 PMCID: PMC8081714 DOI: 10.1007/s00132-021-04103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/02/2022]
Abstract
Die Beachtung der Beinachse und die Möglichkeiten zur deren Korrektur stellen beim jungen Patienten mit Arthrose ein Grundpfeiler der Therapie dar. Die Kombination einer Gelenksverletzung und einer Achsdeviation führt unweigerlich, je nach Ausmaß und Komorbiditäten, schon nach wenigen Jahren zur fortschreitenden Gonarthrose. Neben der genauen Deformitätenanalyse zur Osteotomieplanung, gilt es, Normbereiche der entsprechenden Winkel zu kennen und eine Zielgröße zur Achskorrektur festzulegen. Aus dem Repertoire der verschiedenen kniegelenksnahen Osteotomien sind dann die Nebeneffekte in Bezug auf patellofemorales Maltracking, ligamentäres Balancing und die Beinlänge abzuschätzen. Gerade im Hinblick auf mögliche (und wahrscheinliche) Folgeoperationen beim jungen Patienten müssen neue knöcherne Deformitäten oder ligamentäre Insuffizienzen, welche potenziell bei Überkorrektur entstehen, unbedingt vermieden werden.
Collapse
Affiliation(s)
- Florian B Imhoff
- Orthopädie, Universitätsklinik Balgrist, Forchstrasse 340, 8008, Zürich, Schweiz.
| | - Sandro F Fucentese
- Orthopädie, Universitätsklinik Balgrist, Forchstrasse 340, 8008, Zürich, Schweiz
| | - Jörg Harrer
- Abteilung für Orthopädie und Unfallchirurgie, Helmut-G.-Walther-Klinikum, Lichtenfels, Deutschland
| | - Thomas Tischer
- Sektion Sportorthopädie, Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| |
Collapse
|
23
|
Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N, Ollivier M. Evaluation of the "Minimal Clinically Important Difference" (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:820-826. [PMID: 32342141 DOI: 10.1007/s00167-020-06026-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outcome Measures (PROMs) is crucial for determining the effectiveness of a procedure and calculating the sample size for trial planning. The purpose of this study was to determine the MCID of several PROMs (Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and the SF-12) in patients who underwent medial opening-wedge High-Tibial Osteotomy (owHTO) with Patient-Specific Cutting Guides (PSCGs), using anchor-based methods. METHODS Patients undergoing isolated medial owHTO with PSCGs between January 2013 and January 2017 were enrolled in this single-center, prospective, observational study. Three outcome scores were collected pre-operatively and at the 2 years follow-up evaluation: KOOS, KSS and SF-12. The MCIDs were calculated using anchor-based method: at 2 years postoperatively: "Compared with before surgery, how would you rate operated joint now?" The responses were recorded using a five-point scale. Patients who answered "about the same" or "somewhat worse" were classified into the no change group, while those who answered "somewhat better" were classified into the minimal change group. A receiver operating characteristic (ROC) curve was used to define the cutoff point that best discriminated between the minimal change and no change groups for each PROMs RESULTS: 196 patients were included, 75 (somewhat better) and 24 patients (about the same and somewhat worse) were, respectively, assigned to the "no change" and "minimal change" groups. There was no significant difference between the two groups in terms of baseline characteristics and postoperative complications. At 24 months follow-up all the PROMs (KOOS, KSS and SF-12) were significantly better for the "minimal change" group compared to the "no change" group. MCID was 15.4 for KOOS pain, 15.1 for KOOS symptoms, 17 for KOOS ADL, 11.2 for KOOS sports/recreation, 16.5 for KOOS QQL, 3 for KSS symptoms, 5.6 for KSS activity, 7.2 for SF-12 physical component and 6.3 for PCS mental component. CONCLUSION This study determined the MCIDs of common used PROMs in patients undergoing owHTO. LEVEL OF EVIDENCE Prospective Cohort Study, Level II.
