Better survival of valgus opening-wedge high tibial osteotomy: 10-year results of a RCT comparing closing wedge and opening wedge technique

Abstract

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S468 855 BETTER SURVIVAL OF VALGUS OPENING-WEDGE HIGH TIBIAL OSTEOTOMY: 10-YEAR RESULTS OF A RCT COMPARING CLOSING WEDGE AND OPENING WEDGE TECHNIQUE T. Duivenvoorden y, R. Brouwer z, K. Bos y, M. Reijman y, S. Bierma Zeinstra y, J. Verhaar y. y Erasmus Univ. Med. Ctr., Rotterdam, Netherlands; zMartini Hosp., Groningen, Netherlands Background: Varus deformity increases the risk of progression of medial compartment knee osteoarthritis (OA). Patients with this condition can be treated with a valgus high tibial osteotomy (HTO) with a closing-wedge or opening-wedge technique. Little is known about the long-term results of closing-wedge versus opening-wedge osteotomy. Purpose: The aim of this study was to investigate the clinical and radiological long-term results of closing-wedge and opening-wedge HTO. Methods: Between January 2001 and March 2004, 92 patients were randomized to either a closing-wedge or opening-wedge HTO. The clinical outcome and radiological results were examined pre-operatively, at one year, six years, and, for the present study, at ten years post-operatively. Our outcomes included the endurance of achieved correction, progression of OA (Kellgren & Lawrence), severity of pain (visual analogue scale and Intermittent and Constant OsteoArthritis Pain score), knee function (Hospital for Special Surgery score, Knee Injury and Osteoarthritis Outcome Score), walking distance, complications and survival.We defined the non-survivors in our survival analysis as “patients converted to a total knee arthroplasty (TKA)” or as “patients in need for a TKA” according to the OARSI-criteria. The results were analyzed on basis of the intention to treat principle. The provisional ten year follow-up results are presented in this abstract. Results: In the meantime 80 of the 92 patients are analysed 10 years post-operatively. Until March 2014 the remaining 12 patients will be invited to visit the outpatient clinic to ensure a minimal follow-up of 10 years. Twelve (39%) patients in the closing-wedge and six (18%) in the opening-wedge group were converted to a TKA after ten years (p < 0.05). Eighteen (58%) patients in the closing-wedge and 15 (44%) patients in the opening-wedge group were in need for a TKA after 10 years (p 1⁄4 0.26). Ten years post-operatively, the hip-knee-ankle (HKA) angle was 0.1 ( 5.0 SD) of valgus after a closing-wedge HTO and 2.4 ( 6.9 SD) of valgus after an opening-wedge HTO (p 1⁄4 0.276). In both groups the 10-year post operative HKA-angles did not differ from the oneand six-year post-operative angles. No difference in severity of pain or knee function was found between the two groups. Four (9%) complications occurred in the closing-wedge and 17 (37%) in the opening-wedge group. Conclusions: Of the patients who had no conversion to a TKA, no difference in clinical outcome and radiological alignment was seen 10years post-operatively between the closing-wedge and opening-wedge HTOs. In the present study, opening-wedge HTO was found to be associated with more complications. Closing-wedge HTO was associated with more conversions to a TKA, however no difference in number of patients in need for a TKA was found. 856 HIP RESURFACING VERSUS TOTAL HIP ARTHROPLASTY IN PATIENTS WITH HIP OSTEOARTHRITIS: COMPARING STANDARDIZED OUTCOMES K.V. MacDonald y, C. Frank z, T. Noseworthy x, D. Lorenzetti y, J. Werle y, T. Wasylak k, D. Dick k, G. O’Connor {, D.A. Marshall y. yUniv. of Calgary, Calgary, AB, Canada; zAlberta Innovates Hlth.Solutions, Calgary, AB, Canada; xAlberta Hlth.Services; Univ. of Calgary, Calgary, AB, Canada; kAlberta Hlth.Services, Calgary, AB, canazda; {Univ. of Alberta, Calgary,