The Influence of Preoperative Tibial Bone Marrow Edema on Outcomes After Medial Opening-Wedge High Tibial Osteotomy

Abstract

Background: The relationship between preoperative subchondral bone marrow edema (BME) in the osteoarthritic knee and pain has been established. However, little is known about the influence of preoperative BME on outcomes after medial opening-wedge high tibial osteotomy (MOHTO). The purpose of this study was to clarify the association between preoperative BME severity and clinical outcomes after MOHTO at intermediate follow-up. Methods: We reviewed the cases of 105 consecutive patients who underwent MOHTO for osteoarthritis of the knee with preoperative subchondral BME in the medial aspect of the tibia between January 2005 and December 2015. BME was evaluated using magnetic resonance imaging (MRI). The sizes of the BME lesions were determined on the basis of the maximum diameter and were classified as small (<1 cm), medium (<2 cm), large (<4 cm), or very large (diffuse; >4 cm). Associations between preoperative BME severity and postoperative outcomes at a mean follow-up of 6.2 years (range, 2.0 to 14.3 years) were evaluated according to a Spearman correlation matrix with each reviewer’s grades. Functional outcomes were assessed using the Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Short Form-12 (SF-12) questionnaire. Survival rate and complications were also evaluated. Results: The degree of preoperative BME was not significantly correlated with postoperative outcomes (p > 0.05). There were significant improvements between the preoperative and latest follow-up assessments in all functional outcome categories (p < 0.001). Patients demonstrated marked improvements with respect to pain, function, and quality of life. The overall survival rate was 95.2%, with a mean follow-up of 6.2 years. Six major complications were identified in 5.7% of the patients, and these resulted in 5 patients (4.8%) who had conversion to total knee arthroplasty. Conclusions: We did not find any correlation between preoperative subchondral BME severity and postoperative outcomes. MOHTO showed good functional outcomes, a low major complication rate, and an excellent survival rate with a mean follow-up of 6.2 years, regardless of the degree of preoperative BME. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Association of Preoperative Tibial Varus Deformity With Joint Line Orientation and Clinical Outcome After Open-Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis: A Propensity Score–Matched Analysis

“…In practical terms, according to recently published studies on OWHTO, the mean value of preoperative MPTA ranged from 83°to 86°(SD, 2°-3°), indicating that some patients who underwent OWHTO had no definite tibial-based varus deformity. 2,14,22,24,25 Similarly, in the present study, the mean preoperative MPTA was 85.0°6 2.2°, and definite tibial deformity was not noted in about 40% of patients.…”

Postoperative Bone Marrow Lesions (BMLs) are Associated with Pain Severity in Patients Undergoing Open Wedge High Tibial Osteotomy (OWHTO)

“…Lately, a few studies have revealed the relationship between preoperative BMLs and postoperative clinical outcomes including pain relief 24,26 . However, to our knowledge, no studies have investigated the relationship between postoperative BMLs and pain states in patients undergoing OWHTO.…”

“…So far, only a few studies have analyzed the BMLs changes and their effect on the prognosis for patients undergoing OWTHO [23][24][25] . Yang et.al reviewed 105 patients who underwent OWHTO, and they did not nd any correlation between preoperative bone marrow edema (BME) severity and postoperative outcomes 26 .…”

Editorial Commentary: Chronological Age Is Not Associated With Adverse Postoperative Outcomes After High Tibial Osteotomy: Contradiction of Another Dogma From the Past

“…O pen wedge high tibial osteotomy (OWHTO) is an effective surgical procedure for the treatment of medial compartment osteoarthritis of the knee and for correction of lower extremity malalignment. [1][2][3] Numerous clinical studies have demonstrated good and satisfactory outcomes with HTO [4][5][6] ; however, questions remain regarding potential factors that lead to deteriorating outcomes over time. 7,8 One such question is whether patient age leads to poor outcomes or survival, and the question has become more relevant with population aging and increased demand for the retention of native knee joints.…”