The outcome at ten years of lateral closing-wedge high tibial osteotomy

Abstract

The aim of this study was to examine the functional outcome at ten years following lateral closing wedge high tibial osteotomy for medial compartment osteoarthritis of the knee and to define pre-operative predictors of survival and determinants of functional outcome. 164 consecutive patients underwent high tibial osteotomy between 2000 and 2002. A total of 100 patients (100 knees) met the inclusion criteria and 95 were available for review at ten years. Data were collected prospectively and included patient demographics, surgical details, long leg alignment radiographs, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and Knee Society scores (KSS) pre-operatively and at five and ten years follow-up. At ten years, 21 patients had been revised at a mean of five years. Overall Kaplan-Meier survival was 87% (95% confidence interval (CI) 81 to 94) and 79% (95% CI 71 to 87) at five and ten years, respectively. When compared with unrevised patients, those who had been revised had significantly lower mean pre-operative WOMAC Scores (47 (21 to 85) vs 65 (32 to 99), p < 0.001), higher mean age (54 yrs (42 to 61) vs 49 yrs (26 to 66), p = 0.006) and a higher mean BMI (30.2; 25 to 39 vs 27.9; 21 to 36, p = 0.005). Each were found to be risk factors for revision, with hazard ratios of 10.7 (95% CI 4 to 28.6; pre-operative WOMAC < 45), 6.5 (95% CI 2.4 to 17.7; age > 55) and 3.0 (95%CI 1.2 to 7.6; BMI > 30). Survival of patients with pre-operative WOMAC > 45, age < 55 and BMI < 30 was 97% at five and ten years. WOMAC and KSS in surviving patients improved significantly between pre-operative (mean 61; 32 to 99) and five (mean 88; 35 to 100, p = 0.001) and ten years (mean 84; 38 to 100, p = 0.001). Older patients had better functional outcomes overall, despite their higher revision rate. This study has shown that improved survival is associated with age < 55 years, pre-operative WOMAC scores > 45 and, a BMI < 30. In patients over 55 years of age with adequate pre-operative functional scores, survival can be good and functional outcomes can be significantly better than their younger counterparts. We recommend the routine use of pre-operative functional outcome scores to guide decision-making when considering suitability for high tibial osteotomy.

The Effect of Sliding Humeral Osteotomy (SHO) on Frontal Plane Thoracic Limb Alignment: An Ex Vivo Canine Cadaveric Study

“…In conclusion, in the ex vivo setting, SHO was associated with significant alterations in thoracic limb alignment when assessed using both standing and recumbent limb positions. The results of our study suggest a novel mechanism by which SHO might assert clinical effects in vivo, namely through alteration of thoracic limb alignment as has been documented in high tibial osteotomies in people . Future work is necessary to determine whether the differences in limb alignment described in our ex vivo study occur after SHO in the clinical setting.…”

“…The results of our study suggest a novel mechanism by which SHO might assert clinical effects in vivo, namely through alteration of thoracic limb alignment as has been documented in high tibial osteotomies in people. 9,10,38,39 Future work is necessary to determine whether the differences in limb alignment described in our ex vivo study occur after SHO in the clinical setting.…”

Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis

“… 19 2015 OCS 89 6 5 Hernigou and Ma 20 2001 OCS 245 8 5, 10 Howells et al . 21 2014 OCS 95 5 5, 10 Hui et al . 22 2010 OCS 413 6 5, 10 Koshino et al .…”

Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review

“…Previous studies have reported that a pre-operative BMI higher than 27.5 is a significant risk factor for early failure [25], and patients with BMI over 30 exhibit significantly lower KSS and WOMAC scores 5 years after HTO [28]. Moreover, HTO is not advisable for patients older than 65 years due to the 7.6% increased risk per year of age and the 1.5-fold relative risk of failure compared to younger patients [29].…”