Clinical and radiologic results after open‐wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

Cho, Y. J.; Song, Sang Jun; Rhyu, Kee Hyung; Jang, Taesu; Park, C. H.

doi:10.1111/hae.13566

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…This systematic review included 2,341 patients across 50 cohorts. The numbers of males and females in 3 cohorts was not provided 12 , 13 ( Table 2 ). However, of the remaining 47 cohorts, there were 1,429 males and 785 females (64.5% vs. 35.5%).…”

Section: Resultsmentioning

confidence: 99%

“…10,26 However, 1 patient from Cho's study underwent a subsequent knee replacement due to severe postoperative pain, highlighting that pain scores do not improve universally for all patients. 12 Gouin and colleagues compared the outcomes of MOWHTO with calcium phosphate ceramic spacers to autologous bone grafts. 27 Patients who had autologous bone grafts had significantly better pain scores at 3 months (P = 0.04), but these differences were insignificant after 6 months.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…Two articles (4.0%) did not describe the fixation type used with their patient cohorts (Table 3). 12,15 Radiographic Outcomes…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…Many studies included in this review investigated the outcomes of MOWHTO. 12,[19][20][21][22][23][24][25] Although the populations and approaches varied between studies, statistically significant improvements in the VAS were observed in the majority of cohorts postoperatively. Da Cunha and Mhaskar also found the VAS to improve following bilateral MOWHTO.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

et al. 2021

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Objective This systematic review aimed to determine whether coronal angular corrections correlate with patient reported outcomes following valgus-producing high tibial osteotomy (HTO). Design Ovid MEDLINE, Embase, and Web of Science were systematically searched. Studies that reported hip-knee-ankle angles (HKA) or femorotibial angles (FTA), and the Oxford Knee Score (OKS), visual analogue scale (VAS) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), or EQ-5D before and after valgus-producing HTO were eligible. Correlation analyses were performed where appropriate to investigate the relationships between variables. PROSPERO ID: CRD42019135467. Results This study included 39 articles including 50 cohorts. VAS was reported in 22 studies, OKS in 9, KOOS in 12 and EQ-5D in 2. The HKA angle was corrected from 7.1° ± 1.7° varus to 2.3° ± 1.7° valgus at final follow-up. The FTA changed from 3.0° ± 2.0° varus to 7.7° ± 1.3° valgus. Outcome scores improved with clinical and statistical significance postoperatively. Spearman correlations for nonparametric data revealed greater changes in knee alignment were moderately associated with larger improvements in VAS scores ( r = 0.50). Furthermore, those who experienced greater changes in alignment showed larger improvements in the KOOS Activity and Quality of Life domains ( r = 0.72 and r = 0.51, respectively). Conclusion On average, patients did not achieve the “ideal correction” of 3° to 6° valgus postoperatively. Nevertheless, statistical and clinical improvements in patient-reported outcome measure scores were consistently reported. This suggests that the “ideal correction” may be more flexible than 3° to 6°.

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

“…Two articles (4.0%) did not describe the fixation type used with their patient cohorts (Table 3). 12,15 Radiographic Outcomes…”

Section: Participant Characteristicsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

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The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

et al. 2021

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“…25 OWHTO has recently become more popular as a result of innovations in lower-profile plates and fixation techniques alongside the ease of adjustment of the correction angle during the operation. 3 However, CWHTO is still used widely and recommended rather than OWHTO in several clinical situations, such as insufficient anterior cruciate ligament, patella baja, steep tibial posterior slope angle, poor bone quality, or heavy smoking history. 16,19,20 A possible negative effect on the patellofemoral joint has been an established concern when OWHTO is performed.…”

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confidence: 99%

Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction

2020

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Background: Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO). Purpose: To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO ( P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups. Results: No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group ( P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367). Conclusion: Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.

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Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients

Song

Yoon²,

Kim³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the incidence of correction loss and survival rate between closed-wedge and open-wedge high tibial osteotomies (CWHTO and OWHTO, respectively) in patients with osteopenic and normal bone. Methods Retrospective review was conducted for 115 CWHTOs and 119 OWHTOs performed in osteopenic patients [− 2.5 < Bone mineral density (BMD) T scores ≤ − 1] and 136 CWHTOs and 138 OWHTOs performed in normal patients (BMD T score > − 1) from 2012 to 2019. Demographics were not diferent between CW-and OWHTOs in osteopenic and normal patients (n.s., respectively). Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated pre-and postoperatively (2 weeks after HTO). The occurrence of hinge fractures was investigated using radiographs taken on the operation day. The correction change was calculated as the last follow-up value minus postoperative MPTA. Correction loss was deined when the correction change was ≥ 3°. The survival rate (failure: correction loss) was investigated. Results There were no signiicant diferences in the pre and postoperative MA, MPTA, PTS, and value changes between CW-and OWHTOs in osteopenic and normal patients (n.s., respectively); the incidence of unstable hinge fractures also did not difer signiicantly (CWHTO vs. OWHTO = 7 vs. 7.6% in osteopenic patients; 2.9 vs. 3.6% in normal patients; n.s., respectively). The average correction change (CWHTO = − 0.6°, OWHTO = − 1.3°, p = 0.007), incidence of correction loss (CWHTO = 1.7%, OWHTO = 9.2%, p = 0.019), and 5-year survival rates (CWHTO = 98.3%, OWHTO = 90.8%, p = 0.013) difered signiicantly in osteopenic patients; there were no signiicant diferences in these results in normal patients (n.s., respectively). Conclusion CWHTO was more advantageous than OWHTO regarding the correction loss in osteopenic patients. Intra-and postoperative care that consider poor bone quality will be required when performing OWHTOs in osteopenic patients. Level of evidence III.

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Clinical and radiologic results after open‐wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

Abstract: Open-wedge HTO should be considered in cases of HA with varus deformity in young haemophilic patients, even though inflammatory arthritis is not an optimal indication for this procedure. It can be an appropriate treatment with respect to the choice to postpone TKA.

Cited by 8 publications

References 35 publications

The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction

Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients

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