Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients

Abstract Purpose To evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years. Methods Our retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis. Results The preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01). Conclusion Age at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.

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Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06717-2 ◽

2021 ◽

Author(s):

B. L. Schelker ◽

C. S. Moret ◽

O. Dogan ◽

F. Amsler ◽

H. Rasch ◽

...

Keyword(s):

Clinical Outcome ◽

High Tibial Osteotomy ◽

Womac Score ◽

Tracer Uptake ◽

Tibial Osteotomy ◽

Level Of Evidence ◽

Opening Wedge ◽

Alignment Correction ◽

Wedge High Tibial Osteotomy ◽

Bone Tracer Uptake

Abstract Purpose The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. Methods Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11–30) after MOWHTO by collecting the WOMAC score. Results Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. Conclusion This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. Level of evidence Level III.

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