scholarly journals Obesity Following Antiretroviral Therapy (ART) Initiation is Common and Influenced by Both Traditional and HIV-/ART-Specific Risk Factors

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S37-S38 ◽  
Author(s):  
David Bakal ◽  
Lara Coelho ◽  
Paula M Luz ◽  
Jesse L Clark ◽  
Raquel De Boni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Cox Regression ◽  
Integrase Inhibitor ◽  
Incidence Rates ◽  
Loss To Follow Up ◽  
Female Sex ◽  
Art Initiation ◽  
Specific Risk

Abstract Background Weight gain commonly occurs among HIV-infected (HIV+) adults initiating modern ART regimens, and obesity is increasingly reported in this population. However, data regarding specific risk factors for obesity development after ART initiation are conflicting. Methods We retrospectively analyzed data from a cohort of HIV+ adults who initiated ART between January 1, 2000 and December 31, 2015 in Rio de Janeiro, Brazil. Body mass index (BMI) was assessed at ART initiation. Participants who were non-obese (BMI < 30kg/m2) at baseline and had ≥90 days of ART exposure were followed for development of obesity. Participants were censored at the time of obesity diagnosis or at end of follow-up (defined as death, loss to follow-up, end of study period or 2 years after their last weight measurement). Incidence rates were estimated using Poisson regression models and risk factor assessment was calculated using Cox regression models accounting for death and loss to follow-up as competing risks. Results Participants (n = 1,794) were 61.3% male, 48.3% white and had a median age of 36.3 years. At ART initiation, participants had a median BMI of 22.6kg/m2 and BMI category distribution was: underweight 14%, normal weight 56%, overweight 22% and obese 8%. Of the 1,567 non-obese participants followed after ART initiation, 76% gained weight, 44% increased their BMI category and 18% developed obesity. Median BMI at the end of follow-up was 24.7kg/m2 (0.4kg/m2 median annual change), the obesity incidence rate was 37.4 per 1000 person-years and the median time to obesity diagnosis was 1.9 years (vs. 4.7 years of follow-up for participants remaining non-obese). Factors associated with obesity after ART initiation included younger age at ART initiation, female sex, higher baseline BMI, lower baseline CD4+ T lymphocyte count, higher baseline HIV-1 RNA, having an integrase inhibitor as the most-used ART core drug and having diagnoses of hypertension and diabetes mellitus (Figure). Conclusion Obesity following ART initiation is frequent among HIV+ adults, with rates increasing in recent years. Both traditional (female sex) and HIV-specific (more advanced HIV disease, integrase inhibitor use) risk factors contribute importantly to obesity incidence following ART initiation. Disclosures All authors: No reported disclosures.

scholarly journals Role of Disease Modifying Treatment in the Risk of Alloimmunization in Transfused Patients with Myelodysplastic Syndromes: A Population-Based Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4253-4253
Author(s):  
Hanne Rozema ◽  
Robby Kibbelaar ◽  
Nic Veeger ◽  
Mels Hoogendoorn ◽  
Eric van Roon
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Incidence Rates ◽  
Blood Products ◽  
Cox Regression Analysis ◽  
In The Beginning ◽  
Observation Period

