孤立的胫骨畸形是最常见的内翻模式在北美的患者进行内侧开楔形高位胫骨截骨

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-24 DOI:10.1002/jeo2.70357

Takaaki Hiranaka, Takeo Tokura, Nicola D. Mackay, Ryan M. Degen, Kevin R. Willits, Robert B. Litchfield, Alan M. J. Getgood

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引用次数: 0

摘要

目的评估北美人群中内翻对准畸形的位置，并评估基于骨畸形位置的内侧开口楔形高位胫骨截骨术（MOWHTO）后早期全膝关节置换术（TKA）转换率和无TKA生存率。方法对内翻对准患者行MOWHTO手术进行回顾性分析。畸形分析采用自动化软件测量髋关节-膝关节-踝关节（HKA）角、胫骨近端机械内侧角（mMPTA）和股骨远端机械外侧角（mLDFA）。mMPTA异常定义为>； 85°，mLDFA异常定义为>；90°。病例根据畸形位置分为四组：胫骨、股骨、合并或无骨畸形。使用卡方检验分析各组间TKA转换率的差异，使用Kaplan-Meier生存分析确定无TKA生存，使用log-rank检验评估组间差异。结果共纳入271例患者，平均年龄51.6岁；平均随访时间：3.6年)。平均HKA角度为173.0°±3.1°。271例患者中，胫骨畸形占38%（103例），股骨畸形占18%（48例），合并畸形占11%（30例），无骨畸形占33%（90例）。胫骨组、股骨组、合并组和无骨畸形组TKA转换率分别为3% （n = 3/103）、0% （n = 0/48）、7% （n = 2/30）和9% (n = 8/90)，组间差异无统计学意义（p = 0.080）。Kaplan-Meier生存分析显示，四组患者无tka生存率无显著差异（p = 0.185）。结论在这个北美队列中，分析了不同的内翻畸形位置，孤立的胫骨畸形是最常见的。无论畸形位置如何，TKA转换率仍然很低，这表明即使对于没有孤立性胫骨畸形的患者，MOWHTO也可能是有益的。证据等级三级。

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Isolated tibial deformity is the most prevalent varus pattern in North American patients undergoing medial opening wedge high tibial osteotomy

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Isolated tibial deformity is the most prevalent varus pattern in North American patients undergoing medial opening wedge high tibial osteotomy

Purpose

To evaluate the location of deformity in varus alignment in a North American population and assess early total knee arthroplasty (TKA) conversion rates and TKA-free survival following medial opening wedge high tibial osteotomy (MOWHTO) based on the bony deformity location.

Methods

A retrospective analysis was performed on patients with varus alignment who underwent MOWHTO. Deformity analysis measured the hip–knee–ankle (HKA) angle, mechanical medial proximal tibial angle (mMPTA) and mechanical lateral distal femoral angle (mLDFA) using automated software. An abnormal mMPTA was defined as <85° and an abnormal mLDFA was defined as >90°. Cases were classified into four groups based on deformity location: tibial, femoral, combined or no bony deformity. The differences in TKA conversion rates among groups were analysed using the chi-square test, while TKA-free survival was determined using Kaplan–Meier survival analysis, with between-group differences assessed using the log-rank test.

Results

A total of 271 patients were included (mean age: 51.6 years; mean follow-up: 3.6 years). The mean HKA angle was 173.0° ± 3.1°. Among the 271 patients, 38% (n = 103), 18% (n = 48), 11% (n = 30) and 33% (n = 90) had tibial, femoral, combined and no bony deformity, respectively. TKA conversion rates were 3% (n = 3/103), 0% (n = 0/48), 7% (n = 2/30) and 9% (n = 8/90) for the tibial, femoral, combined and no bony deformity groups, respectively, with no significant difference among the groups (p = 0.080). Kaplan–Meier survival analysis showed no significant difference in TKA-free survival among the four groups (p = 0.185).

Conclusion

In this North American cohort, various varus deformity locations were analysed, with isolated tibial deformity being the most prevalent. Regardless of deformity location, TKA conversion rates remained low, suggesting that MOWHTO may be beneficial even in patients without isolated tibial deformity.