Functional results following high tibial osteotomy: a review of the literature

Webb, Mark; Dewan, Varun; Elson, David W.

doi:10.1007/s00590-017-2112-8

Cited by 25 publications

(19 citation statements)

References 31 publications

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“…Several authors report an improvement of clinical scores for up to 5 years postoperatively after HTO. The average postoperative Lysholm score is reported to range between 69 and 96 points and the mean SF-36 between 73 and 89 points [33][34][35][36][37][38]. Referring to those reports, the clinical results of our oHTO patients are within the upper range.…”

Section: Clinical Outcomesupporting

confidence: 60%

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Fürmetz

Patzler

Wolf

et al. 2020

BMC Musculoskelet Disord

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Background: Varus deformities of the knee are frequently corrected by osteotomies, which should be performed at the level of origin. But in contrast to high tibial osteotomies (HTO), little data exists for distal femoral osteotomies (DFO). This study evaluates radiological and clinical outcomes after valgisation osteotomies in the proximal tibia and distal femur. Methods: We used an observational cohort study design and prospectively performed preoperative long standing radiographs (LSR), lateral x-rays and clinical questionnaires (SF-36, Lysholm score, VAS). Postoperative LSR and lateral x-rays were obtained on average 18 months postoperative and postoperative clinical questionnaires at final visit (mean follow up 46 months). A subgroup analysis of the different surgical techniques (oHTO vs. cDFO) was performed, with regards to radiological and clinical outcomes. Results: Finally 28 osteotomies with medial tibial opening (oHTO) or lateral femoral closing (cDFO) wedge osteotomies in 25 consecutive patients (mean age 40 years) were identified. There were 17 tibal and 11 femoral procedures. All osteotomies were performed at the origin of deformity, which was of different etiology. The average deviation of the final HKA compared to the preoperative planning was 2.4°± 0.4°. Overall, there was a significant improvement in all clinical scores (SF-36: 61.8 to 79.4, p < 0.001; Lysholm-score: 72.7 to 90.4, p < 0.001; VAS: 3 to 1, p < 0.001). There was no significant correlation between surgical accuracy and outcome scores. Conclusion: Valgisation osteotomies lead to a significant improvement in all clinical scores with the demonstrated treatment protocol. An appreciable proportion of varus deformities are of femoral origin. Since cDFO provides comparable radiological and clinical results as oHTO, this is an important treatment option for varus deformities of femoral origin.

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Section: Clinical Outcomesupporting

confidence: 60%

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Fürmetz

Patzler

Wolf

et al. 2020

BMC Musculoskelet Disord

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“…High tibial osteotomy (HTO) is an effective procedure for knee osteoarthritis with varus malalignment in young people [1,2]. As joint preservation surgery, the procedure moderates the mechanical axis of the lower limb to relieve pain [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics Related to Blood Loss in High Tibial Osteotomy in Novel Multiple Linear Regression Analysis

Zhu

Chen

Wang

et al. 2020

BioMed Research International

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The purpose of the study was to identify patient characteristics related to blood loss following high tibial osteotomy (HTO). We evaluated 48 patients undergoing HTO from August 2018 to August 2019. The data of 48 patients were collected, including gender, age, height, weight, body mass index (BMI), smoking, alcohol consumption, hypertension, diabetes, history of aspirin, and pre-postoperative hematocrit (Hct). Multiple linear regression analysis was used to analyze the risk factors related to blood loss in HTO. The mean age of patients was 56.6±10.2 years, including 22 males and 26 females. The mean BMI was 28.5±4.2 kg/m2, and the mean blood loss volume was 383.3±181.3 mL, 13 patients with smoking (27.1%), 15 patients with alcohol consumption (31.3%), 23 patients with hypertension (47.9%), 10 patients with diabetes mellitus (20.8%), and 12 patients with history of aspirin (25.0%). Multiple linear regression model suggested alcohol consumption and BMI were associated with blood loss in HTO, R2=0.451, F9,38=3.462 (P<0.05). Our study indicates that alcohol consumption and BMI are important risk factors related to blood loss in HTO.

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“…Hence, a lack of robust evidence from large HTO cohorts on relevant patient outcomes, including RTS, still exists. 8,34 Additionally, prognostic factors for a successful RTS have never been described. Identifying such factors could improve preoperative counseling and shared decision making, which is essential in obtaining satisfying results in the challenging young knee OA population.…”

mentioning

confidence: 99%

Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

et al. 2019

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Background: High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. Purpose: To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results: We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up ( P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). Conclusion: More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.

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Functional results following high tibial osteotomy: a review of the literature

Cited by 25 publications

References 31 publications

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Patient Characteristics Related to Blood Loss in High Tibial Osteotomy in Novel Multiple Linear Regression Analysis

Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach

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