The majority of patients with myelodysplastic syndromes (MDS) require regular red blood cell (RBC) transfusions. Alloimmunization (AI) against blood products is an adverse event, causing time-consuming RBC compatibility testing. The reported incidence of AI in MDS patients varies greatly. Even though different studies on AI in MDS patients have been performed, there are still knowledge gaps. Current literature has not yet fully identified the risk factors and dynamics of AI in individual patients, nor has the influence of disease modifying treatment (DMT) been explored. Therefore, we performed this study to evaluate the effect of DMT on AI. An observational, population-based study, using the HemoBase registry, was performed including all newly diagnosed MDS patients between 2005 and 2017 in Friesland, a province of the Netherlands. All available information about treatment and transfusions, including transfusion dates, types, and treatment regimens, was collected from the electronic health records and laboratory systems. Follow-up occurred through March 2019. For our patient cohort, blood products were matched for AB0 and RhD, and transfused per the 'type and screen' policy (i.e. electronic matching of blood group phenotype between patient and donor). After a positive antibody screening, antibody identification and Rh/K phenotyping was performed and subsequent blood products were (cross)matched accordingly. The observation period was counted from first transfusion until last transfusion or first AI event. Univariate analyses and cumulative frequency distributions were performed to study possible risk factors and dynamics of AI. DMT was defined as hypomethylating agents, lenalidomide, chemotherapy and monoclonal antibodies. The effect of DMT as a temporary risk period on the risk of AI was estimated with incidence rates, relative risks (RR) and hazard ratios (HR) using a cox regression analysis. Follow-up was limited to 24 months for the cox regression analysis to avoid possible bias by survival differences. Statistical analyses were performed using IBM SPSS 24 and SAS 9.4. Out of 292 MDS patients, 236 patients received transfusions and were included in this study, covering 463 years of follow-up. AI occurred in 24 patients (10%). AI occurred mostly in the beginning of the observation period: Eighteen patients (75%) were alloimmunized after receiving 20 units of RBCs, whereas 22 patients (92%) showed AI after 45 units of RBCs (Figure 1). We found no significant risk factors for AI in MDS patients at baseline. DMT was given to 67 patients (28%) during the observation period. Patients on DMT received more RBC transfusions than patients that did not receive DMT (median of 33 (range: 3-154) and 11 (range: 0-322) RBC units respectively, p<0,001). Four AI events (6%) occurred in patients on DMT and 20 AI events (12%) occurred in patients not on DMT. Cox regression analysis of the first 24 months of follow-up showed an HR of 0.30 (95% CI: 0.07-1.31; p=0.11). The incidence rates per 100 person-years were 3.19 and 5.92 respectively. The corresponding RR was 0.54 (95% CI: 0.16-1.48; p=0.26). Based on our results, we conclude that the incidence of AI in an unselected, real world MDS population receiving RBC transfusions is 10% and predominantly occurred in the beginning of follow-up. Risk factors for AI at baseline could not be identified. Our data showed that patients on DMT received significantly more RBC transfusions but were less susceptible to AI. Therefore, extensive matching of blood products may not be necessary for patients on DMT. Larger studies are needed to confirm the protective effect of DMT on AI. Disclosures Rozema: Celgene: Other: Financial support for visiting MDS Foundation conference.

Incidence and Predictors of Suicide Attempts in Bipolar I and II Disorders: A Five-year Follow-up

2017 ◽  
Vol 41 (S1) ◽  
pp. S87-S87
Author(s):  
S. Pallaskorpi ◽  
K. Suominen ◽  
M. Ketokivi ◽  
H. Valtonen ◽  
P. Arvilommi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Suicide Attempts ◽  
Incidence Rates ◽  
Personality Factors ◽  
Long Term Study ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionAlthough suicidal behavior is very common in bipolar disorder (BD), few long-term studies have investigated incidence and risk factors of suicide attempts (SAs) specifically related to illness phases of BD.ObjectivesWe examined incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and II (BD-II) patients and risk factors specifically for SAs during major depressive episodes (MDEs).MethodsIn the Jorvi bipolar study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to five years. Incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models.ResultsDuring the five-year follow-up, 90 SAs per 718 patient-years occurred. Compared with euthymia the incidence was highest, over 120-fold, during mixed states (765/1000 person-years [95% confidence interval (CI) 461–1269]) and also very high in MDEs, almost 60-fold (354/1000 [95%CI 277–451]). For risk of SAs during MDEs, the duration of MDEs, severity of depression and cluster C personality disorders were significant predictors.ConclusionsIn this long-term study, the highest incidences of SAs occurred in mixed phases and MDEs. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question “when” rather than “who” may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Risk Factors for Second Malignancies after Transplantation Differ between Allogeneic and Autologous Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1121-1121
Author(s):  
Debra L. Friedman ◽  
Wendy Leisenring ◽  
Mary E. Flowers ◽  
Leona Holmberg ◽  
Jeffrey Schwartz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Cox Regression ◽  
Autologous Transplantation ◽  
Allogeneic Transplant ◽  
Allogeneic Hsct ◽  
Autologous Transplant ◽  
Increased Risk ◽  
Autologous Hsct

