Assessment of unloading effects after open wedge high tibial osteotomy using quantitative bone scintigraphy

Goshima, Kenichi; Sawaguchi, Takahiro; Shigemoto, Kazuhiro; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken

doi:10.1016/j.jos.2018.12.020

Cited by 9 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…31 Marti et al 28 recommended individual tailoring of the degree of correction of leg alignment with regard to the degree of cartilage loss in the affected knee compartment. Goshima et al 10 targeted 65% to 70% lateral on the transverse diameter of the tibial plateau when performing OWHTO. They reported that quantitative bone scintigraphy showed a significant decrease in bone tracer uptake in the medial compartment and that the bone tracer uptake in the lateral compartment did not change significantly.…”

Section: Discussionmentioning

confidence: 99%

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

et al. 2021

View full text Add to dashboard Cite

Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

show abstract

Section: Discussionmentioning

confidence: 99%

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In the present study, the 88.6% rate of patient satisfaction after OWHTO was comparable with the overall satisfaction after modern OWHTO, as reported by Han et al 18 The advantages of high initial stability, early weightbearing after surgery, and satisfactory PROM-based clinical outcomes likely accounted for greater patient satisfaction after OWHTO with a rigid long plate than after conventional HTO. 12,15,16,20 Only a few studies have reported on factors associated with patient satisfaction after OWHTO. Koh et al 23 showed that severe OA was associated with dissatisfaction after OWHTO.…”

Section: Discussionmentioning

confidence: 99%

“…21,22,25 In a previous study that used quantitative bone scintigraphy, the unloading effects of OWHTO led to pain relief after surgery, independent of cartilage regeneration. 16 Therefore, cartilage regeneration after HTO was unlikely to affect patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…Opening-wedge high tibial osteotomy (OWHTO) with locking plates is a commonly used approach for the treatment of medial compartment osteoarthritis (OA) and osteonecrosis of the knee. 12,15,16,20 The biomechanical principle of high tibial osteotomy (HTO) is to redistribute weightbearing forces from the medial toward the lateral compartment by realignment of the mechanical axis. To ensure a satisfactory clinical outcome, several attempts have been made to find a consensus on relative and absolute contraindications for osteotomies over the past decade (Rand and Neyret, 2005, unpublished data).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Factors Associated With Patient Satisfaction After Opening-Wedge High Tibial Osteotomy

Goshima

Sawaguchi

Shigemoto

et al. 2020

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

Background: Opening-wedge high tibial osteotomy (OWHTO) is expected to result in higher patient satisfaction compared with knee arthroplasty due to joint preservation. However, patient satisfaction rates as well as factors associated with satisfaction after OWHTO remain unclear. Purpose: To evaluate patient subjective satisfaction after OWHTO and determine factors associated with patient satisfaction after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study enrolled 123 patients (123 knees) who underwent unilateral OWHTO. Clinical parameters, including range of motion (ROM), visual analog scale (VAS) score for pain, Knee injury and Osteoarthritis Outcome Score (KOOS), weightbearing line ratio (WBLR), and medial proximal tibial angle (MPTA), were assessed before surgery and at the final follow-up at a minimum of 2 years. Patient satisfaction was evaluated using a 5-point scale regarding (1) surgery, (2) pain relief, (3) knee mobility, (4) daily living function, and (5) lower extremity alignment. The mean overall satisfaction scores for the 5 questions were calculated, and the sample was divided into 2 main groups (satisfied or unsatisfied). Preoperative characteristics, physical activity level, patient expectations for surgery, ROM, and KOOS were compared between the groups. Cartilage regeneration was assessed at the time of plate removal, and WBLR and MPTA were also assessed. Factors associated with patient satisfaction were analyzed using multivariable logistic regression analysis. Results: The mean ± SD follow-up was 54.6 ± 20.6 months. The mean WBLR significantly changed from 20.7% ± 11.8% preoperatively to 66.9% ± 10.2% at the final follow-up, and all KOOS subscale scores significantly improved after surgery. Of the 123 patients, 109 (88.6%) were graded as satisfied. Factors associated with patient satisfaction were expectations met (odds ratio, 17.4; P = .026), better postoperative KOOS Pain score (odds ratio, 1.30; P = .001), and better postoperative KOOS Activities of Daily Living score (odds ratio, 1.36; P = .002). Conclusion: OWHTO is an effective treatment in terms of subjective satisfactory outcomes. Patient expectations for surgery have a significant effect on patient satisfaction. Surgeons should consider patient expectations before OWHTO and provide patient education to improve patient satisfaction.

show abstract

“…Considering the theoretical advantages of bone scintigraphy, our institution has started to use this modality before and after MOWHTO to intuitively identify the effect of MOWHTO in patients with OA, because simple radiographs have limited information to reflect the effect of the operation. Despite of potential and clinical usefulness of bone scintigraphy, there is few reports on correlation with postoperative clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Does postoperative quantitative bone scintigraphy reflect outcomes following medial open-wedge high tibial osteotomy?

Bae

Kim

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

Purpose The present study evaluated changes in bone tracer uptake (BTU) after medial open-wedge high tibial osteotomy (MOWHTO) and determined whether postoperative BTU correlates with clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO. Methods A total of 210 knees underwent MOWHTO for medial compartmental osteoarthritis (OA) were enrolled in this study. Mean follow-up period was 42.7 months. We assessed BTU for the medial compartment of the knee before MOWHTO and at the time of plate removal. Radiologic parameters included Kellgren-Lawrence (K-L) grade and Hip-Knee-Ankle angle (HKAA). Clinical evaluation included American Knee Society (AKS) score and cartilage status was graded at the time of MOWHTO and second-look arthroscopy according to the International Cartilage Repair Society (ICRS) grading system and articular cartilage regeneration stage. Statistical analysis performed to assess the relationships among postoperative BTU of the medial compartment, radiologic parameters, arthroscopic changes and clinical outcomes. Results BTU of medial femoral condyle and tibial plateau were significantly decreased at 2 years after MOWHTO (p<0.001). AKS scores and arthroscopic cartilage status were also significantly improved following MOWHTO. BMI and postoperative HKAA showed significant correlations with postoperative changes of BTU in uni- and multi-variable analysis. Meanwhile, postoperative changes of BTU did not show significant correlation with clinical outcomes or cartilage regeneration following MOWHTO. Conclusion Lower BMI and postoperative valgus alignment were significant predictor for postoperative BTU decrease of the medial compartment following MOWHTO. However, postoperative changes of BTU did not reflect cartilage regeneration or clinical outcomes until the midterm follow-up.

show abstract

Assessment of unloading effects after open wedge high tibial osteotomy using quantitative bone scintigraphy

Cited by 9 publications

References 27 publications

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

Factors Associated With Patient Satisfaction After Opening-Wedge High Tibial Osteotomy

Does postoperative quantitative bone scintigraphy reflect outcomes following medial open-wedge high tibial osteotomy?

Contact Info

Product

Resources

About