Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity

Abstract

The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p<0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years.