Skip to main content

Advertisement

SpringerLink
Log in

The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to identify the survivorship of high tibial osteotomy (HTO) to total knee arthroplasty (TKA) on a population level, and identify the patient, provider and surgical factors that influenced eventual TKA.

Methods

Administrative records from physician billings and hospital admissions were used to identify all adults in Ontario, Canada, who underwent an HTO from 1994 to 2010. The primary outcome was time to TKA, which was estimated using Kaplan–Meier (KM) survival analysis. A Cox proportional hazards model examined the risk associated with patient factors (age, sex, income and co-morbidity score), provider factors (hospital status, surgeon volume and surgeon year in practice) and surgical factors (concurrent ligament reconstruction or bone grafting; and previous chondral or meniscal surgery).

Results

A total of 2671 patients who underwent HTO met inclusion. The median age was 46 years (interquartile range 39–53 years), and 62 % were male. The KM survivorship of HTO to TKA at 10 years was 0.67 ± 0.01. Older age [HR 1.05 (95 % CI 1.04, 1.06), p < 0.001; 5 % increased risk for each year over age 46], female sex [HR 1.35 (95 % CI 1.17, 1.55), p < 0.001], higher comorbidity score [HR 1.58 (95 % CI 1.12, 2.22), p = 0.009] and a prior history of arthroscopy/meniscectomy [HR 1.24 (95 % CI 1.08, 1.43), p = 0.002] increased the risk of eventual TKA. However, HTO with concurrent ligament reconstruction was associated with lower [HR 0.62 (95 % CI 0.43, 0.88), p = 0.008] risk of eventual TKA.

Conclusion

In this population, two-thirds of patients were able to avoid a TKA for 10 years after HTO. Specific factors such as older age, female sex, higher comorbidity and prior meniscectomy lowered survival rates. An understanding of patient risk factors for conversion to TKA may help guide surgeons in their selection of patients who will benefit most from HTO.

Level of evidence

Retrospective cohort study, III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90(5):592–596

    Article  CAS  PubMed  Google Scholar 

  2. Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br 66(5):666–671

    CAS  PubMed  Google Scholar 

  3. Armitage PBG, Matthews J (2002) Statistical methods in medical research, 4th edn. Blackwell Science, Malden, p 489

    Book  Google Scholar 

  4. Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G (2006) In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care 44(8):745–753

    Article  PubMed  Google Scholar 

  5. Bonin N, Ait Si Selmi T, Donell ST, Dejour H, Neyret P (2004) Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. Knee 11(6):431–437

    Article  CAS  PubMed  Google Scholar 

  6. Borugian MJ, Spinelli JJ, Mezei G, Wilkins R, Abanto Z, McBride ML (2005) Childhood leukemia and socioeconomic status in Canada. Epidemiology 16(4):526–531

    Article  PubMed  Google Scholar 

  7. Boss A, Stutz G, Oursin C, Gachter A (1995) Anterior cruciate ligament reconstruction combined with valgus tibial osteotomy (combined procedure). Knee Surg Sports Traumatol Arthrosc 3(3):187–191

    Article  CAS  PubMed  Google Scholar 

  8. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75(2):196–201

    Article  CAS  PubMed  Google Scholar 

  9. Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B, Lakemeier S, Schofer MD (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46

    Article  PubMed  PubMed Central  Google Scholar 

  10. Englund M, Roos EM, Lohmander LS (2003) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum 48(8):2178–2187

    Article  CAS  PubMed  Google Scholar 

  11. Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96

    Article  PubMed  Google Scholar 

  12. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180

    Article  PubMed  Google Scholar 

  13. Gaasbeek RD, Nicolaas L, Rijnberg WJ, van Loon CJ, van Kampen A (2010) Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study. Int Orthop 34(2):201–207

    Article  PubMed  Google Scholar 

  14. Gill T, Schemitsch EH, Brick GW, Thornhill TS (1995) Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop Relat Res 321:10–18

    Google Scholar 

  15. Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15(5):597–603

    Article  CAS  PubMed  Google Scholar 

  16. Hawker GA, Guan J, Croxford R, Coyte PC, Glazier RH, Harvey BJ, Wright JG, Williams JI, Badley EM (2006) A prospective population-based study of the predictors of undergoing total joint arthroplasty. Arthritis Rheum 54(10):3212–3220

    Article  PubMed  Google Scholar 

  17. Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM (2000) Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med 342(14):1016–1022

    Article  CAS  PubMed  Google Scholar 

  18. (2003) Health Notes: The Johns Hopkins ACG Case-Mix System Version 6.0 Release Notes. http://s3.amazonaws.com/zanran_storage/www.acg.jhsph.edu/ContentPages/45990640.pdf

  19. Hervey SL, Purves HR, Guller U, Toth AP, Vail TP, Pietrobon R (2003) Provider volume of total knee arthroplasties and patient outcomes in the HCUP-nationwide inpatient sample. J Bone Joint Surg Am 85(9):1775–1783

