Mid- to Long-Term Outcomes After Medial Open-Wedge High Tibial Osteotomy in Patients With Radiological Kissing Lesion

Abstract

Background: Although medial open-wedge high tibial osteotomy (MOWHTO) is the treatment of choice for patients with mild to moderate osteoarthritis with varus malalignment, concerns about inferior outcomes in patients with preoperative radiological kissing lesion (RKL) remain. Purpose: To compare the mid- to long-term clinical and radiological results and survivorship after MOWHTO in patients with versus without preoperative RKL. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 122 knees in patients who underwent MOWHTO with a medial locked plate and had minimum 5-year follow-up data. The mean age at surgery was 55.9 years (range, 38-65 years), and the mean follow-up was 7.5 years (range, 5-12.8 years). All patients had undergone second-look arthroscopy around 2 years after MOWHTO. The knees were divided into an RKL group (n = 17) and no-RKL group (n = 105) based on preoperative standing radiographs. The authors compared postoperative American Knee Society (AKS) knee and function scores, range of motion, and improvements in AKS scores between groups, as well as hip-knee-ankle angle, medial proximal tibial angle, and joint-line convergence angle from preoperatively to postoperatively. Also compared were the degree of cartilage regeneration between first- and second-look arthroscopy and the survival rate after index surgery. Results: Preoperative AKS scores were significantly lower in the RKL group versus the no-RKL group (AKS knee, 79.6 ± 7.5 vs 83.8 ± 3.9, P = .037; AKS function, 68.8 ± 9.3 vs 76.0 ± 5.1, P = .006). Likewise, postoperative AKS scores were significantly lower in the RKL group versus the no-RKL group (AKS knee: 91.3 ± 4.2 vs 94.4 ± 1.6, respectively, P = .008; AKS function: 90.0 ± 10.0 vs 97.6 ± 4.5, respectively, P = .007). However, all patients had excellent postoperative AKS knee and function scores (>80). Moreover, there were no between-group differences in pre- to postoperative improvement in AKS scores, postoperative radiological changes, or grade of cartilage regeneration. The survival rates in the RKL and no-RKL groups were 100% and 97.1%, respectively ( P ≥ .999). Conclusion: Although the latest clinical scores were lower in the RKL group than in the no-RKL group, comparable results in postoperative clinical improvement, cartilage regeneration, and survivorship were observed in patients with RKL at mid- to long-term follow-up.

Change in Cartilage Status of Medial Compartment after Open-Wedge High Tibial Osteotomy without Cartilage Regeneration Procedure: Second Look Arthroscopic Assessment

“…The main goal of a HTO is to improve patient function and relieve pain [ 8 ]. Undoubtedly, HTO has been revealed to enhance postoperative outcomes in patients with medial compartment osteoarthritis with varus deformity [ 38 ]. Numerous investigations aiming to identify the factors that contribute to favorable patient-reported outcomes following HTO have been actively pursued [ 6 , 39 , 40 , 41 ].…”

“…They concluded that over-corrected surgery (weight-bearing line raito > 67%) was correlated with inferior patients’ reported outcomes. Traditionally, younger age is known to be associated with successful outcomes after HTO [ 38 ]. On the other hand, an opposite opinion was suggested.…”

Procedures to prevent cartilage lesions from load

“…[22] Birçok çalışma, PTVO ile birlikte kıkırdak tamir (subkondral drilleme, abrazyon artroplastisi, mikrokırık, kondrosit veya kök hücre implantasyonu) veya rekonstrüksiyon (allogreft transferi) yöntemleriyle birlikte uygulanmasını tavsiye etmiş, ameliyat sonrası 0-3° valgus açılanması olan hastalarda klinik sonuçların daha başarılı olduğunu bildirmiştir. [23][24][25][26] Kıkırdak hasarı ve varus dizilim bozukluğu olan hastalarda PTVO, tek başına veya aynı seansta kıkırdak tamir veya rekonstrüksiyon tedavileri ile birlikte de uygulanabilmektedir (Şekil 3). Hsu ve ark.…”

“…Hastaların beş yıllık takiplerinde hem klinik hem de ikincil bakı artroskopisinde kıkırdak hasarlarında belirgin iyileşme olduğunu tespit etmişlerdir. [26] Bode ve ark. çalışmalarında ortalama 4,9° varus deformitesi ve tam kat kıkırdak lezyonu olan 40 hastaya otolog kondrosit implantasyonu ile birlikte PTVO uygulamışlardır.…”

Topical Use of Low‐dose Tranexamic Acid Has no Effect on Drainage Volume after Medial Open Wedge High Tibial Osteotomy: A Case Control Study

“…Medial opening wedge high tibial osteotomy (MOWHTO) is a well‐established surgical procedure for the treatment of medial compartment knee osteoarthritis (KOA) combined with varus deformity 12 . Much research 13–15 has shown that MOWHTO can effectively relieve pain and improve quality of life in patients with medial KOA, and avoid or delay knee replacement in these patients. Extensive soft tissue release and exposed osteotomy surface in MOWHTO can result in substantial perioperative bleeding, mean total blood loss ranged from 635.0 to 882.7 mL 16–19 …”