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DOI: 10.1055/a-1098-8894
Health-Related Quality of Life – an Underestimated Factor to Evaluate the Treatment Success after Open Wedge HTO Surgery: Prospective 6-Years Follow-Up
Article in several languages: English | deutsch![](https://www.thieme-connect.de/media/zfo/202103/lookinside/thumbnails/10-1055-a-1098-8894_ou5497_en-1.jpg)
Abstract
Background The subjective health related quality of life in patients with degenerative joint diseases is an important variable to evaluate the treatment outcome. In this study, mid-term results of open wedge HTO were analysed and compared to the subjective quality of life (SF 36) of the general population. Furthermore, the relationships of preoperative assessed subscales of the health-related quality of life (SF 36) and the conversion to knee arthroplasty were analysed.
Methods The cohort consisted of 120 patients who were prospectively followed-up after open wedge HTO. At five follow-up points of time, patients were examined and asked about their subjective, health-related quality of life using the SF 36 score.
Results 104 patients were included and evaluated until the last follow-up (mean: 81.2 ± 11.3 months after open wedge HTO; follow-up rate: 86.7%). Six years after open wedge HTO, similar values in several psychologic subscales of the SF 36 (BP, GH, V, MH) and the mental health component summary score (MCS) compared to the general population were found. The physical health component summary score (PCS) showed a significant improvement relative to the preoperative values. Nine out of 104 patients (8.7%) received a knee arthroplasty (50.1 ± 25.0 months). Low preoperative values of the subscales “physical functioning” (PF) and “bodily pain” (BP) were identified as risk factors in terms of conversion to a total knee arthroplasty.
Conclusions Patients with medial unicompartimental knee osteoarthrosis treated with open wedge HTO showed very good results. The health-related quality of life was nearly as high as in the general population. Patients with preoperative low physical function and high pain values have a higher risk to have a conversion to knee arthroplasty. Surgeons should be aware of these factors if an open wedge HTO is considered.
Publication History
Article published online:
27 February 2020
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References/Literatur
- 1 Lobenhoffer P. [Importance of osteotomy around to the knee for medial gonarthritis. Indications, technique and results]. Orthopade 2014; 43: 425-431 doi:10.1007/s00132-013-2189-7
- 2 Oest O. [The significance of axial misalignment as a pre-osteoarthrotic deformity, and its radiological assessment]. Unfallheilkunde 1978; 81: 629-633
- 3 Spahn G, Fritz J, Albrecht D. et al. [Coincidence and therapy of dysalignments and degenerative knee cartilage lesions. Results from the German CartilageRegistry DGOU]. Z Orthop Unfall 2017; 155: 457-467 doi:10.1055/s-0043-108649
- 4 Dickschas J, Staubli A, Harrer J. [Osteotomies around the knee]. Z Orthop Unfall 2019; 157: 203-218 doi:10.1055/a-0582-8040
- 5 Schallberger A, Jacobi M, Wahl P. et al. High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 2011; 19: 122-127 doi:10.1007/s00167-010-1256-4
- 6 Song SJ, Bae DK, Kim KI. et al. Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics. Knee Surg Sports Traumatol Arthrosc 2019; 27: 1310-1319 doi:10.1007/s00167-019-05390-w
- 7 Ryu SM, Park JW, Na HD. et al. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients. Knee Surg Relat Res 2018; 30: 17-22 doi:10.5792/ksrr.17.006
- 8 Cao Z, Mai X, Wang J. et al. Unicompartmental knee arthroplasty vs. high tibial osteotomy for knee osteoarthritis: a systematic review and meta-analysis. J Arthroplasty 2018; 33: 952-959 doi:10.1016/j.arth.2017.10.025
- 9 Robertsson O, W-Dahl A. The risk of revision after TKA is affected by previous HTO or UKA. Clin Orthop Relat Res 2015; 473: 90-93 doi:10.1007/s11999-014-3712-9
- 10 Keenan OJF, Clement ND, Nutton R. et al. Older age and female gender are independent predictors of early conversion to total knee arthroplasty after high tibial osteotomy. Knee 2019; 26: 207-212 doi:10.1016/j.knee.2018.11.008
- 11 van Wulfften Palthe AFY, Clement ND, Temmerman OPP. et al. Survival and functional outcome of high tibial osteotomy for medial knee osteoarthritis: a 10–20-year cohort study. Eur J Orthop Surg Traumatol 2018; 28: 1381-1389 doi:10.1007/s00590-018-2199-6
- 12 Khoshbin A, Sheth U, Ogilvie-Harris D. et al. The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc 2017; 25: 887-894 doi:10.1007/s00167-015-3849-4
