School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
Osteoarthritis Cartilage. 2017 Dec;25(12):1999-2006. doi: 10.1016/j.joca.2017.08.017. Epub 2017 Sep 6.
To evaluate 5-year outcomes after lower limb realignment and test the hypothesis that surgery-induced changes in selected biomechanical risk factors for medial knee osteoarthritis (OA) are associated with clinically important improvements.
We prospectively evaluated patient-reported outcomes, full-limb standing radiographs and gait biomechanics before, 6 months (surgery-induced change) and 5 years after medial opening wedge high tibial osteotomy (HTO) in 170 patients (46.4 ± 8.9 years, 135 males) with knee OA and varus alignment. Logistic regression tested the associations of 6-month changes in mechanical axis angle and knee adduction moment with achieving an increase of ≥10 points in the Knee injury and Osteoarthritis Outcome Score (KOOS)4 at 5 years, with and without adjusting for covariates. Gait data were also compared to existing data from healthy controls.
Mean 5-year changes (95% confidence interval (CI)) were: KOOS4: +14.2 (10.8, 17.6); mechanical axis angle: +8.21° (7.58, 8.83); knee adduction moment: -1.49 %BWHt (-1.35, -1.63). The postoperative knee adduction moments were typically lower than values for healthy controls. When divided into quartiles, although all strata improved significantly, patients with reductions in knee adduction moment of 1.14-1.74 %BWHt (neither largest nor smallest changes) had highest 5-year KOOS4 scores. The 6-month change in knee adduction moment (odds ratios (OR) = 0.38; 95% CI: 0.22, 0.67), preoperative KOOS4 (OR = 0.96; 95% CI: 0.94, 0.99) and preoperative medial tibiofemoral narrowing grade (OR = 0.62; 95% CI: 0.37, 1.00) were negatively associated with having a 5-year clinically important improvement (C-statistic = 0.70).
Substantial improvements in biomechanical risk factors and patient-reported outcomes are observed 5 years after medial opening wedge HTO. The surgery-induced change in load distribution during walking is significantly associated with long-term clinically important improvement.
评估下肢重新排列后的 5 年结果，并验证假设，即手术引起的内侧膝关节骨关节炎（OA）的某些生物力学危险因素的变化与临床重要改善相关。
我们前瞻性地评估了 170 例膝关节 OA 和内翻畸形患者（46.4±8.9 岁，135 例男性）的患者报告结果、全下肢站立位 X 线片和步态生物力学，这些患者在接受内侧开放楔形胫骨高位截骨术（HTO）后 6 个月（手术引起的变化）和 5 年。Logistic 回归测试了机械轴角度和膝关节内收力矩在 6 个月时的变化与 5 年内 KOOS4 评分增加≥10 分的相关性，是否调整了协变量。还将步态数据与健康对照组的现有数据进行了比较。
平均 5 年变化（95%置信区间（CI））为：KOOS4：+14.2（10.8，17.6）；机械轴角度：+8.21°（7.58，8.83）；膝关节内收力矩：-1.49%BWHt（-1.35，-1.63）。术后膝关节内收力矩通常低于健康对照组的值。当分为四等分时，尽管所有分层都有显著改善，但膝关节内收力矩减少 1.14-1.74%BWHt（既不是最大也不是最小的变化）的患者在 5 年内的 KOOS4 评分最高。膝关节内收力矩的 6 个月变化（比值比（OR）=0.38；95%CI：0.22，0.67）、术前 KOOS4（OR=0.96；95%CI：0.94，0.99）和术前内侧胫骨股骨狭窄分级（OR=0.62；95%CI：0.37，1.00）与 5 年内具有临床重要改善（C 统计量=0.70）呈负相关。
内侧开放楔形 HTO 后 5 年，生物力学危险因素和患者报告结果有显著改善。步行时负荷分布的手术诱导变化与长期临床重要改善显著相关。
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