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Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis

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Abstract

Purpose

Proximal tibia osteotomy with absorbable spacer combined with fibular osteotomy (TPOASI) is an emerging surgical technique for treating knee osteoarthritis (KOA); however, the efficacy of this procedure remains unknown. We hypothesize that TPOASI can achieve similar clinical outcomes to opening-wedge high tibial osteotomy (OW-HTO). The objective of this study is to compare the clinical results between these two procedures.

Methods

Patients who underwent TPOASI or OW-HTO from July 2016 to September 2020 were included. The following outcome parameters were determined before and after the surgery: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale of pain, the Intermittent and Persistent Osteoarthritis Pain Scale, femorotibial angle, and post-operative complications.

Results

In total, 209 cases were analyzed (102 in TPOASI group; 107 in OW-HTO group) with 3.1 years average follow-up. Both procedures achieved significant improvement in KOOS (62.0 to 24.4 in the TPOASI and 62.8 to 26.2 in the OW-HTO group, p < 0.001) and WOMAC score (68.9 to 24.1 in the TPOASI versus 69.9 to 26.1 in the OW-HTO group, p < 0.001). There were no significant differences in complications or femorotibial angle between the two groups but the only significant difference in the outcome parameters was the WOMAC stiffness score (19.6 in the TPOASI versus 26.5 in the OW-HTO group).

Conclusion

TPOASI achieves comparable results to OW-HTO in terms of clinical scores, radiographic results, and complications, but has the advantage of avoiding internal fixation removal.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Safiri S, Kolahi A-A, Smith E, Hill C, Bettampadi D, Mansournia MA, Hoy D, Ashrafi-Asgarabad A, Sepidarkish M, Almasi-Hashiani A, Collins G, Kaufman J, Qorbani M, Moradi-Lakeh M, Woolf AD, Guillemin F, March L, Cross M (2020) Global, regional and national burden of osteoarthritis 1990–2017: a systematic analysis of the Global Burden of Disease Study 2017. Ann Rheum Dis 79:819–828. https://doi.org/10.1136/annrheumdis-2019-216515

    Article  PubMed  Google Scholar 

  2. Charlesworth J, Fitzpatrick J, Perera NKP, Orchard J (2019) Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee. BMC Musculoskelet Disord 20:151. https://doi.org/10.1186/s12891-019-2525-0

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SM, Verhaar JA (2014) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 2014:Cd004019. https://doi.org/10.1002/14651858.CD004019.pub4

    Article  PubMed  PubMed Central  Google Scholar 

  4. Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160. https://doi.org/10.1007/s00264-009-0889-8

    Article  PubMed  Google Scholar 

  5. Sun H, Zhou L, Li F, Duan J (2017) Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis. J Knee Surg 30:158–165. https://doi.org/10.1055/s-0036-1584189

    Article  PubMed  Google Scholar 

  6. Park JG, Han SB, Jang KM (2021) Association of preoperative tibial varus deformity with joint line orientation and clinical outcome after open-wedge high tibial osteotomy for medial compartment osteoarthritis: a propensity score-matched analysis. Am J Sports Med 49:3551–3560. https://doi.org/10.1177/03635465211044146

    Article  PubMed  Google Scholar 

  7. He QF, Wang HX, Sun H, Zhan Y, Zhang BB, Xie XT, Luo CF (2019) Medial open-wedge osteotomy with double-plate fixation for varus malunion of the distal femur. Orthop Surg 11:82–90. https://doi.org/10.1111/os.12421

    Article  PubMed Central  Google Scholar 

  8. Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplasty 16:168–173. https://doi.org/10.1054/arth.2001.20538

    Article  CAS  PubMed  Google Scholar 

  9. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA (2014) Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 96:1425–1432. https://doi.org/10.2106/jbjs.M.00786

    Article  CAS  PubMed  Google Scholar 

  10. Duivenvoorden T, van Diggele P, Reijman M, Bos PK, van Egmond J, Bierma-Zeinstra SMA, Verhaar JAN (2017) Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc 25:895–901. https://doi.org/10.1007/s00167-015-3644-2

    Article  CAS  PubMed  Google Scholar 

  11. Cazor A, Schmidt A, Shatrov J, Alqahtani T, Neyret P, Sappey-Marinier E, Batailler C, Lustig S, Servien E (2022) Less risk of conversion to total knee arthroplasty without significant clinical and survivorship difference for opening-wedge high tibial osteotomies in varus knee deformities at 10-year minimum follow-up compared to closing-wedge high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07122-z