    Article  PubMed  Google Scholar 

  20. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P (1974) Factors effecting late results after meniscectomy. J Bone Joint Surg Am 56(4):719–729

    Article  CAS  PubMed  Google Scholar 

  21. Juurlink DPC, Croxford R, Chong A, Austin P, Tu J, Laupacis A (2006) Canadian institute for health information discharge abstract database: a validation study. Institute for Clinical Evaluative Sciences, Toronto

    Google Scholar 

  22. Karabatsos B, Mahomed NN, Maistrelli GL (2002) Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg 45(2):116–119

    PubMed  PubMed Central  Google Scholar 

  23. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E (2004) Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am 86(9):1909–1916

    Article  PubMed  Google Scholar 

  24. Khoshbin A, Leroux T, Wasserstein D, Wolfstadt J, Law PW, Mahomed N, Wright JG (2014) The epidemiology of paediatric supracondylar fracture fixation: a population-based study. Injury 45(4):701–708

    Article  PubMed  Google Scholar 

  25. Khuri SF, Najjar SF, Daley J, Krasnicka B, Hossain M, Henderson WG, Aust JB, Bass B, Bishop MJ, Demakis J, DePalma R, Fabri PJ, Fink A, Gibbs J, Grover F, Hammermeister K, McDonald G, Neumayer L, Roswell RH, Spencer J, Turnage RH, Program VANSQI (2001) Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg 234(3):370-382; discussion 382-373

  26. Kohn L, Sauerschnig M, Iskansar S, Lorenz S, Meidinger G, Imhoff AB, Hinterwimmer S (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):146–151

    Article  CAS  PubMed  Google Scholar 

  27. Krackow KA, Holtgrewe JL (1990) Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty. Clin Orthop Relat Res 258:213–224

    Google Scholar 

  28. Lattermann C, Jakob RP (1996) High tibial osteotomy alone or combined with ligament reconstruction in anterior cruciate ligament-deficient knees. Knee Surg Sports Traumatol Arthrosc 4(1):32–38

    Article  CAS  PubMed  Google Scholar 

  29. Leroux T, Ogilvie-Harris D, Dwyer T, Chahal J, Gandhi R, Mahomed N, Wasserstein D (2014) The risk of knee arthroplasty following cruciate ligament reconstruction: a population-based matched cohort study. J Bone Joint Surg Am 96(1):2–10

    Article  PubMed  Google Scholar 

  30. Leroux T, Wasserstein D, Henry P, Khoshbin A, Dwyer T, Ogilvie-Harris D, Mahomed N, Veillette C (2014) Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study in Ontario, Canada. J Bone Joint Surg Am 96(13):1119–1125

    Article  PubMed  Google Scholar 

  31. Macpherson ASM, Manuel DGC, Redelmeier D, Laupacis A (2005) Injuries in Ontario. ICES Atlas. Institute for Clinical Evaluative Sciences, Toronto

    Google Scholar 

  32. McNicholas MJ, Rowley DI, McGurty D, Adalberth T, Abdon P, Lindstrand A, Lohmander LS (2000) Total meniscectomy in adolescence. A thirty-year follow-up. J Bone Joint Surg Br 82(2):217–221

    Article  CAS  PubMed  Google Scholar 

  33. Miller MD, Fu FH (1993) The role of osteotomy in the anterior cruciate ligament-deficient knee. Clin Sports Med 12(4):697–708

    CAS  PubMed  Google Scholar 

  34. Mont MA, Antonaides S, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group. Clin Orthop Relat Res 299:125–130

    Google Scholar 

  35. Moran M, Yap SL, Walmsley P, Brenkel IJ (2004) Clinical and radiologic outcome of total hip arthroplasty performed by trainee compared with consultant orthopedic surgeons. J Arthroplasty 19(7):853–857

    Article  PubMed  Google Scholar 

  36. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to 22-year followup study. Clin Orthop Relat Res 367:18–27

    Article  Google Scholar 

  37. Odenbring S, Egund N, Knutson K, Lindstrand A, Larsen ST (1990) Revision after osteotomy for gonarthrosis. A 10–19-year follow-up of 314 cases. Acta Orthop Scand 61(2):128–130

    Article  CAS  PubMed  Google Scholar 

  38. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupacis A (2011) Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 305(8):783–789

    Article  CAS  PubMed  Google Scholar 

  39. Phillips MJ, Krackow KA (1998) High tibial osteotomy and distal femoral osteotomy for valgus or varus deformity around the knee. Instr Course Lect 47:429–436

    CAS  PubMed  Google Scholar 

  40. Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS (1998) Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum 41(4):687–693

