Health-related quality of life after open-wedge high tibial osteotomy

AbstractPurposeThe purpose of this prospective study was to analyze the impact of obesity on the clinical and radiological outcomes 6 years after open-wedge high tibial osteotomy (HTO).MethodsA total of 120 prospectively recorded patients with medial compartment osteoarthritis underwent open-wedge HTO between 2008 and 2011. The study cohort was frequently examined over a minimum of a 6-year follow-up. The cohort was divided into three groups according to body mass index (BMI): normal weight patients (BMI < 25 kg/m2), pre-obese patients (BMI 25–30 kg/m2) and obese patients (BMI > 30 kg/m2). Clinical and functional outcomes (Oxford Knee Score, Hospital for Special Surgery Score, Lequesne Score, Tegner Activity Scale), subjective health-related quality of life (SF-36), change in mechanical limb alignment (mTFA) as well as conversion to unicompartmental or total knee arthroplasty (TKA) were evaluated. To compare clinical scoring between the groups, univariate variance analysis was applied. Changes in outcome variables over time were analyzed with dependentttests.ResultsFrom 120 patients, 85 were followed-up over a 6.7-year period on average (6–11.8 years) after HTO. The mean BMI was 28.6 ± 4.6 kg/m2. Each group showed a significant pre- to postoperative increase in all recorded scores(p < 0.05).In absolute terms, both mental and clinical scores of overweight patients did not reach the peak values of the normal weighted population during the period of observation. There was a conversion to TKA in 10.5% after an average of 50.1 ± 25.0 months following surgery. A total of five complications occurred without significant differences (BMI < 25:n = 1, BMI 25–30:n = 2, BMI > 30:n = 2;n.s.).There was a mean pre- to postoperative (six weeks after surgery) correction difference of 6.9° ± 3.2° (mTFA) with higher loss of correction over time in overweight patients.ConclusionIn terms of clinical outcome and health-related quality of life, overweight patients may receive a benefit from open-wedge HTO to the same extent as patients with normal weights and show similar complication rates. However, they have inferior preoperative clinical and functional results and mid-term results after open-wedge HTO compared to patients with normal weights.Level of evidenceLevel III.

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Health-Related Quality of Life – an Underestimated Factor to Evaluate the Treatment Success after Open Wedge HTO Surgery: Prospective 6-Years Follow-Up

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1098-8894 ◽

2020 ◽

Author(s):

Moritz Herbst ◽

Umito Kuwashima ◽

Marc-Daniel Ahrend ◽

Boyko Guergov Gueorguiev ◽

Steffen Schröter ◽

...

Keyword(s):

Quality Of Life ◽

Knee Arthroplasty ◽

Open Wedge ◽

Health Related Quality ◽

Sf 36 ◽

Related Quality ◽

Health Related ◽

Open Wedge Hto

Abstract Background The subjective health related quality of life in patients with degenerative joint diseases is an important variable to evaluate the treatment outcome. In this study, mid-term results of open wedge HTO were analysed and compared to the subjective quality of life (SF 36) of the general population. Furthermore, the relationships of preoperative assessed subscales of the health-related quality of life (SF 36) and the conversion to knee arthroplasty were analysed. Methods The cohort consisted of 120 patients who were prospectively followed-up after open wedge HTO. At five follow-up points of time, patients were examined and asked about their subjective, health-related quality of life using the SF 36 score. Results 104 patients were included and evaluated until the last follow-up (mean: 81.2 ± 11.3 months after open wedge HTO; follow-up rate: 86.7%). Six years after open wedge HTO, similar values in several psychologic subscales of the SF 36 (BP, GH, V, MH) and the mental health component summary score (MCS) compared to the general population were found. The physical health component summary score (PCS) showed a significant improvement relative to the preoperative values. Nine out of 104 patients (8.7%) received a knee arthroplasty (50.1 ± 25.0 months). Low preoperative values of the subscales “physical functioning” (PF) and “bodily pain” (BP) were identified as risk factors in terms of conversion to a total knee arthroplasty. Conclusions Patients with medial unicompartimental knee osteoarthrosis treated with open wedge HTO showed very good results. The health-related quality of life was nearly as high as in the general population. Patients with preoperative low physical function and high pain values have a higher risk to have a conversion to knee arthroplasty. Surgeons should be aware of these factors if an open wedge HTO is considered.

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