    Article  PubMed  Google Scholar 

  12. Jiang WB, Sun SZ, Li C, Adds P, Tang W, Chen W, Yu SB, Sui HJ (2021) Anatomical basis of the support of fibula to tibial plateau and its clinical significance. J Orthop Surg Res 16:346. https://doi.org/10.1186/s13018-021-02500-8

    Article  PubMed  PubMed Central  Google Scholar 

  13. Qin D, Chen W, Wang J, Lv H, Ma W, Dong T, Zhang Y (2018) Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: a prospective study. J Int Med Res 46:3114–3123. https://doi.org/10.1177/0300060518772715

    Article  PubMed  PubMed Central  Google Scholar 

  14. Deng X, Chen W, Zhao K, Zhu J, Hu H, Cheng X, Wang Z, Wang Y, Tan Z, Ye Z, Zhang Y (2021) Changes in patellar height and posterior tibial slope angle following uniplanar medial opening wedge high tibial osteotomy using a novel wedge-shaped spacer implanation concurrent with proximal partial fibulectomy. Int Orthop 45:109–115. https://doi.org/10.1007/s00264-020-04786-5

    Article  PubMed  Google Scholar 

  15. Zheng ZL, Yu XY, Gao SJ, Hou ZY, Chang HR, Zhang YZ (2016) Initial clinical application of high tibial osteotomy with absorbable spacer implantation for the treatment of knee osteoarthritis. J Hebei Med Univ 37:988–989+993

    Google Scholar 

  16. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264. https://doi.org/10.1097/00003086-199201000-00025

  17. Moore J, Mychaltchouk L, Lavoie F (2017) Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc : Off J ESSKA 25:846–852. https://doi.org/10.1007/s00167-015-3954-4

    Article  Google Scholar 

  18. Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354

    Article  CAS  PubMed  Google Scholar 

  19. Hassaballa M, Artz N, Weale A, Porteous A (2012) Alteration in skin sensation following knee arthroplasty and its impact on kneeling ability: a comparison of three common surgical incisions. Knee Surg Sports Traumatol Arthrosc 20:1983–1987. https://doi.org/10.1007/s00167-011-1727-2

    Article  PubMed  Google Scholar 

  20. Oka H, Muraki S, Akune T, Mabuchi A, Suzuki T, Yoshida H, Yamamoto S, Nakamura K, Yoshimura N, Kawaguchi H (2008) Fully automatic quantification of knee osteoarthritis severity on plain radiographs. Osteoarthritis Cartilage 16:1300–1306. https://doi.org/10.1016/j.joca.2008.03.011

    Article  CAS  PubMed  Google Scholar 

  21. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kara S, Küpeli E, Yılmaz HEB, Yabanoğlu H (2020) Predicting pulmonary complications following upper and lower abdominal surgery: ASA vs. ARISCAT Risk Index. Turk J Anaesthesiol Reanim 48:96–101. https://doi.org/10.5152/tjar.2019.28158

    Article  PubMed  Google Scholar 

  23. Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64. https://doi.org/10.1186/1477-7525-1-64

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  25. Fries JF, Spitz PW, Young DY (1982) The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol 9:789–793

    CAS  PubMed  Google Scholar 

  26. Zhang C, Liu DH, Qu YL, Jia ZY, Wang W, Li J, Xu WD (2017) Transcultural adaptation and validation of the Chinese version of the intermittent and constant osteoarthritis pain (ICOAP) measure in patients with knee osteoarthritis. Osteoarthritis Cartilage 25:506–512. https://doi.org/10.1016/j.joca.2016.11.012

    Article  CAS  PubMed  Google Scholar 

  27. Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ (2018) What is the minimum clinically important difference for the WOMAC Index after TKA? Clin Orthop Relat Res 476:2005–2014. https://doi.org/10.1097/CORR.0000000000000444

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhang Q, Xu W, Wu K, Fu W, Yang H, Guo JJ (2022) Intra-articular pure platelet-rich plasma combined with open-wedge high tibial osteotomy improves clinical outcomes and minimal joint space width compared with high tibial osteotomy alone in knee osteoarthritis: a prospective study. Arthroscopy 38:476–485. https://doi.org/10.1016/j.arthro.2021.09.013

