High survivorship and low complication rate in a single‐centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow‐up of 13 years

Abstract

PurposeThis study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single‐centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient‐reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively.MethodsA prospectively maintained single‐centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2, were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow‐up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score‐Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ‐5D, which is a standardised measure of health‐related quality of life. All lower limb alignment measurements were recorded pre‐ and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5‐ and 10‐year survivorship were recorded.ResultsA total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from −5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow‐up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10‐year survivorship was 97.2% and 91.9%, respectively.ConclusionMOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis.Level of EvidenceLevel IV, retrospective cohort study.

Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating

“…A methodical analysis is still prone to possible inaccuracy through PACS annotation planning or the use of software platforms [ 18 , 27 , 48 ]. PSI [ 16 , 22 ] and computer navigation [ 31 , 48 ] are comparable techniques, but each still harbours potential errors. During surgery, the failure to recognise hinge fractures [ 51 ], mismeasurement of the gap or misuse of the alignment may have a significant impact.…”

“…Knee preservation surgery has witnessed a rapid evolution of osteotomy techniques over the past two decades [ 4 , 9 , 21 , 36 , 48 , 56 ]. Medial unicompartmental knee osteoarthritis (OA) may be managed with a high tibial osteotomy (HTO) [ 30 , 31 ], distal femoral osteotomy (DFO) [ 17 , 39 ] or double‐level osteotomy (DLO) [ 4 ].…”

Neutral to slightly undercorrected mechanical leg alignment provides superior long‐term results in patients undergoing matrix‐associated autologous chondrocyte implantation

“…Periarticular osteotomies of the knee have been established as an effective treatment for unicompartmental osteoarthritis in patients with leg malalignment [20,25,27]. Although there is limited evidence for osteotomies in cartilage regenerative surgery, they have become increasingly popular in recent years [2,19].…”

Osteotomy around the painful degenerative varus knee has broader indications than conventionally described but must follow a strict planning process: ESSKA Formal Consensus Part I

“…Later, further series have demonstrated several disadvantages of the LCW technique [12,17,23], which ignited the move towards an opening wedge technique [26,30]. The current practice is largely dominated by either medial opening wedge high tibial osteotomy (MOWHTO) [19], LCW distal femoral osteotomy [27] or a combination of the two with double-level osteotomy (DLO) [32]. Whilst substantial elements of current osteotomy practice are built on solid foundations with a strong scientific evidence base, the inexperienced surgeon still faces several choices in areas where robust scientific evidence is absent [4].…”