Long-term Outcomes after Medial Open Wedge High Tibial Osteotomy – A Retrospective Study of 69 Patients

Abstract

Background

High tibial osteotomy (HTO) is a widespread option to avoid or delay total knee arthroplasty (TKA). The present study aimed to assess the long-term survival rate and postoperative subjective knee function after isolated medial open wedge HTO in patients with symptomatic medial compartment knee osteoarthritis (OA) and varus malalignment.

Methods

Sixty-nine patients (48.8 ± 6.7, 35–66 years; preoperative mechanical tibiofemoral angle [mTFA] −5.3 ± 3.4; −14.9–0.0° varus) treated with medial open wedge HTO using a TomoFix plate were included in this retrospective study, with a follow-up of at least 10 years (11.8 ± 1.0 years). The survival rate after HTO was calculated after 5 and 10 years. Subjective knee function was assessed using Hospital for Special Surgery (HSS), Oxford knee, Lequesne, and Lysholm scores.

Results

Thirty-three patients underwent conversion to TKA, on average, 7.0 ± 3.4 (1.3–13.7) years after HTO. Five- and ten-year survival rates were 84.1 and 60.9%, respectively. Patients without conversion to TKA showed a Lysholm score of 64.5 (35–92), Lequesne score of 7 (1–13), HSS score of 71 (56–86), and Oxford knee score of 38.5 (25–44) at the last follow-up (more than 10 years). Significantly higher scores were registered at the last follow-up compared to the preoperative state regarding the Lysholm score (preoperative: 43.5 [12–95]; follow-up: 64.5 [35–92]; p < 0.001). The HSS score (preoperative: 69.5 [43–93]; follow-up: 71 [56–86]; p = 0.6941) showed no statistically significant change during the 10-year follow-up period. The Lequesne score was significantly lower than the preoperative score (preoperative: 11.5 [0.5–22]; follow-up: 7 [1–13]; p < 0.001), indicating a lower handicap.

Conclusions

The majority of patients with a valgus medial compartmental knee OA treated with HTO with fixation using the TomoFix plate can expect no conversion to TKA for more than 10 years. Furthermore, patients without conversion to TKA after 10 years still had a significantly higher subjective knee function than preoperatively. Further research is needed to identify risk factors for conversion to TKA. This helps to guide surgeons in selecting patients who will benefit most from HTO.

Zusammenfassung

Hintergrund

Die hohe Tibiaosteotomie (HTO) ist ein weit verbreitetes Verfahren zur Vermeidung oder Verzögerung eine Knietotalendoprothese (KTP). Ziel der Studie war es, die langfristige Überlebensrate und die postoperative subjektive Kniefunktion nach isolierter medial öffnender HTO, bei Patienten mit symptomatischer medialer Kniegelenksarthrose (OA) und Varusfehlstellung zu untersuchen.

Methodik

69 Patienten (48,8 ± 6,7, 35–66 Jahre; präoperativer mechanischer tibiofemoraler Winkel [mTFA] −5,3 ± 3,4; −14,9–0,0° varus), die mit einer medial öffnenden HTO, unter Verwendung einer Tomofix-Platte, behandelt wurden, wurden in diese retrospektive Studie mit einem Follow-up von mindestens 10 Jahren (11,8 ± 1,0 Jahren) eingeschlossen. Die Überlebensrate nach HTO wurde nach 5 und 10 Jahren berechnet. Die subjektive Kniegelenksfunktion wurde anhand von HSS, Oxford Knee Score, Lequesne- und Lysholm-Score bewertet.

Ergebnisse

33 Patienten erhielten durchschnittlich 7,0 ± 3,4 (1,3–13,7) Jahre, nach erfolgter HTO, eine Knietotalendoprothese. Die 5- und 10-Jahres-Überlebensraten lagen bei 84,1% respektive 60,9%. Patienten ohne Übergang in eine KTP zeigten einen Lysholm-Score von 64,5 (35–92), einen Lequesne-Score von 7 (1–13), einen HSS-Score von 71 (56–86) und einen Oxford Knee Score von 38,5 (25–44) zum Zeitpunkt des letzten Follow-ups (mehr als 10 Jahre postoperativ). Bei der letzten Nachuntersuchung wurden im Vergleich zum präoperativen Zustand signifikant höhere Werte für den Lysholm-Score (präoperativ: 43,5 [12–95]; Follow-up: 64,5 [35–92]; p < 0,001), verzeichnet. Der HSS-Score (präoperativ: 69,5 [43–93]; Follow-up: 71 [56–86]; p = 0,6941) zeigte keine signifikante Veränderung über den 10-Jahres-Beobachtungszeitraum. Der Lequesne-Score war signifikant niedriger als präoperativ (präoperativ: 11,5 [0,5–22]; Follow-up: 7 [1–13]; p < 0,001), was einer geringeren Einschränkung entspricht.

Schlussfolgerungen

Für die Mehrheit der Patienten mit medialer Gonathrose, die eine Behandlung mittels HTO und Stabilisierung durch eine Tomofix-Platte erhalten, kann erwartet werden, dass mindestens 10 Jahre keine Implantation einer KTP notwendig wird. Darüber hinaus hatten Patienten, die nach 10 Jahren keine KTP erhalten hatten, weiterhin eine signifikant bessere subjektive Kniefunktion als präoperativ. Weitere Forschungsarbeiten sind erforderlich, um Risikofaktoren eines frühzeitigen Versagens der HTO zu identifizieren. Dies ermöglicht dem Operateur, Patienten zu selektieren, die am meisten von diesem Eingriff profitieren werden.

Keywords

HTO - long-term outcome - medial osteoarthritis

Schlüsselwörter

HTO - medial betonte Osteoarthrose - Langzeitergebnisse

Publikationsverlauf

Eingereicht: 02. März 2023

Angenommen nach Revision: 28. Juni 2023

Artikel online veröffentlicht:
30. August 2023

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