Medial opening wedge high tibial osteotomy: A prospective cohort study of gait, radiographic, and patient‐reported outcomes

Abstract

Objective.To evaluate the effect of medial opening wedge high tibial osteotomy on gait, radiographic, and patientreported outcomes over a 2-year postoperative period in patients with varus alignment and medial compartment knee osteoarthritis, and to identify significant predictors of outcome. Methods. We used an observational cohort study design and prospectively administered 3-dimensional quantitative gait analysis, hip to ankle weight-bearing radiographs, and patient-reported outcomes preoperatively and 6, 12, 18, and 24 months postoperatively. Observed changes with 95% confidence intervals (95% CIs) were calculated. Multivariate linear regression and cluster analysis were used to evaluate associations between patient characteristics and 2-year outcomes in dynamic knee joint load (external knee adduction moment during gait) and Knee Injury and Osteoarthritis Outcome Scores (KOOS).

Preoperative Strength Training for Patients Undergoing High Tibial Osteotomy: A Prospective Cohort Study With Historical Controls

“…Both the preoperative resistance training and the control groups experienced substantial improvements in self-reported outcomes and dynamic knee-joint loading after HTO, which is consistent with recent reports. 8,11,45 For example, similar to our previous study, 8 both of the present groups experienced approximately 50% improvement in knee-related quality of life, and approximately 50% reduction in the external knee adduction moment, relative to their baseline scores.…”

“…Compared to our larger cohort of patients undergoing HTO, 8 the participants in this study had similar demographic and clinical characteristics (age, height, body mass, varus alignment, and knee OA severity). The current participants, however, had higher preoperative KOOS scores, especially on the sport and recreation subscale.…”

“…Testing at 6 months coincided with a clinic follow-up with the orthopaedic surgeon and the expectation of large improvements in all clinical outcomes. 8 Participants were recruited from the Fowler Kennedy Sport Medicine Clinic in London, Ontario, Canada. Patients were eligible to participate if they had varus alignment and knee OA according to the Altman classification, 1 with greatest severity in the medial compartment of the tibiofemoral joint.…”

“…The participants for the historical cohort (control group) were selected from a larger, ongoing prospective cohort study evaluating medial opening wedge HTO. 8 Matching was based on baseline measures that were collected before training for the training group and before surgery for the control group. Matching criteria were surgical procedure, sex, age within 5 years, body mass index (BMI) within 3 kg/m 2 , preoperative varus alignment within 4°, and baseline sport and recreation subscale score of the Knee Injury and Osteoarthritis Outcome Score (KOOS) within 10 points.…”

“…8,11,36,45 HTO is suggested to be particularly well suited for relatively young patients with unicompartmental knee osteoarthritis (OA), who want to remain physically active, including participation in sport. 3,46,47 Despite the benefits of the medial opening wedge technique, a potential drawback is the long period of protected weight bearing after surgery.…”