Abstract
Introduction: High tibial medial open-wedge valgus osteotomy (HTO) is a well-established procedure for unicompartimental medial osteoarthritis of the young and active patient. However, the influence of cartilage defects of the lateral compartment on the total outcome remains obscure. Methods: From 2005 to 2012, a total of 63 patients underwent HTO for medial osteoarthritis of the knee at a single university orthopaedic center. Baseline data as well as intraoperative findings, including the grade and location of cartilage lesions, were evaluated retrospectively. Two groups were formed regarding the integrity of the lateral tibiofemoral compartment as measured by the Outerbridge score (group A: no lateral cartilage defects, group B: mild to moderate lateral cartilage defects). Functional outcome was assessed using the Knee and Osteoarthritis Outcome Score (KOOS), including its five subscores. Results: Comparing pre- and postoperative data, we identified an overall benefit of the HTO procedure as measured by the KOOS. Group A (no lateral cartilage defects) showed an increase in all five KOOS subscores (p = 0.00–0.01), whereas for group B (mild to moderate lateral cartilage defects), only two KOOS subscores revealed a significant increase (p = 0.03–0.04). There was also a statistically significant difference in the total KOOS score with higher values for group A at the postoperative visit. Cartilage defects with a higher Outerbridge score were associated with lower postoperative KOOS subscores. Discussion: Mild to moderate cartilage defects of the lateral compartment humble the total outcome after HTO procedure. Thus, indication for HTO should be made very carefully if any degree of lateral cartilage degeneration is present.
Highlights
Osteoarthritis (OA) is one of the most common musculoskeletal disorders, especially among the elderly population
Comparing pre- and postoperative data, we identified an overall benefit of the High tibial medial open-wedge valgus osteotomy (HTO) procedure as measured by the Knee and Osteoarthritis Outcome Score (KOOS)
Recent research has shown that the HTO procedure can significantly reduce pain and improve knee function in patients with medial osteoarthritis by delaying the progress of degeneration of the medial compartment [4]
Summary
Osteoarthritis (OA) is one of the most common musculoskeletal disorders, especially among the elderly population. The available strategies are controversially discussed in current literature. In Germany, the total 12-months prevalence of osteoarthritis has been reported to be 17.9% of adults over 18 years. A steep increase by age was recognized, reaching as high as 48.1% of affected women aged over 65 years [1]. Risk factors for osteoarthritis can be divided into non-modifiable and modifiable factors, with malalignment of the lower extremity being assigned to the latter. Various studies have demonstrated that malalignment can cause increased stress across a focal joint area and leading to subsequent cartilage loss and osteoarthritis [2,3,4]. Even in a neutrally aligned limb, the force distribution across the knee joint is not completely distributed between the medial and lateral compartment
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