Prognostic factors for medial open-wedge high tibial osteotomy with spacer implantation in patients with medial compartmental knee osteoarthritis

Abstract

Background To identify medial open-wedge high tibial osteotomy (MOWHTO) prognostic factors with wedge-shaped spacer implantation (spacer-type MOWHTO) for varus medial compartment knee osteoarthritis. Methods Patients who underwent spacer-type MOWHTO between August 2018 and September 2019 were prospectively enrolled in this study. Patients were divided into effective group and invalid group based on the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) score one year postoperatively. The variables assessed at baseline and one year postoperatively including age, sex, body mass index (BMI), Kellgren–Lawrence (K–L) grade, hip–knee–ankle angle (HKAA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), Blackburn–Peel index (BPI), duration of symptoms, and WOMAC score were compared. Prognostic factors were analyzed using logistic regression, and the corresponding odds ratios were also calculated. Results A total of 104 patients were enrolled in the study protocol at one year postoperatively. The WOMAC score decreased from 72.39 ± 12.95 at baseline to 20.06 ± 12.96 at one year postoperatively. Univariate analysis revealed that the significant predictors of the WOMAC score were age > 70 years, BMI > 30 kg/m2, K–L grade IV, and pre-HKAA > 10° (P < 0.1 for all). Multivariable logistic regression analysis revealed that age > 70 (OR = 4.861) and K–L grade IV (OR = 6.590) were significantly associated with the higher WOMAC score at one year postoperatively. Conclusions Spacer-type MOWHTO is an effective treatment for osteoarthritis with varus deformity. The prognostic factors for spacer-type MOWHTO are age and K–L grade.

Muti-factor analysis of sport activity level after high tibial osteotomy

“…According to the test, the difference in %MA post-op between the sports level-improved group and the level-reduced group is statistically significant ( P < 0.05), while the differences in %MA post-op between the sports level-unchanged and the level-reduced group, and between the level-unchanged and the level-improved group, are not statistically significant ( P > 0.05). Based on previous studies and clinical practice [ 13 , 17 – 19 ], we added several factors (age, BMI, Kallgren–Lawrence osteoarthritis grade of preoperative) and carried out an ordered logistic regression. The results can be seen in Table 3 .…”

Using multivariate nonlinear mixed-effects model to investigate factors influencing symptom improvement after high tibial osteotomy in combination with bone marrow concentrate injection for medial compartment knee osteoarthritis: a prospective, open-label study

“…In addition to KL grade and age, higher BMI was associated with lesser WOMAC and KOOS improvement. Although prior studies of HTO in combination with orthobiologics did not report similar results of BMI [ 27 ], the negative impact of overweight and obesity on the prognosis has been revealed in some of the previous HTO studies [ 21 , 23 , 38 – 40 ].…”

“…For medial opening wedge HTO, several studies have investigated the association of baseline demographic and radiographic features with clinical outcomes [ 19 – 23 ]. Although a few clinical studies and systematic reviews have investigated the efficacy of the combination of HTO and orthobiologics [ 24 – 26 ], few have reported and evaluated various structural, radiographic, and clinical factors that influenced the prognosis [ 27 ].…”

Current progress and trends in musculoskeletal research: Highlights of NSFC-CUHK academic symposium on bone and joint degeneration and regeneration

“…However, the revision rate at 2 years after total joint replacement is 5%–10% [ 6 , 7 ]. Professor Zhang recommended eliminating the mechanical imbalance via osteotomy at the proximal tibia or fibular at an early stage [ 8 , 9 ]. Accordingly, they developed an absorbable β-TCP/PLGA spacer (patent ref.…”