Abstract Survivors of hematopoietic stem cell transplantation (HSCT) are at risk for second malignant neoplasms (SMN). We undertook this analysis to ascertain whether risk of SMN was comparable in survivors of allogeneic and autologous transplantation. Among 8662 transplant recipients treated at the Fred Hutchinson Cancer Research Center between November 1969 and April 2004, who survived at least 100 days post transplant, there were 1743 autologous and 6919 allogeneic HSCT recipients. Within this cohort, there were 56 SMNs among the autologous and 224 among the allogeneic recipients. Cumulative incidence of SMN at 10 years post-HSCT was 2.6% in the allogeneic and 4.2% in the autologous HSCT survivors. A multivariate Cox regression model adjusted for current age, TBI, gender and length of follow-up was fit and the hazard ratio (HR) for SMN for the allogeneic transplant survivors was 0.7 (95% confidence interval {CI} 0.5, 1.0) compared to the autologous transplant survivors (reference group), suggesting that the adjusted hazard of SMN is higher for autologous than for allogeneic HSCT recipients. Risk factors differed between the two groups. For survivors of autologous transplantation, in multivariate Cox regression models, only age > 18 years at transplant was associated with decreased risk of SMN (<18 years HR = 1.0; 18–39 years HR = 0.04; 40+ years HR = 0.004). Use of total body irradiation (TBI) was not significantly associated with risk among the autologous HSCT recipients. For allogeneic transplant survivors, increased risk of SMN was associated with TBI and the effect of TBI was stronger for younger (<18 years at HSCT: HR = 4.6; 95% CI 1.6, 13.5) than for older (≥18 years; HR = 1.5; 95% CI 1.0, 2.3) HSCT recipients (interaction p = 0.04) in multivariate Cox regression models. Risk was also increased after acute graft versus host disease (HR = 1.4; 95% CI 1.0, 1.9) and with ongoing follow-up time, with HRs of 1.7 (95% CI 1.1, 2.5) at 10 – 14 years, 2.2 (95% CI 1.3, 3.7) at 15–19 years and 2.6 (95% CI 1.2, 5.4) at 20+ years of follow-up. Unrelated HSCT also increased risk of SMN (HR = 1.4; 95% CI 1.0, 2.0). In adjusted analyses, risk of SMN thus appears slightly lower in allogeneic versus autologous transplant survivors, and risk factors appear different between the two groups. Attention should focus on modifiable risk factors in both groups. Particularly in autologous transplant survivors, the relative contribution of pre-transplant exposures must be established.

scholarly journals Cardiovascular risk in patients with spondyloarthritis and association with anti-TNF drugs

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110324
Author(s):  
Shirley Chiu Wai Chan ◽  
Cheong Kay Teo ◽  
Philip Hei Li ◽  
Kui Kai Lau ◽  
Chak Sing Lau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Clinical Information ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Crude Incidence ◽  
Cox Regression Analysis ◽  
Cerebrovascular Events ◽  
Propensity Score Adjustment

Background: Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS. CVS risk factors and CVS events are common in spondyloarthritis (SpA). Delineating the CVS risk in patients with SpA and identifying modifiable risk factors would be useful. Methods: Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics, respectively. Clinical information and CVS events were retrieved. Baseline characteristics and incidence rates of CVS events were compared between two groups of patients using an age- and sex-matched cohort. Propensity score adjustment and Cox regression analysis were performed to determine the CVS risk associated with SpA. Results: A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56,484 person-years of follow up, 160 strokes, 84 myocardial infarction (MI) and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, p < 0.01). Crude incidence rates of MACE and stroke were higher in SpA patients. SpA was associated with a higher risk of MACE [hazard ratio (HR) 1.70; 95% confidence interval (CI) 1.29–2.26; p < 0.01] and cerebrovascular events (HR 1.50; 95% CI 1.08–2.07; p = 0.02). SpA patients with anti-TNF use had a reduced risk of MACE (HR 0.37, 95%CI 0.17–0.80, p = 0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06–0.78, p = 0.02) compared with SpA patients without anti-TNF use. Conclusion: SpA is an independent CVS risk factor. Anti-tumor necrosis factor (TNF) drugs were associated with a reduced CVS risk in these patients.

