A predictive score of high tibial osteotomy survivorship to help in surgical decision-making: the SKOOP score

Batailler, Cécile; Gicquel, Thomas; Bouguennec, Nicolas; Steltzlen, Camille; Tardy, Nicolas; Cartier, Jean-Loup; Mertl, P.; Pailhé, Régis; Rochcongar, Goulven; Fayard, Jean Marie

doi:10.1007/s00402-022-04694-w

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…Female sex is another significant predictor of early failure. 4,32,37,47,48 This was insignificant in our cohort, perhaps because of low female inclusion during patient recruitment (n = 26). Other reported significant factors that hinder survival of HTO include degree of preoperative radiographic osteoarthritis, 37 range of motion \120°, 1,2,31 previous arthroscopic surgery, 2,31 loss of alignment, 30 and instability.…”

Section: Discussionmentioning

confidence: 88%

“…In their cohort, patients with a score of ≤3 had a statistically significant improvement in survivorship compared with those with a score >3. 4 The utility of this scoring system in our cohort is low because incomplete articular narrowing was an exclusion criterion, and thus all our patients would score higher. Ishizuka et al 25 also noted that in addition to BMI >25, a preoperative femorotibial angle of <5° varus was a predictor of early failure.…”

Section: Discussionmentioning

confidence: 90%

“…# Poorer baseline scores have also been associated with poor outcome after HTO by others. 45 The SKOOP (Sfa Knee OsteOtomy Predictive) score devised by Batailler et al 4 is a novel way to assess survivorship and accounts for BMI, age, and the degree of articular narrowing (incomplete or complete) to predict success or early failure in HTO. In their cohort, patients with a score of ≤3 had a statistically significant improvement in survivorship compared with those with a score >3.…”

Section: Discussionmentioning

confidence: 99%

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20-Year Outcomes of High Tibial Osteotomy: Determinants of Survival and Functional Outcome

Constantin,

Salmon,

Russell

et al. 2024

Am J Sports Med

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Background: High tibial osteotomy (HTO) is a successful joint-preserving procedure for the treatment of medial compartment osteoarthritis. Long-term survivorship of HTO ranges from 40% to 85%. There are consistent factors that predict failure. Purpose: To determine the 20-year survival of HTO and identify predictors of failure. Study Design: Case series; Level of evidence, 4. Methods: A total of 100 consecutive patients with medial bone-on-bone arthritis were prospectively studied to provide long-term patient-reported outcome measures after lateral closing-wedge HTO and determine the time to failure. Failure was defined as conversion to arthroplasty (total knee arthroplasty or unicompartmental knee arthroplasty) or revision HTO. Results: At 20 years, HTO survival was determined in 95 patients, and 5 were lost to follow-up. The overall survivorship of HTO at 20 years was 44%. The significant factors that were associated with better survivorship were age <55 years, body mass index <30, and Western Ontario and McMaster Universities Osteoarthritis Index pain score >45. These factors were used to define the favorable candidates. In the favorable candidates, survivorship was 100% at 5 years, after which there was a gradual decline to 62% survival at 20 years. Of those with HTO survival, 32 of 33 (97%) reported satisfaction with surgery, with a mean Knee injury and Osteoarthritis Outcome Score Pain score of 91 and Activities of Daily Living score of 97. Conclusion: HTO is a successful surgical option to treat medial compartment osteoarthritis and prevent the need for arthroplasty in young patients. The most suitable candidates for HTO are aged <55 years, are not obese, and have not progressed to severe symptomatic disability.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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20-Year Outcomes of High Tibial Osteotomy: Determinants of Survival and Functional Outcome

Constantin,

Salmon,

Russell

et al. 2024

Am J Sports Med

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“…The endpoint of survival was conversion to TKA. Moreover, we selected 25 variables that have already been demonstrated to be predictive factors in the recent literature and significantly impact HTO outcomes and survival rates [ 11 , 13 – 16 , 27 ]. These included sex, age, BMI, meniscal status, cartilage status using the International Cartilage Repair Society (ICRS) grade, existence of kissing lesions, additional cartilage repair procedures, patient-reported outcome measures (PROMs) (KOOS, International Knee Documentation Committee [IKDC] score, Short-Form 36 [SF-36] questionnaire, Tegner activity scale score), and radiographic evaluations (mechanical hip-knee-ankle [HKA] angle), posterior tibial slope, medial proximal tibial angle [MPTA], and Kellgren–Lawrence grading).…”

Section: Methodsmentioning

confidence: 99%

Factors to improve odds of success following medial opening-wedge high tibial osteotomy: a machine learning analysis

