胫骨高位截骨和初次全膝关节置换术后转换全膝关节置换术的比较临床结果：一项匹配队列研究。

IF 3.3 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-07-28 DOI:10.1016/j.jisako.2025.100931

Ignacio Fernández Z, Myles Coolican

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引用次数: 0

摘要

目的：膝关节骨关节炎（OA）导致疼痛和功能下降。虽然全膝关节置换术（TKA）是一种确定的治疗方法，高胫骨截骨术（HTO）为年轻患者提供了一种保留关节的选择。然而，HTO患者最终可能需要转换为TKA。本研究旨在比较先前内侧开口楔形HTO后接受TKA的患者的临床、功能和患者报告的结果测量（PROMs），并随访≥12个月。方法：这项回顾性队列研究使用了来自澳大利亚悉尼膝关节研究所的数据。根据年龄、性别、外科医生、BMI、内侧室骨关节炎和大约手术年份，将从HTO转换为TKA的患者与原发TKA患者进行1:1的匹配。纳入标准为2011 - 2023年间的TKA，同一膝关节有HTO病史，两种手术均由三名接受过奖学金培训的骨科医生之一进行；随访≥1年。收集的数据包括牛津膝关节评分（OKS）、退伍军人兰德健康调查（VR-12）、活动范围（ROM）、住院时间和卡顿-德尚指数（CDI）。51例TKA患者被匹配。统计分析使用配对t检验、Mann-Whitney U检验、卡方检验和Fisher精确检验。结果：两组术后OKS和VR-12身体评分均有统计学显著改善(结论：从HTO转换为TKA的临床和功能结果与原发性TKA相当。这些发现强调了HTO后TKA的有效性，以及在这类患者中仔细的术前计划的重要性。证据等级：3；

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Comparable clinical outcomes after conversion total knee arthroplasty following high tibial osteotomy and primary total knee arthroplasty: A matched cohort study

Introduction/Objectives

Knee osteoarthritis (OA) leads to pain and functional decline. While total knee arthroplasty (TKA) is a definitive treatment, high tibial osteotomy (HTO) offers a joint-preserving alternative for younger patients with malalignment. However, patients with HTO may eventually require conversion to TKA. This study aimed to compare clinical, functional, and patient-reported outcome measures (PROMs) of patients undergoing TKA after a prior medial opening wedge HTO to a matched cohort who had a primary TKA, with follow-up at ≥12 months.

Methods

This retrospective cohort study used data from The Knee Institute, Sydney, Australia. Patients converted from HTO to TKA were matched 1:1 to primary TKA patients based on age, sex, surgeon, body mass index, medial compartment OA, and approximate year of surgery. Inclusion criteria were TKA between 2011 and 2023, prior HTO in the same knee, both procedures by one of three fellowship-trained orthopaedic surgeons; and ≥ one year of follow-up. Data collected included the Oxford Knee Score (OKS), the Veterans RAND 12-Item Health Survey (VR-12), range of motion (ROM), hospital stay, and the Caton–Deschamps index (CDI). Fifty-one converted TKA patients were matched. Statistical analysis used paired t-tests, Mann–Whitney U, chi-square, and Fisher’s exact tests.

Results

Both groups showed statistically significant postoperative improvements in the OKS and the VR-12 physical scores (p < 0.01), with no statistically significant difference between groups. ROM improved in both groups; flexion was slightly higher in the primary TKA group but not statistically significant. Patella baja was more frequent in the HTO-to TKA group; however, this was not statistically significant (p = 0.054). Both groups had a median hospital stay of 5 days; however, the HTO-to-TKA group demonstrated a statistically significant distribution shift toward longer stays.

Conclusion

Conversion from HTO to TKA yields comparable clinical and functional outcomes to primary TKA. These findings emphasize the effectiveness of TKA after HTO and the importance of careful preoperative planning in this patient population.