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Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up.

Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B, Lakemeier S, Schofer MD - BMC Musculoskelet Disord (2011)

Bottom Line: HTO provides good clinical results in long-term follow-up.Results of HTO may be improved by careful patient selection.Complications associated with HTO should not be underestimated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany. efet@med.uni-marburg.de

ABSTRACT

Background: Closing-wedge high tibial osteotomy (HTO) is successful for the treatment of medial osteoarthritis with varus malalignment. Preoperative risk factors for HTO failure are still controversial. The aim of this study was to elucidate the outcome and assess the influence of risk factors on long term HTO survival.

Methods: 199 patients were retrospectively studied with a mean follow-up period of 9.6 years after HTO. HTO failure was defined as the need for conversion to TKA. Survival was analyzed with the Kaplan-Meier method. Knee function was evaluated by the Hospital for Special Surgery (HSS) score. HTO-associated complications were also assessed. Univariate, multivariate, and logistic regression analysis were performed to evaluate the influence of age, gender, BMI, preoperative Kellgren-Lawrence osteoarthritis grade, and varus angle on HTO failure.

Results: 39 complications were recorded. Thus far, 36 HTOs were converted to TKA. The survival of HTO was 84% after 9.6 years. Knee function was considered excellent or good in 64% of patients. A significant preoperative risk factor for HTO failure was osteoarthritis, Kellgren-Lawrence grade >2.

Conclusion: HTO provides good clinical results in long-term follow-up. Preoperative osteoarthritis Kellgren-Lawrence grade >2 is a significant predictive risk factor for HTO failure. Results of HTO may be improved by careful patient selection. Complications associated with HTO should not be underestimated.

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Survival rate analysis after HTO using the Kaplan-Meier method. The conversion to TKA after HTO was set as the endpoint. 93% of patients at 5 years, 84% of patients at 9.6 years and 68% at 15 years after HTO did not require conversion to TKA.
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Figure 1: Survival rate analysis after HTO using the Kaplan-Meier method. The conversion to TKA after HTO was set as the endpoint. 93% of patients at 5 years, 84% of patients at 9.6 years and 68% at 15 years after HTO did not require conversion to TKA.

Mentions: At latest follow-up, 36 (16%) HTOs had been converted to TKA. The 5-year, 9.6 year, and 15-year HTO survival rates as determined by Kaplan-Meier analysis were 93%, 84%, and 68% (Figure 1). 54 patients had excellent results, 74 good, 51 fair and 20 poor. Pain was absent in 74 patients, mild in 66 cases, and severe in 58 cases (in motion but not at rest). No patient complained of continuous pain.


Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up.

Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B, Lakemeier S, Schofer MD - BMC Musculoskelet Disord (2011)

Survival rate analysis after HTO using the Kaplan-Meier method. The conversion to TKA after HTO was set as the endpoint. 93% of patients at 5 years, 84% of patients at 9.6 years and 68% at 15 years after HTO did not require conversion to TKA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3046001&req=5

Figure 1: Survival rate analysis after HTO using the Kaplan-Meier method. The conversion to TKA after HTO was set as the endpoint. 93% of patients at 5 years, 84% of patients at 9.6 years and 68% at 15 years after HTO did not require conversion to TKA.
Mentions: At latest follow-up, 36 (16%) HTOs had been converted to TKA. The 5-year, 9.6 year, and 15-year HTO survival rates as determined by Kaplan-Meier analysis were 93%, 84%, and 68% (Figure 1). 54 patients had excellent results, 74 good, 51 fair and 20 poor. Pain was absent in 74 patients, mild in 66 cases, and severe in 58 cases (in motion but not at rest). No patient complained of continuous pain.

Bottom Line: HTO provides good clinical results in long-term follow-up.Results of HTO may be improved by careful patient selection.Complications associated with HTO should not be underestimated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany. efet@med.uni-marburg.de

ABSTRACT

Background: Closing-wedge high tibial osteotomy (HTO) is successful for the treatment of medial osteoarthritis with varus malalignment. Preoperative risk factors for HTO failure are still controversial. The aim of this study was to elucidate the outcome and assess the influence of risk factors on long term HTO survival.

Methods: 199 patients were retrospectively studied with a mean follow-up period of 9.6 years after HTO. HTO failure was defined as the need for conversion to TKA. Survival was analyzed with the Kaplan-Meier method. Knee function was evaluated by the Hospital for Special Surgery (HSS) score. HTO-associated complications were also assessed. Univariate, multivariate, and logistic regression analysis were performed to evaluate the influence of age, gender, BMI, preoperative Kellgren-Lawrence osteoarthritis grade, and varus angle on HTO failure.

Results: 39 complications were recorded. Thus far, 36 HTOs were converted to TKA. The survival of HTO was 84% after 9.6 years. Knee function was considered excellent or good in 64% of patients. A significant preoperative risk factor for HTO failure was osteoarthritis, Kellgren-Lawrence grade >2.

Conclusion: HTO provides good clinical results in long-term follow-up. Preoperative osteoarthritis Kellgren-Lawrence grade >2 is a significant predictive risk factor for HTO failure. Results of HTO may be improved by careful patient selection. Complications associated with HTO should not be underestimated.

Show MeSH
Related in: MedlinePlus