Progression of medial compartmental osteoarthritis 2–8 years after lateral closing-wedge high tibial osteotomy
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The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores.
This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren–Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated.
Mean follow-up was 5.2 ± 1.8 years (range 2–8.5). Mean preoperative mJSW was 3.4 ± 1.6 mm, which changed nonsignificantly (p = 0.51) to 3.4 ± 1.7 mm postoperatively. Mean annual joint space narrowing was 0.02 ± 0.34 mm/year. Progression to 1 KL grade or more was seen in 132 (44 %) patients, and annual risk of KL progression was 8.6 %. No KL progression was seen in 56 % of patients. Mean NRS decreased from 7.3 ± 1.5 to 3.5 ± 2.5 (p < 0.001). WOMAC scores decreased from 48.0 ± 17.2 to 23.6 ± 19.7 (p < 0.001). Failure was seen in 21 patients.
Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment.
Level of evidence
KeywordsHigh tibial osteotomy Osteoarthritis Progression Failure Joint space
We thank Inge Reininga for her input setting up this study and her suggestions for statistical analysis.
MH, JG, AD and RB contributed to the conception and design of this study. JG and AD performed data collection. MH and JG conducted data and statistical analysis. MH and JG drafted the manuscript, RB and SB contributed to critical revision. All authors approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare for this manuscript.
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