Health-related quality of life and clinical outcomes following medial open wedge high tibial osteotomy: a prospective study

Abstract

BackgroundOpen wedge high tibial osteotomy (HTO) is an established method for the treatment of patients with varus malalignment and medial compartment osteoarthritis. In these patients, health-related quality of life (HRQL) can be improved by using this procedure. The purpose of the present study consisted in evaluating HRQL up to 18 months after HTO, comparing the results to values of the German normal population, and in analyzing the impact of preoperative HRQL on the postoperative clinical result. It was hypothesized that normal values in physical and mental health can be achieved within 18 months after operation. Study design: Prospective case series. Level of evidence: IV.Methods120 patients were included in this prospective case series from 12/2008 to 12/2011. All patients underwent open wedge HTO without a bone graft using the TomoFixTM plate. HRQL was assessed by using the SF-36 questionnaire, preoperatively, as well as 6, 12, and 18 months postoperatively. Regular scoring, norm-based scaling, and the physical and mental component summary scores (PCS and MCS) were evaluated. Clinical outcome was assessed by using Lequesne, Lysholm, HSS and IKDC Score.ResultsHRQL could be described in 96 patients. The PCS of HRQL showed a statistically significant pre- to postoperative improvement (30.2 ± 13.4 to 45.9 ± 13.5 after 18 months). A reduced preoperative mental component summary score (MCS) resulted in lower values of each clinical score (p < 0.05) and in a prolonged duration of incapacity for work (MCS < 50:15.0 ± 12.8 weeks, vs. MCS ≥ 50: 9.1 ± 4.8 weeks, p < 0.05). MCS values improved from the pre- to postoperative measurements and comparable values to the normal population were reached already within 6 months after surgery (46.0 ± 14.9 pre-operatively and 48.5 ± 13.7 after 6 months), and after 18 months even a score of 49.5 ± 12.4 was achieved.ConclusionLower preoperative mental component score results in reduced postoperative clinical outcome and prolonged duration of incapacity for work after HTO. In contrast to PCS, MCS showed comparable values to the normal population within 6 months after HTO.

Outcome after treatment of osteoarthritis with open-wedge high-tibial osteotomy with a plate: 2-year results of a Japanese cohort study

“…While patients' age in our study is comparable with another study in Japanese OWHTO patients, 28 our patients are more than 15 years older than in other European studies using the same implant in standard size. 6,11,29 Although this suggests a worse functional outcome, we observed a marked improvement in all PROs, ROM, ability to sit Japanese style, and return to sports. This may be attributed to possible cultural differences with high activity at higher age and lower BMI in Japanese patients and is also reported from another HTO study.…”

Clinical Evaluation Of Post High Tibial Osteotomy Patients In Regional General Hospitals Dr. Soetomo Surabaya, Husada Utama Hospital Surabaya, Al-Irsyad Hospital Surabaya In 2010 - 2015

“…The proportion of people with knee OA increases with age in the population in both women and men. Increased prevalence and incidence of OA at older ages is thought to result from the accumulation of exposure to various risk factors and biological changes that occur in the aging process such as cartilage depletion, decrease in muscle strength, decreased proposition and oxidative damage (Ihle, 2016).…”

Health-Related Quality of Life – an Underestimated Factor to Evaluate the Treatment Success after Open Wedge HTO Surgery: Prospective 6-Years Follow-Up

“…Studienkollektiv 120 Patienten willigten vor erfolgter operativer Versorgung mittels valgisierender Open-Wedge-HTO zwischen Dezember 2008 und Dezember 2011 zur Studienteilnahme ein. Im Rahmen einer ersten prospektiven klinischen Untersuchung wurden alle Patienten zunächst präoperativ und im Verlauf postoperativ zu weiteren 3 vordefinierten Zeitpunkten bis 18 Monate nach operativer Versorgung klinisch evaluiert [18,19]. In der vorliegenden Arbeit erfolgte eine weitere klinische Nachuntersuchung mindestens 6 Jahre nach bereits erfolgter Open-Wedge-HTO, um mittelfristige Behandlungsergebnisse darzustellen.…”

“…Betrachtet man die detaillierte Analyse der einzelnen Subskalen, sind insbesondere eine dekompensierte Schmerzsituation (Subskala BP) sowie eine starke Einschränkung der körperlichen Funktionsfähigkeit (Subskala PF) zum Zeitpunkt der Indikationsstellung für den Übergang in eine Knieprothese relevant. [18,29]. Bastard et al zeigten analog zu unseren Ergebnissen eine signifikante Verbesserung 1,3 Jahre nach HTO anhand des SF-36 im mentalen sowie im psychischen Summenscore [30].…”

“…Bastard et al zeigten analog zu unseren Ergebnissen eine signifikante Verbesserung 1,3 Jahre nach HTO anhand des SF-36 im mentalen sowie im psychischen Summenscore [30]. Ebenfalls konnte der Einfluss eines präoperativ reduzierten psychischen Gesundheitszustandes auf ein schlechteres kurzfristiges klinisches Behandlungsergebnis beschrieben werden [18]. Inwiefern sich Aspekte der Lebensqualität zum Zeitpunkt der Indikationsstellung auf das mittelfristige Behandlungsergebnis auswirken, war jedoch nicht bekannt.…”