scholarly journals Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Mingliang He ◽  
Xihong Zhong ◽  
Zhong Li ◽  
Kun Shen ◽  
Wen Zeng
Keyword(s):  
Survival Rate ◽  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Fracture Rate ◽  
Tibial Osteotomy ◽  
Term Survival ◽  
Outcome Indicators ◽  
Wedge High Tibial Osteotomy ◽  
Total Knee

Abstract Background High tibial osteotomy (HTO) has been used for over 60 years in clinical practice and mainly comprises two major techniques: closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). However, these have been gradually replaced by total knee arthroplasty (TKA), due to inconsistent clinical results and many complications. With the concept of knee-protection and ladder treatment of osteoarthritis, as an effective minimally invasive treatment for knee osteoarthritis, HTO has once again received attention. Methods A systematic literature search was conducted in PubMed, Embase, ClinicalKey, CNKI, and the China Wanfang database. The search terms relating to osteoarthritis and high tibial osteotomy were used. Studies were considered eligible if the participants were adults with knee osteoarthritis (KOA) who had undergone HTO. A total of two reviewers participated in the selection of the studies. Reviewer 1 was assigned to screen titles and abstracts, and reviewer 2 to screen full-text data. Data extraction was completed by reviewer 2, and 30% were checked by the research team. Potential conflicts were resolved through discussion. The methodological quality was assessed using a risk of bias, based on the Cochrane handbook and Newcastle-Ottawa assessment scale. The outcome indicators are (1) posterior slope of tibial plateau, (2) the height of the patella, (3) fracture in the osteotomy plane, (4) survival rate, (5) special surgery knee score (HSS), and (6) the recurrence of varus deformity of the included studies were evaluated according to the guidelines of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) working group (Atkins et al., BMJ 328:1490, 2004). Results Among the 18 articles included, 10 were prospective cohort studies, five were randomized controlled trial (RCT) studies, one was prospective comparative study (PCS), one was retrospective comparative study (RCS), and one was retrospective cohort. The earliest publication year was 1999, and the most recent was 2018. A total of 6555 eligible cases were included, comprised of 3351 OWHTO patients and 3204 CWHTO patients. Five RCT were assessed using risk of bias, based on the Cochrane handbook. Eleven cohort studies and two case-control studies were assessed using the Newcastle-Ottawa assessment scale. These six outcome indicators for a total of twenty-four evidence individuals were evaluated separately, among which the GRADE classification of 1, 2, and 6 was medium quality, and 3, 4, and 5 were low quality. Based on our systematic review, regardless of whether the chosen procedure was OWHTO or CWHTO, both HSS scores increased significantly as compared with the preoperative scores. Compared with CWHTO, the height of the patella and tibial posterior slope angle increased following OWHTO. Additionally, OWHTO has a better long-term survival rate and lower fracture rate, supporting OWHTO as the first treatment choice. Conclusions For young patients with knee osteoarthritis (KOA), high tibial osteotomy (HTO) can be considered as a treatment option to replace total knee arthroplasty (TKA) to reduce the economic burden and promote the reasonable allocation of medical resources. This study shows that compared with CWHTO, OWHTO has certain advantages in long-term survival rate and lower fracture rate, but the level of evidence is lower. In the future, we will need larger sample sizes and longer follow-up randomized controlled trials to improve our research.

scholarly journals Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement

2021 ◽  
Vol 10 (13) ◽  
pp. 2743
Author(s):  
Juan Sánchez-Soler ◽  
Alex Coelho ◽  
Raúl Torres-Claramunt ◽  
Berta Gasol ◽  
Albert Fontanellas ◽  
...  
Keyword(s):  
Survival Rate ◽  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA ≤ 180°, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24–180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7° (SD 4.9) in group 1 and 179.5° (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 ± 15.9) and group 2 (84.3 ± 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA ≤ 180° (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study.

scholarly journals Total Knee Arthroplasty Conversion after Open-wedge High Tibial Osteotomy

2021 ◽  
Vol 15 (1) ◽  
pp. 53-56
Author(s):  
Wataru Kusano ◽  
Takatomo Mine ◽  
Koichiro Ihara ◽  
Yasuhiro Tominaga ◽  
Hiroyuki Kawamura ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Soft Tissue Release ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Term Survival ◽  
Wedge High Tibial Osteotomy ◽  
Total Knee ◽  
Open Wedge Hto

