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A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis
Li-Dong Wu1, Hans J Hahne, Toachim Hassenpflug
1Department of Orthopedics, Second Hospital of Medical College, Zhejiang University, Hangzhou 310009, China. ldwu@yahoo.com
Insights
High tibial osteotomy (HTO) effectively treats knee osteoarthritis, but long-term outcomes show a trend of deterioration. Some patients may require revision surgery with total knee arthroplasty (TKA).
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Knee Osteoarthritis Research
Background:
- Medial compartment osteoarthritis of the knee is a prevalent condition often associated with varus alignment.
- High tibial osteotomy (HTO) is a surgical procedure aimed at correcting alignment and offloading the damaged medial compartment.
- Understanding the long-term efficacy and potential complications of HTO is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of high tibial osteotomy (HTO) in patients with medial compartment knee osteoarthritis.
- To assess the survivorship and complication rates associated with HTO.
- To identify factors influencing the success of HTO in the long term.
Main Methods:
- Retrospective analysis of 194 patients (215 knees) who underwent HTO for medial compartment osteoarthritis between 1985 and 1996.
- Follow-up data for 161 knees (144 patients) were reviewed, with an average follow-up of 7.5 years (range: 1.5-12 years).
- Outcomes assessed included excellent outcome rates, revision rates to total knee arthroplasty (TKA), survivorship analysis, and complication incidence.
Main Results:
- Excellent outcome rates were 97.3% at 2 years, 93.6% at 5 years, and 78.2% beyond 5 years post-HTO.
- The revision rate to TKA was 11.8% (19 knees), with a 10-year survivorship rate of 84.1% for these revisions.
- Complications occurred in 5.6% of cases, including infections, delayed bone healing, and peroneal nerve palsy.
Conclusions:
- High tibial osteotomy (HTO) demonstrates effectiveness in treating medial compartment osteoarthritis in varus knees.
- Achieving appropriate overcorrection of femorotibial alignment is critical for successful HTO outcomes.
- A long-term trend of functional deterioration exists, with a subset of patients requiring revision to total knee arthroplasty (TKA).
Objective:
To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees.
Methods:
A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996.
Results:
One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3%, 93.6% and 78.2% two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications (12/161), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees) missed follow-up, among them 10 patients (11 knees) died.
Conclusions:
HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.
