Abstract
PurposeTo evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years.MethodsOur retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis.ResultsThe preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01).ConclusionAge at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.
Highlights
Opening-wedge high tibial osteotomy (OWHTO) is a successful treatment for medial compartment knee osteoarthritis (OA) [1, 2, 19]
The preoperative weight-bearing line ratio (WBLR) was significantly improved from 18.0 ± 13.1 to 57.9 ± 10.0% (p < 0.0001, Table 2), the pelvic inclination (PI) and range of motion (ROM) were not changed after OWHTO
The Lysholm score was improved with OWHTO from 59.5 ± 9.0 to 81.5 ± 11.2 (p < 0.0001, Table 2)
Summary
Opening-wedge high tibial osteotomy (OWHTO) is a successful treatment for medial compartment knee osteoarthritis (OA) [1, 2, 19]. With recent advances in surgical technique, fixation device, and patient selection, OWHTO has yielded good clinical outcomes, especially for young and active patients with symptomatic medial knee compartment OA, and with a 10-year satisfaction rate of > 90% among patients < 50 years of age [5, 7]. Age is a risk factor for OWHTO and connotes a higher failure rate for patients over 65 years [18, 24]; some studies did not identify the effect of age on OWHTO [3, 4, 9]. The clinical outcome was generally evaluated postoperatively, which affected patients’ activity levels. The activity level of elderly patients is generally lower than that of younger patients, and the degree of improvement, measured from pre- to postoperative outcome, should be considered individually to exclude their own potential activity
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