Survival and Risk Factor Analysis of Medial Open Wedge High Tibial Osteotomy for Unicompartment Knee Osteoarthritis

Jin, Cheng; Song, Eun-Kyoo; Santoso, Asep; Ingale, Pramod; Choi, In Suck; Seon, Jong Keun

doi:10.1016/j.arthro.2019.08.040

Cited by 82 publications

(67 citation statements)

References 32 publications

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“…HTO is usually recommended for younger or early OA patients, since poor prognostic factors include severe joint destruction and advanced age [22,23]. However, the present study demonstrated that good results could be expected even in cases with severe knee OA.…”

Section: Discussioncontrasting

confidence: 49%

A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

Akamatsu

Kumagai

Yamada

et al. 2020

Preprint

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Background: The aim of the present study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee.Methods: A total of 90 knees of 76 patients who underwent HTO were investigated. OWHTO was performed in 45 knees of 40 patients with a correction angle of 15° or less, and CWHTO was performed in 45 knees of 36 patients with a correction angle of greater than 15°. Initial arthroscopy was performed at the time of HTO, and a second-look arthroscopy was performed at the time of plate removal. Cartilage repair was classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by measuring the femorotibial angle (FTA).Results: Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P<0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. There was no relationship between clinical outcomes and postoperative cartilage status in both HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair.Conclusions: CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.

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Section: Discussioncontrasting

confidence: 49%

A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

Akamatsu

Kumagai

Yamada

et al. 2020

Preprint

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“…In the carefully selected, young, active patient with coronal plane malalignment in the setting of isolated medial compartment arthrosis or cartilage damage, the medial opening wedge osteotomy has given the surgeon a mean to provide pain relief, increased quality of life, and longevity of activity without relegating the patient to a partial or total knee arthroplasty. 14,22 .…”

Section: Resultsmentioning

confidence: 99%

“…Traditional indications for the procedure include varus malalignment of the knee in conjunction with one of the following: medial compartment arthritic changes in isolation or combined with ligamentous instability, medial compartment collapse following meniscectomy, or large osteochondral lesions. 12,[20][21][22] Patient selection is paramount to achieving success in patients who are indicated for high tibial osteotomies. 11,21 Santoso et al described the ideal patients as those below the age of 65 years with high-activity levels, normal-range BMI, mild articular damage (not severe), no patellofemoral arthritis, good range of motion, and a stable knee.…”

Section: History and Indicationsmentioning

confidence: 99%

Osteotomies for the Management of Medial Compartment Defects of the Knee

et al. 2020

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For nearly three-quarters of a century the proximal tibia osteotomy has been used as an effective treatment for cartilage injuries of the knee. Over this same timeframe several advancements have been made in our diagnostic, preoperative planning, and technical execution of this procedure. As such, good-to-excellent short-, mid-, and long-term outcomes have been reported. Since its inception, the most important step in deciding on this procedure is identifying the ideal candidate. This candidate should be a young patient (<55 years old), active, with isolated medial compartment arthrosis without significant comorbidities. With appropriate patient selection and careful preoperative planning, the patient should achieve excellent results and high satisfaction.

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“…However, statistical signi cance for this nding was lacking [29]. A recent study from Jin et al concluded that grade ≥ 2 cartilage defects of the lateral compartment feature a signi cant risk factor for failure of the HTO procedure [36].…”

Section: Discussionmentioning

confidence: 98%

Focal Cartilage Defects of the Lateral Compartment do Influence the Outcome After High Tibial Valgus Osteotomy

Heinz

Reppenhagen

Horas

et al. 2020

Preprint

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BackgroundHigh tibial medial open-wedge valgus osteotomy (HTO) is a well-established procedure for unicompartimental medial osteoarthritis of the young and active patient. The aim of this study was to evaluate the influence of asymptomatic mild to moderate cartilage lesions of the lateral tibiofemoral compartment on the clinical outcome after HTO. MethodsFrom 2005 to 2012 a total of 63 patients underwent HTO for medial osteoarthritis of the knee at a single university orthopaedic center. Baseline data as well as intraoperative findings including the grade and location of cartilage lesions were evaluated retrospectively. Two groups were formed regarding the integrity of the lateral tibiofemoral compartment as measured by the Outerbridge score (group A: no lateral cartilage defects, group B: mild to moderate lateral cartilage defects). Functional outcome was assessed using the Knee and Osteoarthritis Outcome Score (KOOS) including its five subscores. ResultsComparing pre- and postoperative data, we identified an overall benefit of the HTO procedure as measured by the KOOS. Group A (no lateral cartilage defects) showed an increase in all five KOOS subscores (p=0.00 – 0.01), whereas for group B (mild to moderate lateral cartilage defects) only two KOOS subscores revealed a significant increase (p=0.03 – 0.04). There was also a statistically significant difference of the total KOOS score with higher values for group A at the postoperative visit. Cartilage defects with a higher Outerbridge score were associated with lower postoperative KOOS subscores. ConclusionsMild to moderate cartilage defects of the lateral compartment humble the total outcome after HTO procedure. Thus, indication for HTO should be made very carefully, if any degree of lateral cartilage degeneration is present.

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Survival and Risk Factor Analysis of Medial Open Wedge High Tibial Osteotomy for Unicompartment Knee Osteoarthritis

Cited by 82 publications

References 32 publications

A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

Osteotomies for the Management of Medial Compartment Defects of the Knee

Focal Cartilage Defects of the Lateral Compartment do Influence the Outcome After High Tibial Valgus Osteotomy

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