Purpose: Painful and slow recovery are the presumed disadvantages after opening-wedge high tibial osteotomy (HTO) and play a role in favouring arthroplasty as treatment for moderate isolated medial knee arthritis. The primary study objective was to investigate the effect of press-fit structural impacted bone allograft with locking plate fixation on early ambulation, postoperative pain levels, and resumption of daily-life activities in opening-wedge HTO.
Methods: A prospective consecutive opening-wedge HTO case series was conducted, including 103 patients with final follow-up at 1 year. Weight-bearing was allowed from the day after surgery "as tolerated" by the patient. Clinical assessment included the Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Additionally, the Knee Society Score (KSS) was assessed during consultation at 1, 3, and 12 months postoperatively with special attention for clinical anchor questions. Required sample size was calculated and a linear mixed-effect model was used for repeated measures over time of the clinical scores.
Results: The NRS decreased by 1.5 at 1 month (p < 0.01) and 2.1 at 3 months (p < 0.01), while KOOS pain significantly improved with 19.2 (p < 0.01) by this time compared to baseline. Under reduced pain levels, 98% were able to walk > 500 m without support, while all patients were able to climb up and down the stairs 3 months postoperatively.
Conclusion: The study strongly supports the initial hypothesis that applying structural triangular bone allograft in HTO leads to low postoperative pain levels, early ambulation, and excellent short-term clinical outcomes. Study results have the potential to alter the general perception about HTO being a painful procedure with painstakingly slow recovery and consequently encourage the consideration of HTO as a highly valuable joint-preserving option, while treating unicompartmental knee arthritis.
Level Of Evidence: IV (case series).
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00167-019-05765-z | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Posteromedial opening wedge high tibial osteotomy has favourable outcomes in simultaneous medial meniscus posterior root repair and varus medial knee osteoarthritis patients without concomitant root tear.
J Orthop Surg Res
January 2025
Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Bornova, 35100, Izmir, Turkey.
Purpose: To evaluate the radiological and clinical outcomes in two patient groups: first, varus aligned medial meniscus posterior root tear (MMPRT) patients who underwent posteromedial open wedge high tibial osteotomy (PMOWHTO) and simultaneous root repair; second, patients with varus medial knee osteoarthritis without MMPRT who underwent PMOWHTO.
Methods: Patients had MMPRT repair concomitant with PMOWHTO and varus medial knee osteoarthritis without concomitant root tear patients who underwent PMOWHTO and were reviewed. Radiographic parameters, medial meniscus extrusion (MME) and Knee Society Scores [KSSs, including the following subscores: knee score (KS) and knee function score (KFS)] were evaluated.
Revisiting two thousand hinge fractures in open wedge high tibial osteotomy with a fifty years review: the oscillating saw cannot replace the traditional "ear-hand" dialogue between osteotome and hammer to estimate the elastic modulus of bone.
SICOT J
January 2025
Hospital Henri Mondor, University Paris East (UPEC), Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France.
Background: Hinge fracture on the lateral part of the tibia (LHF) is a common complication of medial Open Wedge High Tibial Osteotomy (OWHTO). Many factors have been described as risks for these fractures, but no study has compared an osteotome or an oscillating saw to prevent LHF following OWHTO.
Methods: This "propensity-score-matched" (PSM) study was conducted from data obtained in the literature from 1974 to November 2024.
HKA angle exceeding 5 degrees is strongly associated with lateral patellar translation beyond 2 mm: surgical recommendations for avoiding adverse effects on the patellofemoral joint after OWHTO.
J Orthop Surg Res
January 2025
Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
Purpose: Previous studies reported that anterior knee pain (AKP) occurs with an incidence of 32% after opening-wedge high tibial osteotomy (OWHTO). However, the biomechanical effects of this procedure on patellofemoral joints (PFJs) remain unclear. We aimed to quantify the changes in the kinematics and cartilage conditions of the PFJ during stair climbing before and after OWHTO.
View Article and Find Full Text PDFDifferential effects of tibia varus deformity on clinical outcomes following high tibial osteotomy and unicompartmental knee arthroplasty for moderate medial compartment osteoarthritis with moderate varus alignment.
Arch Orthop Trauma Surg
January 2025
Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Introduction: There is a lack of clinical evidence supporting the decision-making process between high tibial osteotomy (HTO) and unicomparmental knee arthroplasty (UKA) in gray zone indication, such as moderate medial osteoarthritis with moderate varus alignment. This study compared the outcomes between HTO and UKA in such cases and assessed the risk factor for not maintaining clinical improvements.
Materials And Methods: We retrospectively reviewed 65 opening-wedge HTOs and 55 UKAs with moderate medial osteoarthritis (Kellgren-Lawrence grade ≥ 3 and Ahlback grade < 3) and moderate varus alignment (5°< Hip-Knee-Ankle angle < 10°) over 3 years follow-up.
Positive Results Using Variable Fixation in Medial Opening Wedge High Tibial Osteotomies in Patients with Unilateral Knee Osteoarthritis: An Observational Clinical Investigation.
J Clin Med
December 2024
Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma Surgery and Orthopedics, 33617 Bielefeld, Germany.
Medial opening wedge high tibial osteotomy (HTO) treats medial knee osteoarthritis by realigning the knee joint, though it still carries quite a high risk of complications. A new Variable Fixation Locking Screw technology, designed to gradually reduce construct stiffness and promote bone healing, aims to address these issues. This observational study evaluates the safety and effectiveness of this innovative approach in improving clinical outcomes.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!