    Article  PubMed  Google Scholar 

  29. Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N, Ollivier M (2021) Evaluation of the “Minimal Clinically Important Difference” (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 29:820–826. https://doi.org/10.1007/s00167-020-06026-0

    Article  PubMed  Google Scholar 

  30. Donec V, Kubilius R (2020) The effectiveness of Kinesio Taping((R)) for mobility and functioning improvement in knee osteoarthritis: a randomized, double-blind, controlled trial. Clin Rehabil 34:877–889. https://doi.org/10.1177/0269215520916859

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Der Orthopade 33:153–160. https://doi.org/10.1007/s00132-003-0593-0

    Article  CAS  PubMed  Google Scholar 

  32. van der Woude JAD, Wiegant K, van Heerwaarden RJ, Spruijt S, van Roermund PM, Custers RJH, Mastbergen SC, Lafeber F (2017) Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc : Off J ESSKA 25:876–886. https://doi.org/10.1007/s00167-016-4131-0

    Article  Google Scholar 

  33. Hoell S, Suttmoeller J, Stoll V, Fuchs S, Gosheger G (2005) The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients. Arch Orthop Trauma Surg 125:638–643. https://doi.org/10.1007/s00402-005-0004-6

    Article  CAS  PubMed  Google Scholar 

  34. Walker BF, Williamson OD (2009) Mechanical or inflammatory low back pain. What are the potential signs and symptoms? Man Ther 14:314–320. https://doi.org/10.1016/j.math.2008.04.003

    Article  PubMed  Google Scholar 

  35. Clement ND, Bardgett M, Weir D, Holland J, Deehan DJ (2019) Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction. Knee Surg Sports Traumatol Arthrosc 27:1196–1203. https://doi.org/10.1007/s00167-018-4979-2

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by several grants from the National Natural Science Foundation of China (91949203), Hebei Department of Science and Technology High-Level Talent Team Construction Project (225A7703D), and Hebei Provincial Key Research Projects (192777113D).

Author information

Author notes

  1. Jiahao Yu and Penghuan Wu contributed equally to this work.

Authors and Affiliations

  1. Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China

    Jiahao Yu, Haichuan Guo, Pengzhao Chen, Peizhi Yuwen & Yingze Zhang

  2. Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China

    Jiahao Yu, Haichuan Guo, Pengzhao Chen, Peizhi Yuwen, Juan Wang & Yingze Zhang

  3. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China

    Jiahao Yu, Haichuan Guo, Pengzhao Chen, Peizhi Yuwen, Juan Wang & Yingze Zhang

  4. NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People’s Republic of China

    Jiahao Yu, Haichuan Guo, Pengzhao Chen, Peizhi Yuwen, Juan Wang & Yingze Zhang

  5. Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People’s Republic of China

    Jiahao Yu, Haichuan Guo, Pengzhao Chen, Peizhi Yuwen, Juan Wang & Yingze Zhang

  6. Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People’s Republic of China

    Jiahao Yu, Haichuan Guo, Pengzhao Chen, Peizhi Yuwen, Juan Wang & Yingze Zhang

  7. Department of Orthopaedics, Shaoguan First People’s Hospital, Affiliated Shaoguan First People’s Hospital, Southern Medical University, Shaoguan, Guangdong, China

    Penghuan Wu

  8. Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China

    Penghuan Wu

  9. The School of Medicine, Nankai University, Tianjin, China

    Penghuan Wu

  10. Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China

    Juan Wang

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  1. Jiahao Yu
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Contributions

J-hY writes the manuscript. J-hY, P-hW, H-cG, P-zYw, and P-zC acquired the data for the work. All authors contributed to the analysis and the interpretation of data. J. W. and Y-zZ design and revise the paper. All authors have critically revised the manuscript and have agreed to the final version.

Corresponding authors

Correspondence to Juan Wang or Yingze Zhang.

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Ethics approval

The Ethical Board Review of the Third Hospital of Hebei Medical University (Shijiazhuang, Hebei, China) approved the conduct of the study, and each patient provided informed consent (Ke2021-056–1). The study was performed in accordance with the ethical standards of the Declaration of Helsinki of 1964.

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Yu, J., Wu, P., Guo, H. et al. Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis. International Orthopaedics (SICOT) 47, 2699–2708 (2023). https://doi.org/10.1007/s00264-023-05894-8

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