Abstract
PurposeThe present study evaluated changes in bone tracer uptake (BTU) after medial open-wedge high tibial osteotomy (MOWHTO) and determined whether postoperative BTU correlates with clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO.MethodsA total of 210 knees underwent MOWHTO for medial compartmental osteoarthritis (OA) were enrolled in this study. Mean follow-up period was 42.7 months. We assessed BTU for the medial compartment of the knee before MOWHTO and at the time of plate removal. Radiologic parameters included Kellgren-Lawrence (K-L) grade and Hip-Knee-Ankle angle (HKAA). Clinical evaluation included American Knee Society (AKS) score and cartilage status was graded at the time of MOWHTO and second-look arthroscopy according to the International Cartilage Repair Society (ICRS) grading system and articular cartilage regeneration stage. Statistical analysis performed to assess the relationships among postoperative BTU of the medial compartment, radiologic parameters, arthroscopic changes and clinical outcomes.ResultsBTU of medial femoral condyle and tibial plateau were significantly decreased at 2 years after MOWHTO (p<0.001). AKS scores and arthroscopic cartilage status were also significantly improved following MOWHTO. BMI and postoperative HKAA showed significant correlations with postoperative changes of BTU in uni- and multi-variable analysis. Meanwhile, postoperative changes of BTU did not show significant correlation with clinical outcomes or cartilage regeneration following MOWHTO.ConclusionLower BMI and postoperative valgus alignment were significant predictor for postoperative BTU decrease of the medial compartment following MOWHTO. However, postoperative changes of BTU did not reflect cartilage regeneration or clinical outcomes until the midterm follow-up.
Highlights
Medial open-wedge high tibial osteotomy (MOWHTO) is an established treatment for patients with medial compartment knee arthritis combined with varus malalignment [1,2,3,4]
The post hoc power analysis showed that our tests were overpowered achieved greater than 90% power.; the effect size for bone tracer uptake (BTU) of medial femoral condyle and medial tibial plateau was 0.34 and 0.27, respectively, achieving a power of 0.99 for both sides based on 210 cases at 5% alpha level
BTU of medial femoral condyle and medial tibial plateau was significantly decreased at 2 years after MOWHTO (P
Summary
Medial open-wedge high tibial osteotomy (MOWHTO) is an established treatment for patients with medial compartment knee arthritis combined with varus malalignment [1,2,3,4]. Bone scintigraphy has been shown to be useful as part of reflecting knee joint loading pattern [11]. Bone tracer uptake (BTU) is significantly correlated with mechanical and anatomical alignment of the limb as well as with the degree of osteoarthritis [12]. It provides great benefits for the assessment of patients after realignment procedure such as MOWHTO [13]. Considering the theoretical advantages of bone scintigraphy, our institution has started to use this modality before and after MOWHTO to intuitively identify the effect of MOWHTO in patients with OA, because simple radiographs have limited information to reflect the effect of the operation. Despite of potential and clinical usefulness of bone scintigraphy, there is few reports on correlation with postoperative clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO [15]
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