Collapse
Affiliation(s)
- Christophe Jacquet
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Charles Pioger
- Département de Chirurgie orthopédique de l'hopital Mignot, Le chesnay, France
| | - Raghbir Khakha
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,Guys and St Thomas' Hospital, London, UK
| | - Camille Steltzlen
- Département de Chirurgie orthopédique de l'hopital Mignot, Le chesnay, France
| | - Kristian Kley
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Nicolas Pujol
- Département de Chirurgie orthopédique de l'hopital Mignot, Le chesnay, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| |
Collapse
|
24
|
Giardini P, De Luca L, Crespan B, Christodoulidis A, Molinari M. Does a lateral tibial plateau fracture (Takeuchi type III) occuring during opening wedge high tibial osteotomy induce a higher revision rate to total knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021558. [PMID: 35604265 PMCID: PMC9437674 DOI: 10.23750/abm.v92is3.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIM High tibial osteotomies (HTO) are effective procedures to treat younger patients affected by moderate but symptomatic arthritis. Open-wedge HTO (OW-HTO) is more often performed compared to a closing wedge osteotomy to treat varus arthritis of the knee due to a lower incidence of complications and better results: lateral hinge fracture (LHF) is the most common complication of OW-HTO. Intra articular fractures of the lateral tibial plateau (Takeuchi type III) appear as a particularly serious complication due to its extension to the subchondral bone of the compartment towards which the load is shifted. Aim of our study, is to assess if an intra articular fracture of the lateral tibial plateau occurring during an OW-HTO leads to an higher risk of failure and to an early conversion to a total knee arthroplasty. METHODS Between January 2013 and December 2018 114 patients underwent OW-HTO at our Orthopaedic Department. All the patients underwent the same surgical procedure performed by a skilled knee surgeon: a subcutaneous-medial locked plate (Tomofix®, Synthes, Solothurn, Switzerland) has been used in all the procedures to stabilize the osteotomy. Clinical and radiographic follow up has been performed at one, three, six and twelve months postoperatively afterwards annually. We retrospectively reviewed all the intra operative fluoroscopy of patients to detect those affected by an intra articular fracture of the lateral tibial plateau occurred intra operatively. RESULTS A LHF occurred in 11 out of 114 patients (9.65%) who underwent an OW-HTO; in particular nine patients (7.9%) had a Type III LHF. In all cases such complication has been detected intra operatively. In the subgroup of patients who experienced an intra articular fracture of the tibial plateau at the last follow up only one patients underwent to a revision with a total knee arthroplasty; in other words, the survivorship of an OW-HTO complicated by a LHF type III resulted 89% at a mean follow-up of 5 years. In 103 patients without an intraoperative fracture, the percentage of patients free from revision at the last follow up resulted of 92%. CONCLUSIONS Takeuchi type III fracture is an uncommon but serious complication to manage: in our case series we found that an early recognition and a correct treatment of this occurrence don't lead to a premature conversion to a knee arthroplasty if compared with an uncomplicated osteotomy. Further studies are necessary to establish specific subjective outcomes after OW-HTO burdened by an intra articular fracture of the lateral plateau.
Collapse
Affiliation(s)
- Piero Giardini
- Department of Orthopaedics and Traumatology, Cavalese Hospital, Provincia Autonoma di Trento, Italy
| | - Lapo De Luca
- Department of Orthopaedics and Traumatology, S. Chiara Hospital, Provincia Autonoma di Trento, Italy
| | - Beatrice Crespan
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy
| | - Avraam Christodoulidis
- Department of Orthopaedics and Traumatology, Cavalese Hospital, Provincia Autonoma di Trento, Italy
| | - Marco Molinari
- Department of Orthopaedics and Traumatology, Cavalese Hospital, Provincia Autonoma di Trento, Italy
| |
Collapse
|
25
|
Bouguennec N, Mergenthaler G, Gicquel T, Briand C, Nadau E, Pailhé R, Hanouz JL, Fayard JM, Rochcongar G. Medium-term survival and clinical and radiological results in high tibial osteotomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthop Traumatol Surg Res 2020; 106:S223-S230. [PMID: 32863169 DOI: 10.1016/j.otsr.2020.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two surgical solutions for isolated medial tibiofemoral osteoarthritis. Results depend on preoperative criteria and patient selection, but also on postoperative factors: implant positioning, limb alignment. Factors for HTO survival need identifying to reduce risk of failure requiring total knee arthroplasty (TKA). HYPOTHESIS Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival. MATERIAL AND METHOD As part of a symposium of the French Society of Arthroscopy (SFA), a multicenter retrospective study compared 2 series. The HTO series comprised 488 patients: 153 female (31.4%); mean age, 55.1 years; mean weight, 83.1kg; mean body-mass index (BMI), 28.6. The UKA series comprised 284 patients: 172 female (60.6%); mean age, 64.1 years; mean weight, 75.3kg; mean BMI, 27.6. The main endpoint was comparative survival at 5, 8 and 10 years; secondary endpoints comprised pre- and post-operative hip-knee-ankle (HKA) angle, mechanical femoral angle (mFA) and mechanical tibial angle (mTA), surgical technique, satisfaction, time to and level of return to work, WOMAC and Tegner scores and complications rates. The significance threshold was set at p<0.05; 95% confidence intervals were calculated. RESULTS Age>54 years, male gender, BMI>25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction<8°, postoperative HKA<180° and hinge fracture were significantly associated with poorer survival. There was no impact of type of osteotomy, navigation assistance or postoperative HKA 183-186°. Ten-year survival was 74.3% for HTO and 71% for UKA (non-significant); however, survival curves crossed at 6 years. CONCLUSION HTO showed survival and functional results comparable to those of UKA in selected patients when target limb alignment correction was achieved. The present study determined selection criteria. A predictive score for results of either procedure would facilitate decision-making. LEVEL OF EVIDENCE IV, retrospective cohort study.
