Satisfactory 10-year survivorship of medial opening wedge high tibial osteotomy for isolated medial compartment osteoarthritis and varus alignment: An analysis from a high-volume institution.
Cristian A Brito Ayet, Fabio Mancino, Yoong P Lim, Kevin Qian, George Jacob, David A Parker
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引用次数: 0
Abstract
Purpose: Medial opening wedge high tibial osteotomy (MOWHTO) is a reliable joint-preserving surgical procedure for isolated medial compartment knee osteoarthritis (OA) and overload. The aim of this study was to evaluate the long-term survivorship and clinical outcomes of patients undergoing MOWHTO and to identify the risk factors associated with an increased risk of failure.
Methods: This was a retrospective study of prospectively collected patients who underwent MOWHTO for isolated medial OA and overload between 2002 and 2023. Clinical outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity score. Radiographic analysis included hip-knee-ankle (HKA) angle and medial proximal tibial angle (MPTA). Survivorship was intended from conversion to total knee arthroplasty (TKA). Logistic regression was used to identify risk factors, and p values < 0.05 were considered significant.
Results: Four hundred thirty-one patients who underwent MOWHTO were included for analysis. Males were 82.5%, and the mean age was 49.1 ± 8.0 years. The KOOS increased in any subsection at mean 5.7 ± 4.5 years of follow-up (p < 0.001). Complication rate was 35.9% and reoperation rate was 25.5% at mean 9.6 years of follow-up. Removal of metal hardware due to pain and/or discomfort was the main cause of reoperation in 22% of the patients. The cumulative rate of conversion to TKA at 5 years was 2.2%, at 10 years 17.8% and at 15 years 37.1%. Age (odds ratio [OR]: 1.05, p = 0.017), wedge thickness (OR: 1.08, p = 0.015), medial femoral condyle OA (OR: 3.41, p = 0.029), medial tibial plateau OA (OR: 2.04, p = 0.044), post-operative HKA (OR: 1.25, p = 0.031) and post-operative MPTA (OR: 1.26, p = 0.04) were associated with an increased risk of failure.
Conclusion: MOWHTO yields satisfactory 10-year survivorship in patients with medial compartment isolated knee OA and overload. Age, preoperative stage of OA, cartilage wear and post-operative alignment are relevant patient-related risk factors for reduced survivorship.
Level of evidence: Level III, retrospective cohort study.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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