Yang,

Shin,

Shin

et al. 2024

BMC Musculoskelet Disord

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Background Although high tibial osteotomy (HTO) is an established treatment option for medial compartment osteoarthritis, predictive factors for HTO treatment success remain unclear. This study aimed to identify informative variables associated with HTO treatment success and to develop and internally validate machine learning algorithms to predict which patients will achieve HTO treatment success for medial compartmental osteoarthritis. Methods This study retrospectively reviewed patients who underwent medial opening-wedge HTO (MOWHTO) at our center between March 2010 and December 2015. The primary outcomes were a lack of conversion to total knee arthroplasty (TKA) and achievement of a minimal clinically important difference of improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) at a minimum of five years postoperatively. Recursive feature selection was used to identify the combination of variables from an initial pool of 25 features that optimized model performance. Five machine learning algorithms (XGBoost, multilayer perception, support vector machine, elastic-net penalized logistic regression, and random forest) were trained using five-fold cross-validation three times and applied to an independent test set of patients. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC). Results A total of 231 patients were included, and 200 patients (86.6%) achieved treatment success at the mean of 9 years of follow-up. A combination of seven variables optimized algorithm performance, and the following specific cutoffs increased the likelihood of MOWHTO treatment success: body mass index (BMI) ≤ 26.8 kg/m2, preoperative KOOS for pain ≤ 46.0, preoperative KOOS for quality of life ≤ 33.0, preoperative International Knee Documentation Committee score ≤ 42.0, preoperative Short-Form 36 questionnaire (SF-36) score > 42.25, three-month postoperative hip-knee-ankle angle > 1.0°, and three-month postoperative medial proximal tibial angle (MPTA) > 91.5° and ≤ 94.7°. The random forest model demonstrated the best performance (F1 score: 0.93; AUC: 0.81) and was transformed into an online application as an educational tool to demonstrate the capabilities of machine learning. Conclusions The random forest machine learning algorithm best predicted MOWHTO treatment success. Patients with a lower BMI, poor clinical status, slight valgus overcorrection, and postoperative MPTA < 94.7 more frequently achieved a greater likelihood of treatment success. Level of evidence Level III, retrospective cohort study.

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Higher conversion rate to knee arthroplasty in female patients following medial open‐wedge high tibial osteotomy

Ahrend,

Petzold,

Schuster

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeMost studies about medial open‐wedge high tibial osteotomy (HTO) reported outcomes without focusing on gender differences. Therefore, the study compared the long‐term survival rate and postoperative subjective knee function after HTO in female versus male patients with symptomatic medial compartment knee osteoarthritis.MethodsThe data of three cohorts with long‐term outcomes were analysed (n = 245; 32% females; age: 49 ± 7 years; Kellgren Lawrence Grade I 6.1%, II 32.7%, III 42.4%; IV 18.8%). The minimum follow‐up was at least 6 years or an earlier conversion to total knee arthroplasty (TKA). The gender‐specific survival rate after HTO was calculated after 5 and 10 years and compared using Kaplan–Meier analysis and the logrank test. Baseline characteristics and subjective knee function (International Knee Documentation Committee [IKDC]/Lysholm) were analysed between both genders.ResultsForty of 78 (51.3%) women and 41 of 167 men (24.5%) underwent TKA. HTO survival in females was significantly lower (p = 0.0010). The 5‐ and 10‐year survival rates were 85.9% and 62.6% for females and 93.4% and 77.7% for males. In females and males, from preoperative to the last follow‐up, the IKDC (43 ± 15 to 58 ± 17; 47 ± 14 to 67 ± 18) and the Lysholm (42 ± 18 to 72 ± 18; 55 ± 22 to 77 ± 23) improved significantly (all p < 0.0001). Females had significantly lower preoperative and postoperative IKDC (p = 0.0438; p = 0.0035) and Lysholm scores (p = 0.0002; p = 0.0323). But the absolute improvements of the IKDC and Lysholm were not significantly different between genders.ConclusionsFemales had higher conversion rates to TKA and lower knee function at the last follow‐up. However, preoperative knee function was lower in females and the absolute improvement following HTO was similar for both genders. In general, females benefit from HTO to treat medial knee arthritis, and TKA could be postponed for half of female patients for more than 10 years. However, surgeons must be aware of the described inferior outcomes in females for realistic patient expectation management.Level of EvidenceLevel II.

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A predictive score of high tibial osteotomy survivorship to help in surgical decision-making: the SKOOP score

Cited by 8 publications

References 30 publications

20-Year Outcomes of High Tibial Osteotomy: Determinants of Survival and Functional Outcome

20-Year Outcomes of High Tibial Osteotomy: Determinants of Survival and Functional Outcome

Factors to improve odds of success following medial opening-wedge high tibial osteotomy: a machine learning analysis

Higher conversion rate to knee arthroplasty in female patients following medial open‐wedge high tibial osteotomy

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