Journal
AMERICAN JOURNAL OF SPORTS MEDICINE
Volume 50, Issue 2, Pages 461-470Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/03635465211059811
Keywords
osteotomy; HTO; arthritis; malalignment; joint line obliquity; clinical outcomes
Categories
Ask authors/readers for more resources
This study evaluated the prognostic factors related with the outcomes of opening wedge HTO at 10 years of follow-up, and found that increased lateral JLO was not correlated with the clinical outcomes.
Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176 degrees and 185 degrees were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz-joint line angle (MJL) >= 94 degrees or a mechanical medial proximal tibial angle (mMPTA) >= 95 degrees. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores (P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores (P = .0024). A good preoperative range of motion was associated with better knee score (P = .0399) and function score (P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores (P = .0317). MJL >= 94 degrees and mMPTA >= 95 degrees were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL >= 94 degrees or mMPTA >= 95 degrees) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available