Short-Term Outcomes after High Tibial Osteotomy Aimed at Neutral Alignment Combined with Arthroscopic Centralization of Medial Meniscus in Osteoarthritis Patients.

Mikio Shioda,Toshiyuki Ohara,Ichiro Sekiya,Kazumasa Miyatake,Yusuke Nakagawa,Hideyuki Koga,Hiroki Katagiri

doi:10.1055/s-0041-1731738

Abstract

The study aimed to improve the long-term outcomes of open-wedge high tibial osteotomy (OWHTO); procedures combining OWHTO aimed at neutral alignment and arthroscopic centralization for meniscal extrusion have been introduced. The present study evaluated short-term patient-reported outcome measures; namely, the patient subjective satisfaction scores and Numeric Rating Scale (NRS) for walking pain after OWHTO aimed at neutral alignment with and without arthroscopic centralization for an extruded medial meniscus. A retrospective review of 50 primary OWHTO patients was conducted. Thirty-nine patients were included in the analysis after applying the exclusion criteria. The centralization group included 21 patients with knee osteoarthritis patients who underwent the OWHTO with arthroscopic meniscal centralization, while the control group included 18 patients who underwent OWHTO alone. The patient subjective satisfaction scores and NRS for walking pain were recorded at outpatient visits from before surgery to 3 years after surgery. In terms of the Lysholm knee scale, International Knee Documentation Committee subjective score, and Knee Osteoarthritis Outcome Score, the latest data (at least 2 years after surgery) were reviewed. Radiographic changes in joint space width and joint line congruence angle were measured 2 years postoperatively. Patient demographic data were also reviewed. One patient in the centralization group experienced a superficial surgical site infection. The patient subjective satisfaction and NRS scores for walking pain gradually improved by 1 year after surgery and were sustained until 3 years after surgery in both groups, with no significant difference between the groups. The course of patient-reported outcome measures from before surgery to 3 years after surgery for solely OWHTO aimed at neutral alignment and OWHTO aimed at neutral alignment with arthroscopic centralization showed the similar trends.

Highlights

Two national registry-based studies reported that the 5-year conversion rate of open-wedge high tibial osteotomy (OWHTO) to total knee arthroplasty was approximately 10% and the 10-year conversion rate to total knee arthroplasty reached approximately 30%.1, 2 Clinical outcomes of OWHTO had deteriorated over time with conversion to total knee arthroplasty.[3]
Change of joint space width (JSW) after OWHTO aimed at neutral alignment with arthroscopic centralization for extruded medial meniscus was greater than solely OWHTO, and there was no significant difference in the short-term clinical outcomes between the 2 procedures at the final follow-up
Procedures combining OWHTO aimed at neutral alignment and arthroscopic centralization of the medial meniscus for medial unicompartmental knee osteoarthritis with an extruded medial meniscus have been developed to decrease tibiofemoral contact pressure and achieve superior long-term results

Summary

Introduction

Two national registry-based studies reported that the 5-year conversion rate of open-wedge high tibial osteotomy (OWHTO) to total knee arthroplasty was approximately 10% and the 10-year conversion rate to total knee arthroplasty reached approximately 30%.1, 2 Clinical outcomes of OWHTO had deteriorated over time with conversion to total knee arthroplasty.[3]. Two national registry-based studies reported that the 5-year conversion rate of open-wedge high tibial osteotomy (OWHTO) to total knee arthroplasty was approximately 10% and the 10-year conversion rate to total knee arthroplasty reached approximately 30%.1, 2. Arthroscopic centralization for an extruded lateral meniscus results in good clinical outcomes of the Lysholm knee scale and the Knee Osteoarthritis Outcome Score (KOOS) and radiographic outcomes with the lateral joint space widening at 2-years follow-up.[9] In a study using rats, the centralization technique of extruded medial meniscus successfully delayed cartilage degeneration.[10] procedures combining OWHTO aimed at neutral alignment (weight bearing line ratio aimed at 57%) and arthroscopic centralization of the medial meniscus for medial unicompartmental knee osteoarthritis with an extruded medial meniscus have been developed to decrease tibiofemoral contact pressure and achieve superior long-term results. Its clinical and radiological outcomes are yet to be reported

Objectives

Methods

Results

Discussion

Conclusion