Collapse
Affiliation(s)
- Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Nègrevergne, 33700 Merignac, France.
| | - Guillaume Mergenthaler
- Département de Chirurgie Orthopédique et Traumatologique, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Thomas Gicquel
- Clinique Mutualiste de la Porte de L'Orient, 3, rue Robert de La Croix, 56100 Lorient, France
| | - Cyril Briand
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice, CHU de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Elodie Nadau
- Service de Chirurgie Orthopédique, Traumatologique, CHU Amiens Picardie, 80054 Amiens cedex 1, France
| | - Régis Pailhé
- Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres, Hôpital Sud - CHU de Grenoble, Laboratoire TIMC-GMCAO UMR 5525 UGA/CNRS, 38000 Grenoble, France
| | - Jean Luc Hanouz
- Service d'Anesthésie Réanimation, CHU de Caen, 14033 Caen cedex, France
| | - Jean Marie Fayard
- Centre Orthopédique Santy-Hopital Privé Jean Mermoz-Ramsay Générale de Santé, 69008 Lyon, France
| | - Goulven Rochcongar
- Département de Chirurgie Orthopédique et Traumatologique, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | -
- 15, rue Ampère, 92500 Rueil Malmaison, France
| |
Collapse
|
26
|
Percutaneous Skeletal Fixation of Painful Subchondral Bone Marrow Edema of the Knee. Arthrosc Sports Med Rehabil 2020; 2:e583-e590. [PMID: 33134998 PMCID: PMC7588638 DOI: 10.1016/j.asmr.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the change in patient-reported pain after percutaneous skeletal fixation (PSF) and to determine the success rate of PSF in the prevention of additional intervention for the treatment of painful subchondral bone marrow edema (SBME) of the knee over a 2-year postoperative period. Methods This was a retrospective, single-surgeon analysis of patients undergoing PSF for painful, atraumatic SBME of the knee confirmed on preoperative magnetic resonance imaging with a minimum 2-year follow-up. Inclusion criteria were age >18 years, pain localized to the area of edema, failure of nonsurgical intervention (4 weeks of physical therapy and non-steroidal medication use), and absence of tricompartmental Kellgren–Lawrence grade 4 osteoarthritis. All patients underwent arthroscopy, followed by isolated PSF without additional chondral procedures. Pre- and postoperative visual analog scale scores were compared. The primary outcome measure of success was defined as a lack of additional intervention. This included viscosupplementation, corticosteroid injection, or conversion to arthroplasty. Results A total of 74 patients with a mean age of 47.2 years and average follow-up time of 38.9 months (range 24-61 months) were evaluated. Successful treatment was noted in 61 patients (82.4%). Of the 13 patients who did not respond to PSF, 5 (6.8%) had been converted to arthroplasty, 11 received viscosupplementation, and 8 required cortisone injections. The average visual analog scale score decreased from 7.55 preoperatively to 3.16 at 2-year follow-up (P < .001). The average body mass index of successfully treated patients (28.2) was significantly less than that of the patients experiencing failure (32.2) (P = .001). Conclusions Patients undergoing PSF for the treatment of painful SBME may expect a decrease in knee pain and low rates of additional intervention over a 2-year postoperative period. Level of Evidence Level IV; Therapeutic Case Series
Collapse
|
27
|
Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy. J Orthop Surg Res 2020; 15:504. [PMID: 33138838 PMCID: PMC7607877 DOI: 10.1186/s13018-020-02033-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background The accuracy of targeted lower limb alignment correction following HTO is closely related to patients’ pain relief and knee joint survival time. How to accurately perform osteotomy and how to obtain the ideal target limb alignment to maximize the curative effect are the difficulty in HTO practice. The purpose of this study is to evaluate the predictive and application value of osteotomy master software (OsteoMaster) in coronal plane preoperative planning of high tibial osteotomy. Method Sixty-seven patients with medial compartment osteoarthritis and varus deformity treated by medial open-weight high tibial osteotomy were enrolled and divided into observation group (31 cases) and control group (36 cases). The observation group was planned by OsteoMaster, while the control group was planned by Miniaci. The preoperative predicted values of osteotomy depth, open height, correction angle, WBL ratio, and FTA of the observation group were compared with the actual intraoperative values to study their accuracy. The operative time, blood loss, number of fluoroscopy, and WBL ratio were compared between the observation group and the control group to study its application value. Result There was no significant difference between two groups in preoperative prediction and intraoperative reality of osteotomy depth, open height, correction angle, FTA, and WBL ratio (P > 0.05). The operation time and number of fluoroscopy in the observation group were significantly less than those in the control group (P < 0.05), while the difference in blood loss was not statistically significant (P > 0.05). The good rate of WBL ratio was 87.1% in the observation group and 75% in the control group. Conclusion OsteoMaster has predictive value in osteotomy depth, open height, correction angle, FTA, and WBL ratio of HTO, which is also helpful to reduce the number of fluoroscopy, shorten the operation time, and improve the accuracy of target limb alignment. The drawback of this approach is 2-dimensional approach in contrast to 3-dimensional preoperative planning that is including the more real study.
Collapse
|