The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study
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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.
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).
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.
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.
KeywordsHigh tibial osteotomy Total knee arthroplasty Osteoarthritis Risk factors Survival
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.
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.
Compliance with ethical standards
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.
- 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 321:10–18Google 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
- 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, TorontoGoogle 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 382-373Google 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 258:213–224Google 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):1119–1125CrossRefPubMedGoogle Scholar
- 31.Macpherson ASM, Manuel DGC, Redelmeier D, Laupacis A (2005) Injuries in Ontario. ICES Atlas. Institute for Clinical Evaluative Sciences, TorontoGoogle 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 299:125–130Google Scholar
- 45.Takai S, Yoshino N, Hirasawa Y (1997) Revision total knee arthroplasty after failed high tibial osteotomy. Bulletin 56(4):245–250Google Scholar