Birmingham Trevor B, Giffin J Robert, Chesworth Bert M, Bryant Dianne M, Litchfield Robert B, Willits Kevin, Jenkyn Thomas R, Fowler Peter J
The Wolf Orthopaedic Biomechanics Laboratory and Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
Arthritis Rheum. 2009 May 15;61(5):648-57. doi: 10.1002/art.24466.
To evaluate the effect of medial opening wedge high tibial osteotomy on gait, radiographic, and patient-reported outcomes over a 2-year postoperative period in patients with varus alignment and medial compartment knee osteoarthritis, and to identify significant predictors of outcome.
We used an observational cohort study design and prospectively administered 3-dimensional quantitative gait analysis, hip to ankle weight-bearing radiographs, and patient-reported outcomes preoperatively and 6, 12, 18, and 24 months postoperatively. Observed changes with 95% confidence intervals (95% CIs) were calculated. Multivariate linear regression and cluster analysis were used to evaluate associations between patient characteristics and 2-year outcomes in dynamic knee joint load (external knee adduction moment during gait) and Knee Injury and Osteoarthritis Outcome Scores (KOOS).
A total of 126 patients (mean age 47.48 years) were included in the study. Mean changes suggested clinically important improvements in malalignment (change in mechanical axis angle 8.04 degrees [95% CI 7.16 degrees , 8.93 degrees ]), medial compartment load during gait (change in knee adduction moment -1.38 [95% CI -1.53, -1.22] percentage body weight x height), and all KOOS domain scores (change in pain 23.19 [95% CI 19.49, 26.89] KOOS points). A small (13%) increase in knee adduction moment was observed from 6 to 24 months postoperatively. Few preoperative clinical and/or gait characteristics assessed at baseline were significantly associated with 2-year outcomes.
A medial opening wedge high tibial osteotomy with correction to approximately neutral alignment produces substantial and clinically important changes in dynamic knee joint load and patient-reported measures of pain, function, and quality of life 2 years postoperatively. Changes in knee adduction moment observed in the first 2 years postoperatively should be explored as potential predictors of longer-term success and subgroups of patients with poor outcomes.
评估内翻型膝关节内侧间室骨关节炎患者行内侧张开楔形高位胫骨截骨术后2年的步态、影像学及患者报告结局，并确定结局的显著预测因素。
采用观察性队列研究设计，前瞻性地在术前以及术后6、12、18和24个月进行三维定量步态分析、髋至踝关节负重X线片检查以及患者报告结局评估。计算95%置信区间（95%CI）内的观察到的变化。采用多变量线性回归和聚类分析评估患者特征与动态膝关节负荷（步态期间的膝关节外翻力矩）和膝关节损伤与骨关节炎结局评分（KOOS）的2年结局之间的关联。
本研究共纳入126例患者（平均年龄47.48岁）。平均变化表明在对线不良（机械轴角变化8.04度[95%CI 7.16度，8.93度]）、步态期间内侧间室负荷（膝关节外翻力矩变化-1.38[95%CI -1.53，-1.22]体重×身高百分比）以及所有KOOS领域评分（疼痛变化23.19[95%CI 19.49，26.89]KOOS分）方面有具有临床意义的改善。术后6至24个月观察到膝关节外翻力矩有小幅（13%）增加。基线时评估的术前临床和/或步态特征中，很少有与2年结局显著相关。
内侧张开楔形高位胫骨截骨矫正至近似中立对线在术后2年可使动态膝关节负荷以及患者报告的疼痛、功能和生活质量测量指标产生显著且具有临床意义的变化。术后头2年观察到的膝关节外翻力矩变化应作为长期成功的潜在预测因素以及结局不佳患者亚组进行探索。
