Age predicts outcome of high-tibial osteotomy

Trieb, Klemens; Grohs, Josef G.; Hanslik-Schnabel, Beatrice; Stulnig, Thomas M.; Panotopoulos, Joannis; Wanivenhaus, A.

doi:10.1007/s00167-005-0638-5

Cited by 80 publications

(59 citation statements)

References 24 publications

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“…There were several limitations to our study, including its retrospective design and lack of control group. There were a significant number of patients who were lost to follow-up, although over 80% of patients could be included, which is satisfactory when compared with other studies in this area [18,24]. …”

Section: Discussionmentioning

confidence: 75%

“…Despite the fact that HTO results show its effectiveness, great debate on risk factors influencing HTO survival is still on-going. Various factors including age, gender, BMI, activity level, and varus angle are claimed to affect the duration of survival [13-18]. Selecting the ideal patient and identifying risk factors that may affect osteotomy longevity is important to obtain satisfactory results with HTO.…”

Section: Introductionmentioning

confidence: 99%

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Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up

Efe¹,

Ahmed²,

Heyse³

et al. 2011

BMC Musculoskelet Disord

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BackgroundClosing-wedge high tibial osteotomy (HTO) is successful for the treatment of medial osteoarthritis with varus malalignment. Preoperative risk factors for HTO failure are still controversial. The aim of this study was to elucidate the outcome and assess the influence of risk factors on long term HTO survival.Methods199 patients were retrospectively studied with a mean follow-up period of 9.6 years after HTO. HTO failure was defined as the need for conversion to TKA. Survival was analyzed with the Kaplan-Meier method. Knee function was evaluated by the Hospital for Special Surgery (HSS) score. HTO-associated complications were also assessed. Univariate, multivariate, and logistic regression analysis were performed to evaluate the influence of age, gender, BMI, preoperative Kellgren-Lawrence osteoarthritis grade, and varus angle on HTO failure.Results39 complications were recorded. Thus far, 36 HTOs were converted to TKA. The survival of HTO was 84% after 9.6 years. Knee function was considered excellent or good in 64% of patients. A significant preoperative risk factor for HTO failure was osteoarthritis, Kellgren-Lawrence grade >2.ConclusionHTO provides good clinical results in long-term follow-up. Preoperative osteoarthritis Kellgren-Lawrence grade >2 is a significant predictive risk factor for HTO failure. Results of HTO may be improved by careful patient selection. Complications associated with HTO should not be underestimated.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up

Efe¹,

Ahmed²,

Heyse³

et al. 2011

BMC Musculoskelet Disord

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“…Previous studies have supported the finding that older patients have a higher rate of revision following HTO. Trieb et al 36 reported higher rates of revision in patients > 65 years of age, whilst Hui et al 12 reported a hazard ratio for revision of 3.4 in patients over 50 years of age when compared with patients under 50; neither study presented any information on the effect of age on functional outcome. Only one study, a matched-pair study by Kohn et al, 24 has studied the effect of age on functional outcome following HTO.…”

Section: Discussionmentioning

confidence: 90%

The outcome at ten years of lateral closing-wedge high tibial osteotomy

Howells

Salmon

Waller

et al. 2014

The Bone & Joint Journal

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The aim of this study was to examine the functional outcome at ten years following lateral closing wedge high tibial osteotomy for medial compartment osteoarthritis of the knee and to define pre-operative predictors of survival and determinants of functional outcome. 164 consecutive patients underwent high tibial osteotomy between 2000 and 2002. A total of 100 patients (100 knees) met the inclusion criteria and 95 were available for review at ten years. Data were collected prospectively and included patient demographics, surgical details, long leg alignment radiographs, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and Knee Society scores (KSS) pre-operatively and at five and ten years follow-up. At ten years, 21 patients had been revised at a mean of five years. Overall Kaplan-Meier survival was 87% (95% confidence interval (CI) 81 to 94) and 79% (95% CI 71 to 87) at five and ten years, respectively. When compared with unrevised patients, those who had been revised had significantly lower mean pre-operative WOMAC Scores (47 (21 to 85) vs 65 (32 to 99), p < 0.001), higher mean age (54 yrs (42 to 61) vs 49 yrs (26 to 66), p = 0.006) and a higher mean BMI (30.2; 25 to 39 vs 27.9; 21 to 36, p = 0.005). Each were found to be risk factors for revision, with hazard ratios of 10.7 (95% CI 4 to 28.6; pre-operative WOMAC < 45), 6.5 (95% CI 2.4 to 17.7; age > 55) and 3.0 (95%CI 1.2 to 7.6; BMI > 30). Survival of patients with pre-operative WOMAC > 45, age < 55 and BMI < 30 was 97% at five and ten years. WOMAC and KSS in surviving patients improved significantly between pre-operative (mean 61; 32 to 99) and five (mean 88; 35 to 100, p = 0.001) and ten years (mean 84; 38 to 100, p = 0.001). Older patients had better functional outcomes overall, despite their higher revision rate. This study has shown that improved survival is associated with age < 55 years, pre-operative WOMAC scores > 45 and, a BMI < 30. In patients over 55 years of age with adequate pre-operative functional scores, survival can be good and functional outcomes can be significantly better than their younger counterparts. We recommend the routine use of pre-operative functional outcome scores to guide decision-making when considering suitability for high tibial osteotomy.

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“…Previous studies have reported that a pre-operative BMI higher than 27.5 is a significant risk factor for early failure [25], and patients with BMI over 30 exhibit significantly lower KSS and WOMAC scores 5 years after HTO [28]. Moreover, HTO is not advisable for patients older than 65 years due to the 7.6% increased risk per year of age and the 1.5-fold relative risk of failure compared to younger patients [29]. …”

Section: Discussionmentioning

confidence: 99%

Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review

Santoso¹,

Wu²

2017

J Orthop Surg Res

114

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Background: Debate remains whether high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA) is more beneficial for the treatment of unicompartmental knee osteoarthritis. The purpose of this study was to compare the functional results, knee scores, activity levels, and complications between the two procedures. Methods: We performed a systematic review of published literature from August 1982 through January 2017. Fifteen papers reporting three prospective randomized trials were subjected to a meta-analysis. Results: No significant difference between the two groups was noted with respect to free walking (velocity), knee score, deterioration of the contralateral or patellofemoral knee, or revision rate and total knee arthroplasty. However, UKA produced better outcomes compared to HTO in terms of the functional results, pain assessment, and complications, although patients who underwent HTO tended to have slightly better range of motion. Conclusions: Valgus HTO provides better physical activity for younger patients whereas UKA is more suitable for older patients due to shorter rehabilitation time and faster functional recovery. Although UKA patients tended to have improved overall long-term outcomes, which may be due to accurate indications and patient selection, both treatment options yielded pleasing results. Therefore, we are unable to conclude that either method is superior.

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Age predicts outcome of high-tibial osteotomy

Cited by 80 publications

References 24 publications

Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up

Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up

The outcome at ten years of lateral closing-wedge high tibial osteotomy

Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review

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