Article
Long-term outcomes after medial open wedge high tibial osteotomy – a prospective cohort study
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Authors
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Marc-Daniel Ahrend
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Daniel Petzold
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Steffen Schröter
- Jung-Stilling-Krankenhaus, Department of Traumatology and Reconstructive Surgery, Siegen, Germany
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Felix Finger
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Tina Histing
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Christoph Ihle
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
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Moritz Herbst
- Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Tübingen, Germany
| Published: | October 21, 2024 |
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Outline
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Objectives: Medial open wedge high tibial osteotomy (HTO) is a widespread and commonly accepted surgery to avoid or delay total knee arthroplasty (TKA) in patients with medial compartment knee osteoarthritis and varus malalignment. However, prospectively collected long-term outcomes and survival rates are limited. Therefore, the purpose of this cohort study was to assess the long-term subjective outcome and the survival rate (no conversion to TKA) following HTO.
Methods: In this prospective cohort study with initially 120 patients treated from 2008 to 2011 with medial open-wedge HTO (Tomofix plate), 76 patients (female: n = 20; age: 60.7 ± 7.8 years) were followed-up (follow-up rate: 63%). The minimum follow-up was 12 years or an earlier conversion to TKA. The 5-, 10- and 12-year survival rates were calculated. The Lysholm score and the IKDC score were assessed preoperatively as well as at 1.5, 6 and 12 years postoperatively. Data was presented as (mean ± standard deviation (minimum-maximum) or n (%)). Wilcoxon Signed-Rank tests were used to compare preoperative knee scores to postoperative score values at the 12-year follow-up in patients without conversion to TKA.
Results: At the last follow-up (12.8 ± 0.7 (12.0 – 15 years), 67.1% (n = 51) had no conversion to TKA. 25 patients (32.9%) received a knee arthroplasty in average 7.6 ± 3.6 (1.5 – 13.0) years after the HTO surgery. The 5-year, 10-year and 12-year survival rate was 88.2%, 76.3%, 69.7%.
Patients without conversion to TKA had still significantly higher scores at the last follow-up compared to preoperatively: The Lysholm score changed from 59.2 ± 21.6 (14 – 91) preoperatively to 88.2 ± 13.5 (39 – 100), 85.5 ± 14.4 (39 – 100) and 83.6 ± 18.1 (30 – 100) 1,5 years, 6 years and 12 years postoperatively. The IKDC score changed from 51.9 ± 15.8 (18 – 93) preoperatively to 76.2 ± 15.7 (21 – 100), 69.8 ± 16.1 (26 – 98) and 72.7 ± 18.7 (14 – 95) 1,5 years, 6 years and 12 years postoperatively.
Conclusion: Medial open-wedge HTO to treat varus medial compartmental knee osteoarthritis showed good long-term outcomes. The majority of patients can expect no conversion to TKA for more than twelve years.Furthermore, patients without conversion to TKA had still a significantly higher subjective knee function than preoperatively.
These findings help for realistic patient expectation management. Further research is needed to identify risk factors for conversion to TKA.
