Abstract
Purpose
To report the long-term outcomes of medial open wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in patients younger than 45 years old. It was hypothesized that the correction of knee alignment would result in preservation of knee function in a long-term follow-up.
Methods
Patients under 45 years old, who underwent MOWHTO for symptomatic medial compartment knee osteoarthritis between 2001 and 2005 were retrospectively reviewed after a minimum of 10 years. The osteotomy was performed utilizing a locking plate without the use of bone graft. Patients were evaluated pre- and postoperatively using the International Knee Documentation Committee Score, the Oxford Knee Score, the Knee injury Osteoarthritis Outcome Score and the Short Form-12 Score. Standardized standing whole-limb radiographs were also obtained to assess mechanical tibiofemoral angle (mTFA) and the grade of osteoarthritis.
Results
A total of 20 patients (18 males, 2 females, mean age 35.4 years) with a mean follow-up of 12.3 years were included in the study. During the follow-up period, one patient required conversion to total knee replacement (95% survival rate). All clinical outcome scores (IKDC, KOOS, OKS, and SF-12) significantly improved postoperatively (p < 0.05), with no significant deterioration over time. Preoperative varus alignment with an mTFA of − 5.8 ± 2.4° was corrected to 2.5 ± 1.9° immediately after surgery (p < 0.05), and remained 2.2 ± 1.7° at the last follow-up. Furthermore, no significant radiographic progression of osteoarthritis was observed.
Conclusions
MWOHTO with a locking plate is an effective joint preservation method to treat medial compartment OA in active patients less than 45 years. Clinical and radiological results are satisfactory and the survival rate is 95%, 12 years after the procedure.
Level of evidence
Level IV therapeutic, retrospective, cohort study.
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Abbreviations
- OA:
-
Osteoarthritis
- HTO:
-
High tibial osteotomy
- MOWHTO:
-
Medial open wedge high tibial osteotomy
- mTFA:
-
Mechanical tibiofemoral angle
- IKDC:
-
International knee documentation committee
- OKS:
-
Oxford Knee Score
- KOOS:
-
Knee Injury Osteoarthritis Outcome Score
- SF-12:
-
Short Form-12
- TKA:
-
Total knee arthroplasty
- LCWHTO:
-
Lateral closing wedge high tibial osteotomy
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MH conceived, designed and co-ordinated the study, and critically reviewed the manuscript. PN collected data and analysed the data, and drafted the manuscript. AK drafted the manuscript and analysed the data. YO collected data and drafted the manuscript. ND collected data and drafted the manuscript. KN participated in the design of the study, and critically reviewed the manuscript. All authors have read and approved the final manuscript.
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Michael E. Hantes, Prodromos Natsaridis, Koutalos A. Antonios, Yohei Ono, Nikos Doxariotis, and Konstantinos N. Malizos declare that they have no conflicts of interest.
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No funding has been received for this study.
Ethical approval
Ethical approval was obtained for this study by the local ethical committee.
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Informed consent was obtained by all patients.
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Hantes, M.E., Natsaridis, P., Koutalos, A.A. et al. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 26, 3199–3205 (2018). https://doi.org/10.1007/s00167-017-4816-z
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DOI: https://doi.org/10.1007/s00167-017-4816-z