Mild asymptomatic lateral osteoarthritis does not compromise outcomes after medial opening-wedge high tibial osteotomy

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2026-03-31 Epub Date: 2026-01-21 DOI:10.1002/ksa.70268

Dries Van Leemput, Jens Vanlommel, Nathalie Van Beek, Steven Claes

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引用次数: 0

Abstract

Purpose

High tibial osteotomy (HTO) is a reliable treatment for medial gonarthrosis in painful varus knees, relieving pain by redistributing load to the lateral compartment. Traditionally, lateral compartment osteoarthritis (OA) has been considered a contraindication. However, the recent ESSKA consensus suggests that mild lateral OA may not be an absolute contraindication, although supporting evidence remains limited. This retrospective study investigates the safety and efficacy of HTO in patients with mild-to-moderate asymptomatic lateral OA, hypothesising that HTO provides significant pain relief and functional improvement.

Methods

A single-centre retrospective observational study was conducted on 132 patients who underwent HTO between 2017 and 2020 at AZ Herentals, Belgium. Inclusion criteria were completion of a 2-year postoperative questionnaire and preoperative magnetic resonance imaging (MRI) or single-photon emission computed tomography (SPECT-CT) within 1 year before surgery. The ‘Knee Injury and Osteoarthritis Outcome Score–Physical Function Short Form’ and ‘Numeric Pain Rating Scale’ were used. Lateral OA severity was assessed using radiographs, MRI and SPECT-CT. Outcomes were compared across different grades of lateral OA.

Results

A total of 132 patients (95 men, 38 women; mean age 56 ± 8.7 years) were included. Patients with mild or moderate lateral OA signs on MRI showed significant improvement in pain and function up to 2 years. This was consistent with SPECT-CT and radiographic findings. No significant differences were observed between patients with different degrees of lateral OA. Linear regression revealed that larger osteophytes on MRI predicted more pain (β = 40.2, p = 0.0037) and worse function (β = 23.2, p = 0.049), while lower SPECT uptake predicted less pain (β = –16.9, p = 0.031).

Conclusion

At 2 years post-HTO, pain and function did not differ significantly between patients with or without mild-to-moderate lateral gonarthrosis. Thus, mild asymptomatic lateral gonarthrosis should not be considered a contraindication for HTO. Longer-term studies are needed to confirm these findings.

Level of Evidence

Level III, retrospective comparative study.

查看原文本刊更多论文

轻度无症状外侧骨关节炎不影响内侧开楔形胫骨高位截骨后的预后。

目的：胫骨高位截骨术（HTO）是治疗疼痛性膝内翻的内侧关节病的可靠方法，通过将负荷重新分配到外侧腔室来减轻疼痛。传统上，侧室骨关节炎（OA）被认为是一种禁忌。然而，最近的ESSKA共识表明，尽管支持证据仍然有限，但轻度外侧OA可能不是绝对禁忌症。本回顾性研究探讨了HTO治疗轻至中度无症状侧位性骨关节炎患者的安全性和有效性，并假设HTO能显著缓解疼痛和改善功能。方法：对2017年至2020年在比利时AZ Herentals接受HTO治疗的132例患者进行单中心回顾性观察研究。纳入标准为术前1年内完成术后2年问卷和术前磁共振成像（MRI）或单光子发射计算机断层扫描（SPECT-CT）。采用“膝关节损伤和骨关节炎结局评分-身体功能简表”和“数值疼痛评定量表”。通过x线片、MRI和SPECT-CT评估侧OA严重程度。比较不同级别侧骨关节炎的结果。结果：共纳入132例患者，其中男性95例，女性38例，平均年龄56±8.7岁。MRI显示轻度或中度侧位性OA症状的患者疼痛和功能显著改善长达2年。这与SPECT-CT和x线检查结果一致。不同程度侧骨关节炎患者间无明显差异。线性回归结果显示，MRI骨赘越大，疼痛程度越重（β = 40.2, p = 0.0037），功能越差（β = 23.2, p = 0.049）， SPECT骨赘摄取越低，疼痛程度越轻（β = -16.9, p = 0.031）。结论：在hto后2年，有或没有轻度至中度外侧关节病的患者的疼痛和功能没有显着差异。因此，轻度无症状外侧关节病不应被视为HTO的禁忌症。需要更长期的研究来证实这些发现。证据等级：III级，回顾性比较研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

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).