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Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis
AIMS: To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. METHODS: In all, 49 patients (52 knees) with a mean age of 47 yea...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The British Editorial Society of Bone and Joint Surgery
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659673/ https://www.ncbi.nlm.nih.gov/pubmed/33215123 http://dx.doi.org/10.1302/2633-1462.17.BJO-2020-0081.R1 |
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author | Ekeland, Arne Nerhus, Tor Kjetil Dimmen, Sigbjørn Heir, Stig |
author_facet | Ekeland, Arne Nerhus, Tor Kjetil Dimmen, Sigbjørn Heir, Stig |
author_sort | Ekeland, Arne |
collection | PubMed |
description | AIMS: To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. METHODS: In all, 49 patients (52 knees) with a mean age of 47 years (31 to 64) underwent high tibial osteotomies (HTO), and 24 patients with a mean age of 48 years (31 to 62) low femoral osteotomies (LFO) with opening wedge technique due to medial, respectively lateral knee OA with malalignment. All osteotomies were stabilized with a Puddu plate and bone grafting performed in the same time period (2000 to 2008). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-operatively and at six months, and at one, two, five, and ten years postoperatively. The knee OA was graded according to the Ahlbäck and Kellgren-Lawrence radiological scoring systems. RESULTS: The mean angular corrections were 8.0° (4° to 12°) for the HTO and 9.6° (4° to 20°) for the LFO. Both the pre-operative KOOS and the osteoarthritic gradings were similar for the two patient groups. The five subscores of KOOS increased significantly during the postoperative period (p < 0.001 to 0.029) levelling out after one year in both groups. The KOOS subscore symptoms was significantly higher for patients with HTO than those with LFO at all follow-up times, for sport and recreation in the period one to five years, and for pain and quality of life at two to five years (p < 0.001 to 0.009). Eight HTOs (15%) and five LFOs (21%) were converted to total knee arthroplasty after mean 6.7 years (2.0 to 9.8) and 5.4 years (4.0 to 8.0) respectively. The ten-year osteotomy survival rates were 88% for the HTO and 79% for the LFO (p = 0.745). CONCLUSION: Patients with unicompartmental knee OA improved after a corrective opening wedge osteotomy, but four of the five subscores of KOOS were significantly higher for those with medial than those with lateral OA in most of the ten-year follow-up period. Cite this article: Bone Joint Open 2020;1-7:346–354. |
format | Online Article Text |
id | pubmed-7659673 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | The British Editorial Society of Bone and Joint Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-76596732020-11-18 Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis Ekeland, Arne Nerhus, Tor Kjetil Dimmen, Sigbjørn Heir, Stig Bone Jt Open Knee AIMS: To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. METHODS: In all, 49 patients (52 knees) with a mean age of 47 years (31 to 64) underwent high tibial osteotomies (HTO), and 24 patients with a mean age of 48 years (31 to 62) low femoral osteotomies (LFO) with opening wedge technique due to medial, respectively lateral knee OA with malalignment. All osteotomies were stabilized with a Puddu plate and bone grafting performed in the same time period (2000 to 2008). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-operatively and at six months, and at one, two, five, and ten years postoperatively. The knee OA was graded according to the Ahlbäck and Kellgren-Lawrence radiological scoring systems. RESULTS: The mean angular corrections were 8.0° (4° to 12°) for the HTO and 9.6° (4° to 20°) for the LFO. Both the pre-operative KOOS and the osteoarthritic gradings were similar for the two patient groups. The five subscores of KOOS increased significantly during the postoperative period (p < 0.001 to 0.029) levelling out after one year in both groups. The KOOS subscore symptoms was significantly higher for patients with HTO than those with LFO at all follow-up times, for sport and recreation in the period one to five years, and for pain and quality of life at two to five years (p < 0.001 to 0.009). Eight HTOs (15%) and five LFOs (21%) were converted to total knee arthroplasty after mean 6.7 years (2.0 to 9.8) and 5.4 years (4.0 to 8.0) respectively. The ten-year osteotomy survival rates were 88% for the HTO and 79% for the LFO (p = 0.745). CONCLUSION: Patients with unicompartmental knee OA improved after a corrective opening wedge osteotomy, but four of the five subscores of KOOS were significantly higher for those with medial than those with lateral OA in most of the ten-year follow-up period. Cite this article: Bone Joint Open 2020;1-7:346–354. The British Editorial Society of Bone and Joint Surgery 2020-11-02 /pmc/articles/PMC7659673/ /pubmed/33215123 http://dx.doi.org/10.1302/2633-1462.17.BJO-2020-0081.R1 Text en © 2020 Author(s) et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/. |
spellingShingle | Knee Ekeland, Arne Nerhus, Tor Kjetil Dimmen, Sigbjørn Heir, Stig Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis |
title | Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis |
title_full | Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis |
title_fullStr | Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis |
title_full_unstemmed | Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis |
title_short | Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis |
title_sort | better functional results of opening wedge hto for varus knees with medial osteoarthritis than opening wedge lfo for valgus knees with lateral osteoarthritis |
topic | Knee |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659673/ https://www.ncbi.nlm.nih.gov/pubmed/33215123 http://dx.doi.org/10.1302/2633-1462.17.BJO-2020-0081.R1 |
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