Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Orthopaedic Surgery, Japan Community Health Care Organization, Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu 806-8501, Japan.
Knee. 2021 Mar;29:441-447. doi: 10.1016/j.knee.2021.02.031. Epub 2021 Mar 17.
This study aimed to evaluate the effect of osteoarthritis severity on clinical outcomes using the 2011 Knee Society Score (KSS2011) and survival rates after closed wedge high tibial osteotomy (CWHTO).
In this retrospective study, KSS2011 questionnaires were mailed to patients who had undergone CWHTO between January 1991 and December 2011. The completed questionnaires returned by the patients were analyzed. Preoperative osteoarthritis severity was evaluated by Kellgren-Lawrence (K-L) grade. KSS2011 was compared between the K-L grade groups. To determine the effect of K-L grade for revision surgery, Kaplan-Meier survival curves were created using the need for total knee arthroplasty (TKA) as the endpoint to estimate the probability of failure.
There were 16, 81, and 47 knees with preoperative K-L 2, 3, and 4, respectively. Among the KSS2011 sub-scores, the symptom score showed significant differences between the groups (p = 0.006). However, no significant difference was found regarding satisfaction, expectation, and functional activity scores. No significant difference in the symptom score was found between the K-L 2 and 3 groups (p > 0.05). Eighteen knees were treated with TKA at a mean of 9 years after CWHTO. Using the Kaplan-Meier survival estimates, the K-L 4 group showed a significantly higher rate of total knee arthroplasty conversion than the K-L 2 and 3 groups (p < 0.001).
Osteoarthritis severity affects clinical outcomes and survival rates during long-term follow-up after CWHTO. Surgeons should consider the preoperative osteoarthritis grade for long-term outcomes when considering CWHTO for patients with varus knees.
本研究旨在通过使用 2011 年膝关节协会评分（KSS2011）和闭合楔形胫骨高位截骨术（CWHTO）后的生存率来评估骨关节炎严重程度对临床结果的影响。
在这项回顾性研究中，向 1991 年 1 月至 2011 年 12 月期间接受 CWHTO 的患者邮寄了 KSS2011 问卷。对患者返回的完整问卷进行了分析。术前骨关节炎严重程度采用 Kellgren-Lawrence（K-L）分级评估。对 K-L 分级组之间的 KSS2011 进行了比较。为了确定 K-L 分级对翻修手术的影响，使用全膝关节置换术（TKA）作为终点绘制 Kaplan-Meier 生存曲线，以估计失败的概率。
术前 K-L 分别为 2、3 和 4 的膝关节分别有 16、81 和 47 个。在 KSS2011 子评分中，症状评分在组间存在显著差异（p=0.006）。然而，在满意度、期望和功能活动评分方面没有发现显著差异。K-L 2 组和 3 组之间的症状评分没有显著差异（p>0.05）。18 例膝关节在 CWHTO 后平均 9 年接受了 TKA 治疗。使用 Kaplan-Meier 生存估计，K-L 4 组的全膝关节置换术转化率明显高于 K-L 2 组和 3 组（p<0.001）。
骨关节炎严重程度会影响 CWHTO 后长期随访的临床结果和生存率。当考虑 CWHTO 治疗内翻膝患者时，外科医生应考虑术前骨关节炎分级的长期结果。
