Patellofemoral Osteoarthritis Progression After Open-Wedge High Tibial Osteotomy Does Not Affect the Clinical Outcomes or Survivorship at Minimum 7 Years’ Follow-Up

Abstract

The aim of this study was to evaluate the clinical and radiological outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess the effects of patellofemoral osteoarthritis (OA) progression after OWHTO on clinical outcomes at minimum 7 years follow up. We retrospectively reviewed 95 knees that underwent OWHTO and at least seven years of follow-up. Clinical parameters including anterior knee pain, Japanese Orthopedic Association (JOA) score, Oxford knee score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Hospital for Special Surgery patella score, and KOOS-patellofemoral subscale (KOOS-PF) were evaluated. Radiological outcomes were evaluated preoperatively and at final follow-up. Patellofemoral OA progressions were evaluated using Kellgren-Lawrence grade, and we divided the patients into two groups (progression group and non-progression group) to evaluate the effect of patellofemoral OA progression after OWHTO on long-term clinical outcomes. The mean follow-up period was 10.8 ± 2.6 years (range: 7.6-17.3 years). The mean JOA score significantly improved (from 64.4 ± 11.6 to 90.9 ± 9.3, P < 0.001), and the mean OKS at final follow-up was 40.4 ± 8.3. Due to medial OA progression, five cases were converted to total knee arthroplasty, and the survival rate was 94.7% at 10.8 years of follow-up. Radiologically, patellofemoral OA progression was observed at final follow-up in 48 knees (50.5%). However, there were no significant differences in all clinical outcomes at final follow-up between the progression and non-progression groups. Patellofemoral OA progression may progress over long-term follow-up after OWHTO. Related symptoms are minimal and this does not affect the clinical outcomes or survivorships at minimum 7 years follow-up. Level IV, Therapeutic case series.