J Korean Orthop Assoc.  2014 Dec;49(6):439-445. 10.4055/jkoa.2014.49.6.439.

Survival and Risk Factor Analysis of Open Wedge Tibial Osteotomy for Medial Unicompartmental Osteoarthritis

• Kim GW
• Song EK

• KMID: 2185157
• DOI: http://doi.org/10.4055/jkoa.2014.49.6.439

Abstract

PURPOSE
The purpose of this study was to evaluate the mid to long-term clinicoradiological results of open wedge high tibial osteotomy performed as the primary treatment for medial unicompartmental osteoarthritis of the knee and to analyze the factors that affect the survival rate.
MATERIALS AND METHODS
The study cohort consisted of 124 patients who underwent open wedge high tibial osteotomy for medial unicompartmental osteoarthritis of the knee and had a minimum follow-up period of five years. Hospital for special surgery (HSS) and the Western Ontario and MacMaster (WOMAC) scores, tibiofemoral angle, mechanical axis of lower limb, medial proximal tibia angle, and tibia posterior slope angle were used to evaluate the clinical and radiographic outcomes over the mean follow-up period of 85 months. The risk factors that affected the survival rate were calculated by multivariate regression analysis.
RESULTS
Mean HSS scores and WOMAC scores showed significant improvements at the final follow-up. The tibiofemoral angle was improved to 8.4 degrees of valgus after surgery. A total of 12 patients (9.7%) failed to survive until the final follow-up resulting in 8 year survivorship of 90.3%. Risk factors significantly affecting the survival rate afteropen wedge high tibial osteotomy included a high body mass index (BMI), severe varus deformity, severe osteoarthritis (Kellgren-Lawrence Grade III or IV) preoperatively and overcorrection angles in operation.
CONCLUSION
Open wedge high tibial osteotomy showed good clinical and radiological outcomes in the current study. Analysis of the risk factors influencing survivorship after open wedge high tibial osteotomy suggests that the surgical procedure be avoided or modified with patients who have a high BMI, severe varus deformity, or severe osteoarthritis symptoms preoperatively.

Keyword

high tibial osteotomy; medial unicompartment knee osteoarthritis; survivalship

MeSH Terms

Axis, Cervical Vertebra
Body Mass Index
Cohort Studies
Congenital Abnormalities
Follow-Up Studies
Humans
Knee
Lower Extremity
Ontario
Osteoarthritis*
Osteotomy*
Risk Factors*
Survival Rate
Tibia

Figure

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  Figure 1 The radiographic indices in a knee. (A) Measurement of tibiofemoral angle. (B) Measurement of mechanical axis. (C) Measurement of medial proximal tibia angle. (D) Measurement of post slope angle.

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  Figure 2 Kaplan-Meier survivorship analysis (with 95% confidence intervals) for all high tibial osteotomies.

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