Paredes-Carnero Xavier, Leyes Manuel, Forriol Francisco, Fernández-Cortiñas Ana Belén, Escobar Jesús, Babé Javier G
Servizo de Ortopedia e Traumatoloxía, Cooperativa Sanitaria de Galicia, COSAGA, Rúa Sáenz Díez, 11, 32003, Ourense, Spain.
Clínica CEMTRO, Madrid, Spain.
Int Orthop. 2018 Sep;42(9):2087-2096. doi: 10.1007/s00264-018-3837-7. Epub 2018 Feb 20.
Sometimes, total knee replacement (TKR) is performed after a tibial osteotomy. It is not known if the osteotomy influences the clinical process of a TKR. The aim of this study was to look at the clinical outcome of a TKR after high tibial osteotomy (HTO) compared to a TKR with no HTO.
Between 1995 and 2005, 41 post-HTO TKRs (group A) with a minimum follow-up of ten years were selected. In parallel, it was selected a control group undergoing simple TKR, consisting of 41 patients (group B) matched with group A. The Knee Society Knee Score (KS), Knee Score Functional Score (FS), the Oxford Knee Score (OKS), and the range of motion (ROM) were used for evaluation at one, five and ten years after surgery. The Insall-Salvatti ratio (ISR), the posterior tibial slope (PTS), and the joint height line (JHL) were also measured both pre-operatively and post-operatively.
No differences were found between both groups in KS, FS, OKS, and ROM at the pre-operative stage or at any of the post-operative controls. Higher patellar height was found in group A, both pre-operatively and post-operatively (p < 0.005), and the same for PTS pre-operative (p < 0.001) and post-operative (p < 0.05). No differences were found regarding the JHL. Post-operative differences were found among the post-HTO subgroups at the FS (p < 0.02), the OKS (p < 0.05), and the ROM (p < 0.01) as a function of whether there was a varus or a valgus deformity before the TKR.
A HTO was not determinant for having a worse outcome at the TKR, even when there were radiographic differences. The coronal alignment with valgus deformity pre-TKR after a HTO showed better functional results than in the case of varus deformity. Level of evidence III.
有时，全膝关节置换术（TKR）是在胫骨截骨术后进行的。目前尚不清楚截骨术是否会影响TKR的临床进程。本研究的目的是观察高位胫骨截骨术（HTO）后TKR的临床结果，并与未行HTO的TKR进行比较。
在1995年至2005年期间，选择了41例行HTO后TKR的患者（A组），其最短随访时间为10年。同时，选择了一个接受单纯TKR的对照组，由41例与A组匹配的患者组成（B组）。在术后1年、5年和10年，使用膝关节协会膝关节评分（KS）、膝关节功能评分（FS）、牛津膝关节评分（OKS）以及活动范围（ROM）进行评估。术前和术后还测量了Insall-Salvatti比率（ISR）、胫骨后倾（PTS）和关节高度线（JHL）。
在术前阶段或任何术后对照中，两组在KS、FS、OKS和ROM方面均未发现差异。A组术前和术后的髌骨高度均较高（p < 0.005），术前PTS（p < 0.001）和术后PTS（p < 0.05）情况相同。JHL方面未发现差异。根据TKR前是否存在内翻或外翻畸形，HTO后亚组在FS（p < 0.02）、OKS（p < 0.05）和ROM（p < 0.01）方面存在术后差异。
即使存在影像学差异，HTO也不是导致TKR结果更差的决定性因素。HTO后TKR前伴有外翻畸形的冠状面排列显示出比内翻畸形更好的功能结果。证据等级III。