scholarly journals Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review

2021 ◽  
pp. 219256822098227
Author(s):  
Max J. Scheyerer ◽  
Ulrich J. A. Spiegl ◽  
Sebastian Grueninger ◽  
Frank Hartmann ◽  
Sebastian Katscher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Treatment Failure ◽  
Patient Specific ◽  
Mineral Density ◽  
Radiographic Findings ◽  
Specific Risk ◽  
Fracture Development ◽  
Predict Treatment Failure

Study Design: Systematic review. Objectives: Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. Methods: We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. Results: After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <−2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. Conclusion: In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.

scholarly journals POS1015 ANTI-TNF DRUGS AND CARDIOVASCULAR EVENTS IN PATIENTS WITH SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 775.2-776
Author(s):  
C. W. S. Chan ◽  
P. H. LI ◽  
C. S. Lau ◽  
H. Y. Chung
Keyword(s):  
Risk Factors ◽  
Psoriatic Arthritis ◽  
Cardiovascular Events ◽  
Clinical Information ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cross Sectional ◽  
Cerebrovascular Events ◽  
Cardiovascular Morbidity And Mortality

Background:Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS risk including stroke and myocardial infarction (MI) (1-3). CVS risk factors and CVS events are common in SpA (4). Delineating the CVS risk and the association with medications in patients with SpA would be useful.Objectives:The objective of this study was to delineate the CVS risk and the association with medications in patients with SpA.Methods:Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics respectively. Clinical information and CVS events were retrieved. Incidence rates were calculated. Association analysis was performed to determine the CVS risk of SpA and other modifiable risk factors.Results:A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56 484 person-years of follow-up, 160 strokes, 84 MI and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, P<0.01). Crude incidence rates of stroke and MI were higher in SpA patients. SpA was associated with a higher risk of MACE (HR 1.66, 95%CI 1.22-2.27, P<0.01) and cerebrovascular events (HR 1.42, 95%CI 1.01-2.00, p=0.04). The use of anti-tumor necrosis factor (TNF) drugs was associated with a reduced risk of MACE (HR 0.37, 95%CI 0.17-0.80, P=0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06-0.78, P=0.02).Conclusion:SpA is an independent CVS risk factor. Anti-TNF drugs were associated with a reduced CVS risk in these patients.References:[1]Crowson CS, Liao KP, Davis JM, 3rd, Solomon DH, Matteson EL, Knutson KL, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-8 e1.[2]Verhoeven F, Prati C, Demougeot C, Wendling D. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine. 2020;87(5):413-8.[3]Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):369-89.[4]Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23.Disclosure of Interests:None declared.

Maternal age at birth and daughter’s fecundability

2021 ◽  
Author(s):  
Olga Basso ◽  
Sydney K Willis ◽  
Elizabeth E Hatch ◽  
Ellen M Mikkelsen ◽  
Kenneth J Rothman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Maternal Age ◽  
Limited Information ◽  
Loss To Follow Up ◽  
Older Mothers ◽  
Registration Number ◽  
The Usa ◽  
Competing Interest