    Article  CAS  PubMed  Google Scholar 

  41. Rorabeck CH, Smith PN (1998) Results of revision total knee arthroplasty in the face of significant bone deficiency. Orthop Clin North Am 29(2):361–371

    Article  CAS  PubMed  Google Scholar 

  42. Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(1):96–112

    Article  PubMed  Google Scholar 

  43. Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthr Cartil 14(2):190–195

    Article  CAS  PubMed  Google Scholar 

  44. Staeheli JW, Cass JR, Morrey BF (1987) Condylar total knee arthroplasty after failed proximal tibial osteotomy. J Bone Joint Surg Am 69(1):28–31

    Article  CAS  PubMed  Google Scholar 

  45. Takai S, Yoshino N, Hirasawa Y (1997) Revision total knee arthroplasty after failed high tibial osteotomy. Bulletin 56(4):245–250

    CAS  Google Scholar 

  46. Tapper EM, Hoover NW (1969) Late results after meniscectomy. J Bone Joint Surg Am 51(3):517–526

    Article  CAS  PubMed  Google Scholar 

  47. Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A (2006) Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(2):149–152

    Article  CAS  PubMed  Google Scholar 

  48. Trypuc J, Hudson A, MacLeod H (2006) The pivotal role of critical care and surgical efficiencies in supporting Ontario’s Wait Time Strategy: Part 3. Healthc Q 9(4):37–45, 32

    Article  PubMed  Google Scholar 

  49. van Raaij T, Reijman M, Brouwer RW, Jakma TS, Verhaar JN (2008) Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10–16 years. Acta Orthop 79(2):230–234

    Article  PubMed  Google Scholar 

  50. Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N (2003) Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br 85(1):52–56

    Article  CAS  PubMed  Google Scholar 

  51. W-Dahl A, Robertsson O, Lidgren L (2010) Surgery for knee osteoarthritis in younger patients. Acta Orthop 81(2):161–164

    Article  PubMed  PubMed Central  Google Scholar 

  52. W-Dahl A, Robertsson O, Lohmander LS (2012) High tibial osteotomy in Sweden, 1998-2007: a population-based study of the use and rate of revision to knee arthroplasty. Acta Orthop 83(3):244–248

    Article  PubMed  PubMed Central  Google Scholar 

  53. Wai EK, Kreder HJ, Williams JI (2002) Arthroscopic debridement of the knee for osteoarthritis in patients fifty years of age or older: utilization and outcomes in the Province of Ontario. J Bone Joint Surg Am 84(1):17–22

    Article  PubMed  Google Scholar 

  54. Wasserstein D, Dwyer T, Gandhi R, Austin PC, Mahomed N, Ogilvie-Harris D (2013) A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. Am J Sports Med 41(2):349–355

    Article  PubMed  Google Scholar 

  55. Henry P, Wasserstein D, Paterson M, Kreder H, Jenkinson R (2015) Risk Factors for re-operation and mortality following the operative treatment of tibial plateau fractures in Ontario, 1996–2009. J Orthop Trauma 29(4):182–188

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by funds from the Arthritis Research Program of the University Health Network. The study was performed at the Institute for Clinical Evaluative Sciences, a non-profit research institute funded by the Ontario Ministry of Health and Long-Term Care.

Disclaimer

The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. Parts of this material are based on data and information compiled and provided by the CIHI. However, the analyses, conclusions, opinions and statements expressed herein are those of the author and not necessarily those of CIHI. No endorsement by the Institute for Clinical Evaluative Sciences (ICES) or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. ICES policies require that small cells (≤6) be suppressed to protect patient confidentiality.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, St. Michael’s Hospital, 1507-37 Grosvenor Street, Toronto, ON, M4Y 3G5, Canada

    Amir Khoshbin

  2. University Health Network Arthritis Program, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada

    Ujash Sheth

  3. University Health Network Arthritis Program, 399 Bathurst St., 435, 1 East Wing, Toronto, ON, M5T 2S8, Canada

    Darrell Ogilvie-Harris, Nizar Mahomed & Rajiv Gandhi

  4. Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, MG301, Toronto, ON, M4N 3M5, Canada

    Richard Jenkinson & David Wasserstein

  5. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Nizar Mahomed

Authors
  1. Amir Khoshbin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ujash Sheth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darrell Ogilvie-Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nizar Mahomed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard Jenkinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rajiv Gandhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Wasserstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ujash Sheth.

Ethics declarations

Conflict of interest

No authors have signed any agreement with a commercial interest related to this study, which would in any way limit publication of any and all data generated for the study or delay publication for any reason. None of the authors are paid consultants or have any conflicts of interests.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 55 kb)

Supplementary material 2 (PDF 63 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khoshbin, A., Sheth, U., Ogilvie-Harris, D. et al. The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc 25, 887–894 (2017). https://doi.org/10.1007/s00167-015-3849-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3849-4

Keywords

Search

Navigation