scholarly journals Postoperative Bone Marrow Lesions (BMLs) Are Associated with Pain Severity in Patients Undergoing Open Wedge High Tibial Osteotomy (OWHTO)

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Bo Zhu ◽  
Tong-Fu Wang ◽  
De-Sheng Chen ◽  
Jia-Wang Zhu ◽  
Zeng-Liang Wang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Pain Severity ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Bone Marrow Lesions ◽  
Pain Scores ◽  
Osteoarthritis Knee ◽  
Wedge High Tibial Osteotomy ◽  
Vas Scores

The purpose of the study was to investigate the relationship between postoperative bone marrow lesions (BMLs) and pain severity in patients undergoing open wedge high tibial osteotomy (OWHTO). We reviewed the patients undergoing OWHTO between April 2018 and April 2020. The demographic and clinical data of patients were collected. Clinically, VAS and Knee injury and Osteoarthritis Outcome Score (KOOS) were used to assess pain level and functional outcomes of patients. The MRI Osteoarthritis Knee Score (MOAKS) was used to assess the total BMLs size in medial tibiofemoral (MTF), lateral tibiofemoral (LTF), and patellofemoral (PF) joints. 98 patients were enrolled in the study, including 57 male and 41 female patients. The VAS scores improved significantly from 6.1 ± 0.8 to 1.5 ± 0.9 ( p < 0.001 ), and all subscales of KOOS improved significantly after surgery ( p < 0.001 ). There were no significant differences between the pre- and postoperative total BML size of PF and LTF joints ( p > 0.05 ). We observed significant improvements in the total BML size of MTF joint ( p < 0.001 ). The VAS scores and KOOS pain scores improved better in patients without postoperative MTF joint BMLs ( p < 0.001 ). Postoperative MTF joint BMLs were correlated with postoperative VAS ( p < 0.001 ) and KOOS pain ( p < 0.001 ). Our study demonstrates that MTF joint BMLs improved significantly after OWTHO. We confirmed that the presence of postoperative MTF joint BMLs are strongly associated with pain severity. The greater the improvement in postoperative MTF joint BMLs, the less pain. Our findings provide valuable understandings of OWHTO in the treatment of knee osteoarthritis (KOA) and potential future directions for KOA treatment approaches.

scholarly journals Postoperative Bone Marrow Lesions (BMLs) are Associated with Pain Severity in Patients Undergoing Open Wedge High Tibial Osteotomy (OWHTO)

2021 ◽  
Author(s):  
Bo Zhu ◽  
Tong-Fu Wang ◽  
Jia-Wang Zhu ◽  
Zeng-Liang Wang ◽  
Jian-Gang Cao ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Pain Severity ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Bone Marrow Lesions ◽  
Pain Scores ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy ◽  
Vas Scores

Abstract Background: The purpose of the study was to investigate the relationship between postoperative bone marrow lesions (BMLs) and pain severity in patients undergoing open wedge high tibial osteotomy (OWHTO). Methods: We retrospectively reviewed the patients undergoing OWHTO between April 2018 and April 2020. The demographic and clinical data of patients were collected. Clinically, VAS and Knee injury and Osteoarthritis Outcome Score (KOOS) were used to assess pain level and functional outcomes of patients. Histologically, The MRI Osteoarthritis Knee Score (MOAKS) was used to assess semi-quantitatively the total BMLs size in medial tibiofemoral (MTF), lateral tibiofemoral (LTF), and patellofemoral (PF) joints. Results: 98 patients were enrolled in the study, including 57 male and 41 female patients. The VAS scores improved significantly from 6.1 ± 0.8 to 1.5 ± 0.9 (p < 0.001), and all subscales of KOOS improved significantly after surgery (p < 0.001). There were no significant difference between the pre-and postoperative total BMLs size in PF and LTF joints (p > 0.05). We observed significant improvements in the total BMLs size of MTF joint (p < 0.001). All patients had preoperative MTF joint BMLs, in contrast, 13 patients had no postoperative MTF joint BMLs. The independent sample t-test showed that the VAS scores and KOOS pain scores improved better in patients without postoperative MTF joint BMLs (p < 0.001). Pearson correlations showed that postoperative MTF joint BMLs were correlated with postoperative VAS (p < 0.001) and KOOS pain (p < 0.001). Conclusion: Our study demonstrates that MTF joint BMLs improved significantly after OWTHO. We confirmed that the presence of postoperative MTF joint BMLs are strongly associated with pain severity, the greater the improvement in postoperative MTF joint BMLs, the less pain. Our findings provide valuable understandings of OWHTO in the treatment of Knee osteoarthritis (KOA), and potential future directions for KOA treatment approaches.

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

2021 ◽  
pp. 036354652110021
Author(s):  
Han Gyeol Choi ◽  
Joo Sung Kim ◽  
Hyun Jin Yoo ◽  
You Sun Jung ◽  
Yong Seuk Lee
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Insufficiency Fracture ◽  
Tibial Osteotomy ◽  
Pathological Feature ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Bone Marrow Lesions ◽  
Wedge High Tibial Osteotomy

Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

scholarly journals Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

2021 ◽  
Vol 10 (8) ◽  
pp. 1727
Author(s):  
Ta-Wei Liu ◽  
Chih-Hao Chiu ◽  
Alvin Chao-Yu Chen ◽  
Shih-Sheng Chang ◽  
Yi-Sheng Chan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Arthroscopic Surgery ◽  
Underlying Disease ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Background: Medial open wedge high tibial osteotomy (MOWHTO) is a well-established treatment for osteoarthritis of the medial tibiofemoral compartment. Surgical site infection (SSI) after MOWHTO is a devastating complication that may require further surgery. In this study, we aimed to identify the risk factors for infection after MOWHTO over 1 to 4 years of follow-up. Methods: Fifty-nine patients who underwent MOWHTO combined with knee arthroscopic surgery were included in this prospective study. Artificial bone grafts were used in all cases. Possible risk factors, including sex, age, body mass index (BMI), underlying disease, hospitalization length, correction angle, and surgery time, were recorded. Both univariate and multivariate analysis were used. Results: A total of 59 patients who underwent 61 operations were included. Eleven patients (18.0%) were reported to have SSI. Univariate analysis showed that smoking and diabetes mellitus were positively associated with SSI. Multivariate analysis showed that smoking and age were positively associated with SSI. Three patients (4.9%) were reported to suffer from deep SSI, requiring surgical debridement, all of whom were male smokers. Conclusion: Smoking, diabetes mellitus, and old age were identified to be possible risk factors of SSI after MOWHTO. These findings are common risk factors of SSI after orthopedic surgery according to the literature. Patient selection should be performed cautiously, and postoperative prognosis for MOWHTO should be carefully explained to patients who smoke.

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