Abstract STUDY QUESTION Do daughters of older mothers have lower fecundability? SUMMARY ANSWER In this cohort study of North American pregnancy planners, there was virtually no association between maternal age ≥35 years and daughters’ fecundability. WHAT IS KNOWN ALREADY Despite suggestive evidence that daughters of older mothers may have lower fertility, only three retrospective studies have examined the association between maternal age and daughter’s fecundability. STUDY DESIGN, SIZE, DURATION Prospective cohort study of 6689 pregnancy planners enrolled between March 2016 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnancy Study Online (PRESTO) is an ongoing pre-conception cohort study of pregnancy planners (age, 21-45 years) from the USA and Canada. We estimated fecundability ratios (FR) for maternal age at the participant’s birth using multivariable proportional probabilities regression models. MAIN RESULTS AND THE ROLE OF CHANCE Daughters of mothers ≥30 years were less likely to have previous pregnancies (or pregnancy attempts) or risk factors for infertility, although they were more likely to report that their mother had experienced problems conceiving. The proportion of participants with prior unplanned pregnancies, a birth before age 21, ≥3 cycles of attempt at study entry or no follow-up was greater among daughters of mothers &lt;25 years. Compared with maternal age 25–29 years, FRs (95% CI) for maternal age &lt;20, 20–24, 30–34, and ≥35 were 0.72 (0.61, 0.84), 0.92 (0.85, 1.00), 1.08 (1.00, 1.17), and 1.00 (0.89, 1.12), respectively. LIMITATIONS, REASONS FOR CAUTION Although the examined covariates did not meaningfully affect the associations, we had limited information on the participants’ mother. Differences by maternal age in reproductive history, infertility risk factors and loss to follow-up suggest that selection bias may partly explain our results. WIDER IMPLICATIONS OF THE FINDINGS Our finding that maternal age 35 years or older was not associated with daughter’s fecundability is reassuring, considering the trend towards delayed childbirth. However, having been born to a young mother may be a marker of low fecundability among pregnancy planners. STUDY FUNDING/COMPETING INTEREST(S) PRESTO was funded by NICHD Grants (R21-HD072326 and R01-HD086742) and has received in-kind donations from Swiss Precision Diagnostics, FertilityFriend.com, Kindara.com, and Sandstone Diagnostics. Dr Wise is a fibroid consultant for AbbVie, Inc. TRIAL REGISTRATION NUMBER n/a

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

scholarly journals Long-term follow-up results of medial opening wedge high tibia osteotomy with a pre-countered non-locking steel plate

2021 ◽  
Author(s):  
Simo S. A. Miettinen ◽  
Hannu J. A. Miettinen ◽  
Jussi Jalkanen ◽  
Antti Joukainen ◽  
Heikki Kröger
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Mechanical Axis ◽  
Steel Plate ◽  
Cox Regression ◽  
Opening Wedge ◽  
Cumulative Survival ◽  
Long Term Follow Up

Abstract Introduction This retrospective study investigated the long-term follow-up results of medial opening wedge high tibial osteotomy (MOWHTO) with a pre-countered non-locking steel plate implant (Puddu plate = PP) used for medial knee osteoarthrosis (OA) treatment. Materials and methods Consecutive 70 MOWHTOs (66 patients) were performed between 01.01.2004 and 31.12.2008 with the mean follow-up time of 11.4 (SD 4.5; range 1.2–16.1) years. The Kaplan–Meier survival analysis was used to evaluate the cumulative survival of the implant in terms of age (< 50 years old and ≥ 50 years old) and gender. Adverse events were studied and Cox regression analysis was used to evaluate risk factors [age, gender, body mass index (BMI), preoperative mechanical axis, severity of OA, use of bone grafting or substitution and undercorrection of mechanical axis from varus to valgus] for revisions. Results The estimates for the cumulative survival with no need for TKA after MOWHTO were 86% at 5 years, 67% at 10 years and 58% at 16.1 years (SE 0.6, CI 95% 11.1–13.5). A total of 33/70 (47%) adverse events occurred and 38/70 (54%) knees required some revision surgery during the follow-up. Cox regression did not show any statistically significant risk factors for revision. Conclusions The PP has feasible MOWHTO results with a cumulative survival of 67% at 10 years with no need for conversion to TKA. Many adverse events occurred and revision rate due to any reason was high. Age or gender did not have statistically significant differences in terms of survival.

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