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

Abstract

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.

Impact of the Weightbearing Line on Cartilage Regeneration of the Medial Knee Compartment after Open-Wedge High Tibial Osteotomy, Based on Second-Look Arthroscopy

“…While some authors had demonstrated that articular cartilage regeneration of the medial compartment of the knee can be expected after medial OWHTO, 3,4,[20][21][22] others did not identify a positive effect of OWHTO on cartilage regeneration or clinical outcomes. 8,9,23,24 The optimal correction angle for knee alignment for postoperative cartilage regeneration and associated clinical outcomes remains an issue of controversy. Correction of knee alignment with OWHTO aims to either restore a "normal" lower limb alignment or change an "over-correction" into a valgus alignment, to unload the medial compartment with OA.…”

“…While some authors had demonstrated that articular cartilage regeneration of the medial compartment of the knee can be expected after medial OWHTO, 3 , 4 , 20 - 22 others did not identify a positive effect of OWHTO on cartilage regeneration or clinical outcomes. 8 , 9 , 23 , 24 The optimal correction angle for knee alignment for postoperative cartilage regeneration and associated clinical outcomes remains an issue of controversy.…”

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy

“… 4 , 7 , 28 Patient satisfaction after osteotomy surgery was reported to be in the range of 75% to 85%; conversely, a significant number of patients were dissatisfied after OWHTO. 8 , 25 One reason for dissatisfaction was the presence of severe knee-articular cartilage damage. 26 , 37 A previous study demonstrated that patients with varus recurrence after OWHTO do not experience poor clinical outcomes compared to patients with no varus recurrence.…”

Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy

“…If necessary, CT scanning and 3D reconstruction can be performed to evaluate the joint space between the medial and lateral compartments to indirectly evaluate cartilage regeneration and OA progression, and, if necessary, magnetic resonance examination can be performed. (iii) Functional evaluation: At present, quantitative evaluation methods such as HSS, KSS, KOOS, and the WOMAC osteoarthritis index can be used to evaluate knee joint function after knee osteotomy for alignment correction 77‐79 . (iv) Guiding rehabilitation exercise: Postoperative rehabilitation focuses on improving lower extremity muscle strength, training for normal walking, and increasing the knee joint range of motion.…”

“…(iii) Functional evaluation: At present, quantitative evaluation methods such as HSS, KSS, KOOS, and the WOMAC osteoarthritis index can be used to evaluate knee joint function after knee osteotomy for alignment correction. 77 , 78 , 79 (iv) Guiding rehabilitation exercise: Postoperative rehabilitation focuses on improving lower extremity muscle strength, training for normal walking, and increasing the knee joint range of motion. (v) If the patient requires removal of the internal fixation, local and full‐length X‐ray films of both lower extremities should be taken 12–18 months after surgery.…”