- 13 Floerkemeier S, Staubli AE, Schroeter S. et al. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 2013; 21: 170-180 doi:10.1007/s00167-012-2087-2
- 14 Goshima K, Sawaguchi T, Sakagoshi D. et al. Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25: 918-923 doi:10.1007/s00167-015-3847-6
- 15 Kohn L, Sauerschnig M, Iskansar S. et al. Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21: 146-151 doi:10.1007/s00167-012-2016-4
- 16 Schuster P, Geßlein M, Schlumberger M. et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 2018; 46: 1362-1370 doi:10.1177/0363546518758016
- 17 Saier T, Minzlaff P, Feucht MJ. et al. Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25: 934-942 doi:10.1007/s00167-015-3938-4
- 18 Ihle C, Ateschrang A, Grunwald L. et al. Health-related quality of life and clinical outcomes following medial open wedge high tibial osteotomy: a prospective study. BMC Musculoskelet Disord 2016; 17: 215 doi:10.1186/s12891-016-1076-x
- 19 Schröter S, Ateschrang A, Lowe W. et al. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 2017; 25: 325-332 doi:10.1007/s00167-015-3592-x
- 20 Galla M, Lobenhoffer P. Die öffnende valgisierende Umstellungsosteomie der proximalen Tibia mit dem TomoFix™-Plattenfixateur. Oper Orthop Traumatol 2004; 16: 397-417
- 21 Staubli AE, De Simoni C, Babst R. et al. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 2003; 34 (Suppl. 02) B55-B62
- 22 Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2003; 11: 132-138
- 23 Ihle C, Merk J, Schröter S. et al. Rehabilitation nach kniegelenksnaher Umstellungsosteotomie. Knie Journal 2019; 1: 36-44
- 24 Ware jr. JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998; 51: 903-912
- 25 Morfeld M, Kirchberger I, Bullinger M. Fragebogen zum Gesundheitszustand (SF-36). Göttingen: Hogrefe; 2011
- 26 Cotic M, Vogt S, Hinterwimmer S. et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2032-2040 doi:10.1007/s00167-014-2914-8
- 27 Schröter S, Gonser CE, Konstantinidis L. et al. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy 2011; 27: 644-652 doi:10.1016/j.arthro.2011.01.008
- 28 Bode G, Ogon P, Pestka J. et al. Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 2015; 39: 689-696 doi:10.1007/s00264-014-2547-z
- 29 Morin V, Pailhe R, Duval BR. et al. Gait analysis following medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1838-1844 doi:10.1007/s00167-017-4421-1
- 30 Bastard C, Mirouse G, Potage D. et al. Return to sports and quality of life after high tibial osteotomy in patients under 60 years of age. Orthop Traumatol Surg Res 2017; 103: 1189-1191 doi:10.1016/j.otsr.2017.08.013
- 31 Bode G, von Heyden J, Pestka J. et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1949-1955 doi:10.1007/s00167-013-2762-y
- 32 McNamara IR, Birmingham TB, Marsh JD. et al. A preference-based single-item measure of quality of life following medial opening wedge high tibial osteotomy: large improvements similar to arthroplasty. Knee 2014; 21: 456-461 doi:10.1016/j.knee.2013.11.014
- 33 Grünwald L, Angele P, Schröter S. et al. Patientsʼ expectations of osteotomies around the knee are high regarding activities of daily living. Knee Surg Sports Traumatol Arthrosc 2019; 27: 3022-3031 doi:10.1007/s00167-018-5326-3
- 34 Petersen W, Metzlaff S. Open wedge high tibial osteotomy (HTO) versus mobile bearing unicondylar medial joint replacement: five years results. Arch Orthop Trauma Surg 2016; 136: 983-989 doi:10.1007/s00402-016-2465-1
- 35 Song SJ, Bae DK, Kim KI. et al. Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics. Knee Surg Sports Traumatol Arthrosc 2019; 27: 1310-1319 doi:10.1007/s00167-019-05390-w
- 36 Santoso MB, Wu L. Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. J Orthop Surg Res 2017; 12: 50 doi:10.1186/s13018-017-0552-9
- 37 Lim JBT, Chong HC, Pang HN. et al. Revision total knee arthroplasty for failed high tibial osteotomy and unicompartmental knee arthroplasty have similar patient-reported outcome measures in a two-year follow-up study. Bone Joint J 2017; 99-B: 1329-1334 doi:10.1302/0301-620X.99B10.BJJ-2017-0034.R1
- 38 Pailhé R, Cognault J, Massfelder J. et al. Comparative study of computer-assisted total knee arthroplasty after opening wedge osteotomy versus after unicompartmental arthroplasty. Bone Joint J 2016; 98-B: 1620-1624 doi:10.1302/0301-620X.98B12.38064
- 39 Niemeyer P, Schmal H, Hauschild O. et al. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 2010; 26: 1607-1616 doi:10.1016/j.arthro.2010.05.006
- 40 Bonnin M, Chambat P. [Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis]. Orthopade 2004; 33: 135-142 doi:10.1007/s00132-003-0586-z