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Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors
Codie A Primeau1, Trevor B Birmingham2, Kristyn M Leitch1
1Fowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Most patients (79%) avoid total knee replacement (TKR) for 10 years after high tibial osteotomy (HTO). Greater radiographic osteoarthritis severity at the time of HTO is the strongest predictor for conversion to TKR.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Knee Osteoarthritis Research
Background:
- High tibial osteotomy (HTO) aims to delay or prevent total knee replacement (TKR) in patients with knee osteoarthritis (OA).
- Understanding the conversion rate and predictors of TKR after HTO is crucial for patient selection and surgical planning.
Purpose of the Study:
- To estimate the frequency and timing of conversion from HTO to TKR.
- To identify preoperative factors associated with conversion to TKR.
Main Methods:
- Prospective evaluation of 556 patients undergoing 643 medial opening wedge HTO procedures (2002-2014).
- Cumulative incidence curves analyzed time to TKR, with data updated to July 2019.
- Multivariable Cox proportional hazards analysis assessed preoperative predictors: radiographic severity, alignment, correction size, pain, sex, age, BMI, and surgical year.
Main Results:
- The cumulative incidence of TKR was 5% at 5 years and 21% at 10 years post-HTO.
- Significant predictors for TKR conversion included: radiographic OA severity (HR 1.96), pain (HR 0.85), female sex (HR 1.67), age (HR 1.50 per 10 yr), and BMI (HR 1.31 per 5 kg/m²).
- 79% of knees did not require TKR within 10 years of HTO.
Conclusions:
- Medial opening wedge HTO effectively delays TKR in a majority of knee OA patients.
- Radiographic osteoarthritis severity at the time of HTO is the most significant preoperative predictor for subsequent TKR conversion.
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