Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea; Gimpo Woori Hospital, Gimpo, Republic of Korea.
Arthroscopy. 2021 Feb;37(2):638-644. doi: 10.1016/j.arthro.2020.09.033. Epub 2020 Sep 28.
(1) To investigate whether patients with bone-on-bone (BOB) medial OA (Ahlback grade 2) had comparable clinical improvement to those with non-BOB arthritis with remaining joint space (Ahlback grades 0/1) after medial open-wedge high tibial osteotomy (MOWHTO); (2) to determine whether the radiological results differ between these 2 groups from 1 month postoperatively to last follow-up ≥2 years later.
Data of 132 knees (40 males and 92 females) who underwent MOWHTO were retrospectively reviewed. Preoperative standing anteroposterior radiographs were evaluated according to the Ahlback classification. Patients with Ahlback grade ≤1 were classified as the non-BOB group (group I, n = 88; mean age, 50.5 ± 6.3 years) and those with grade 2 as the bone-on-bone group (group II, n = 44; age, 51.6 ± 5.3 years). Clinical outcomes were assessed using Hospital for Special Surgery (HSS) and Knee Society (KS) functional scores. Medial joint space width (JSW), medial proximal tibial angle (MPTA), and mechanical alignment were considered radiological parameters.
Preoperative clinical scores were significantly lower in patients with BOB arthritis (HSS score: group I, 73.5 ± 10.7 versus group II, 69.2 ± 9.1, P = .026; KS score: group I, 72.9 ± 10.3 versus group II, 63.2 ± 11.6 points, P < .001). However, HSS and KS functional scores improved in both groups without a significant difference at a mean follow-up of 3.4 ± 2.5 and 4.1 ± 3.1 years in groups I and II, respectively (HSS score: 89.2 ± 9.5 versus 89.4 ± 7.3 points, P = .258; KS functional score: 90.1 ± 7.1 versus 87.8 ± 8.9 points, P = .105). Preoperative and postoperative medial JSWs were narrower in group II, but the JSW opening was wider in group II at 1 month after surgery and was maintained until the last follow-up (preoperative, 3.0 ± 0.9 versus 0.0 ± 0.1 mm; 1 month, 3.1 ± 1.0 versus 1.4 ± 0.8; last follow-up, 3.0 ± 1.0 versus 1.4 ± 0.9 mm; P < .001).
Patients with BOB medial OA achieved clinical outcomes comparable to those with remaining joint space after MOWHTO. The medial JSW showed a significant increase without OA progression during midterm follow-up in these patients. Therefore, MOWHTO can be an effective treatment choice for symptomatic improvement in middle-aged patients with severe medial OA, if there is no subchondral bone attrition.
III, retrospective comparative study.
（1）探讨内侧开放楔形胫骨高位截骨术（MOWHTO）后，骨对骨（BOB）内侧骨关节炎（Ahlback 分级 2 级）患者与仍存在关节间隙（Ahlback 分级 0/1 级）的非 BOB 关节炎患者的临床改善情况是否相当；（2）确定这两组患者在术后 1 个月至末次随访≥2 年期间的影像学结果是否存在差异。
回顾性分析了 132 例膝关节（40 例男性，92 例女性）接受 MOWHTO 的患者资料。术前站立位前后位 X 线片根据 Ahlback 分级进行评估。Ahlback 分级≤1 级的患者被归类为非 BOB 组（I 组，n=88；平均年龄 50.5±6.3 岁），Ahlback 分级 2 级的患者为 BOB 组（II 组，n=44；年龄 51.6±5.3 岁）。采用美国特种外科医院（HSS）和膝关节协会（KS）功能评分评估临床结果。内侧关节间隙宽度（JSW）、内侧胫骨近端角（MPTA）和机械对线被视为影像学参数。
术前 BOB 关节炎患者的临床评分明显较低（HSS 评分：I 组，73.5±10.7 分比 II 组，69.2±9.1 分，P=0.026；KS 评分：I 组，72.9±10.3 分比 II 组，63.2±11.6 分，P<0.001）。然而，两组患者的 HSS 和 KS 功能评分均有改善，I 组和 II 组的平均随访时间分别为 3.4±2.5 年和 4.1±3.1 年，差异无统计学意义（HSS 评分：89.2±9.5 分比 89.4±7.3 分，P=0.258；KS 功能评分：87.8±8.9 分比 89.1±7.1 分，P=0.105）。II 组的术前和术后内侧 JSW 较窄，但术后 1 个月时 II 组的 JSW 开口较宽，且在末次随访时仍保持这一状态（术前：3.0±0.9 毫米比 0.0±0.1 毫米；术后 1 个月：3.1±1.0 毫米比 1.4±0.8 毫米；末次随访：3.0±1.0 毫米比 1.4±0.9 毫米；P<0.001）。
MOWHTO 后 BOB 内侧骨关节炎患者可获得与仍存在关节间隙的患者相当的临床结果。在这些患者中，内侧 JSW 在中期随访期间显示出明显的增加，而没有 OA 进展。因此，如果没有软骨下骨侵蚀，MOWHTO 可以成为治疗中年严重内侧 OA 症状的有效选择。
III，回顾性比较研究。