Background: Open-wedge High Tibial Osteotomy (HTO) is an effective treatment for Osteoarthritis (OA) of the knee; however, postoperative changes due to HTO can make subsequent Total Knee Arthroplasty (TKA) technically difficult and can affect long-term survival. Case Report: Medio-lateral stability along with balanced flexion and extension gaps provides a good functional outcome. A 71-year-old man underwent TKA conversion after open-wedge HTO 12 years earlier; the conversion was performed due to arthritic deterioration in the knee. Medial instability was noted because of poor ligament balancing. The residual medial instability was managed with a knee brace due to the unavailability of the constrained prosthesis. Management of persistent mediolateral instability persisting after soft tissue release and balancing ideally requires varus-valgus constraint. Conclusion: TKA conversion after open-wedge HTO requires a special technique and careful preparation before surgery.

scholarly journals EVALUATION OF OUTCOME OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL KNEE OSTEOARTHRITIS

2020 ◽  
pp. 1-4
Author(s):  
R. N. Shewale ◽  
Ketan J. Khatri
Keyword(s):  
Knee Osteoarthritis ◽  
Functional Outcome ◽  
High Tibial Osteotomy ◽  
Medial Compartment ◽  
Functional Score ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Background: Osteoarthritis is often found in weight-bearing joints, the knee being the most common site. Most patients of symptomatic osteoarthritis of knee are associated with varus malalignment that is causative or contributory to painful arthritis. Correcting the malalignment of the knee relieves symptoms by transferring the functional load to the unaffected compartment. The goal of the treatment is to relieve medial compartment knee pain and slow down the arthritic progression. We report the outcome of a simple technique of medial opening wedge high tibial osteotomy in treating the medial compartment osteoarthritis of the knee. Materials and method: A prospective interventional study was carried out over a period of 2 years from November 2017 to October 2019 in a sample size of randomly selected 41 patients having unilateral knee osteoarthritis. All patients after a proper preoperative assessment underwent high tibial osteotomy and the outcome was evaluated using knee society scoring system. Results: The age of the patients ranged from 40 – 65 years with a mean age of 51 years, 13 were males and 28 were females showing female predominance (68.2%). The mean knee score and the mean functional score of the patients before surgery were 60 and 61.95 respectively and post operatively at the end of 6 months the knee score and functional score was 77 and 80.53 respectively. By the end of 6 months out of 41 patients, 12 patients (29.2%) had excellent functional outcome, 18 patients (43.90%) had good functional outcome, 09 patients (21.95%) had fair functional outcome while only 02 patients (04.87%) had poor functional outcome. Conclusions: The present study shows that HTO is a good option in isolated medial compartment OA of knee. Significant increase in the knee score and functional score was found after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Success of high tibial osteotomy relies on appropriate patient selection, proper osteotomy type and precise surgical technique.

scholarly journals Clinical Effect of Open-wedge High Tibial Osteotomy in Treatment of Kellgren-lawrence IV Knee Osteoarthritis Associated with Varus Tibial Deformity

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Yu Sha ◽  
Lei Yan
Keyword(s):  
Postoperative Complications ◽  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Tertiary Hospital ◽  
Knee Function ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy ◽  
The Difference

Objectives: The purpose of this study is to evaluate the clinical efficacy of open-wedge high tibial osteotomy (HTO) in treatment of kellgren- lawrence IV anterior medial knee osteoarthritis with varus tibia. Methods: Between 2016 and 2018, 56 patients with kellgren -lawrence IV knee osteoarthritis associated with varus tibial deformity who underwent a medial open-wedge high tibial osteotomy at a tertiary hospital were prospectively followed up. The surgical effect and postoperative complications were observed and analyzed. Meanwhile, the hospital for special surgery (HSS) scores of knee function before operation and at the last follow-up after operation was compared. Results: The median follow up was 19.8 months (range, 18 to 24 months). At the last follow-up, there was 40 excellent cases, 14 good cases, 2 fair case and 0 poor case. There were no complications such as vascular and nerve injury, internal fixation fracture and infection. The HSS score of knee function (89.6±3.9) at the last follow-up after operation was higher than (63.2±6.4) points before operation, and the difference was statistically significant ( P ＜0.05). Conclusion: Medial opening high tibial osteotomy shows remarkable therapeutic effect for patients with knee osteoarthritis associated with varus tibial deformity, and it can effectively relief the pain of knee joint with less postoperative complications.

Sign in / Sign up

Export Citation Format

Share Document