Hevesi Mario, Wilbur Ryan R, Keyt Lucas K, Abdel Matthew P, Levy Bruce A, Saris Daniel B F, Stuart Michael J, Krych Aaron J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2022 Mar 16;104(6):552-558. doi: 10.2106/JBJS.21.00761.
Proximal tibial osteotomy (PTO) is a well-established treatment for coronal deformity and focal cartilage defects. However, the utility of joint-preserving interventions must be weighed against potential effects on subsequent total knee arthroplasty (TKA). The purpose of this study was to determine the effect of PTO on subsequent TKA by comparing outcomes in patients with bilateral TKAs following unilateral PTO.
Patients who underwent bilateral TKAs from 2000 to 2015 at a single institution and had previously undergone a unilateral valgus-producing PTO were reviewed. We evaluated 140 TKAs performed in 70 patients (24 female, 46 male) with a mean age at PTO of 50 ± 8 years. The patients underwent conversion to TKA at a mean of 14 ± 7 years following ipsilateral PTO and were followed for a mean of 25 ± 7 years (range, 6 to 40 years) following PTO. The Knee Society Score (KSS), Forgotten Joint Score-12 (FJS-12), subjective knee preference, and revision were compared between the PTO-TKA and contralateral TKA-only sides.
The PTO side demonstrated similar KSS Knee subscores (41 ± 16) compared with the contralateral side (39 ± 16, p = 0.67) immediately prior to arthroplasty. Patients had significant improvements in KSS (p < 0.001) after TKA, with clinically similar KSS values at 2 to 15 years of follow-up when knees were compared in a pairwise fashion (p = 0.10 to 0.83). Five PTO-TKA knees (7%) and 4 control TKA-only knees (6%) underwent revision at a mean of 5 years postoperatively (p = 0.76). The number of all-cause reoperations was approximately twice as high in PTO-TKA knees (13% compared with 6% in TKA-only knees, p = 0.24). At the time of final follow-up, PTO-TKA knees demonstrated similar FJS-12 scores (72 ± 26) compared with the contralateral knees (70 ± 28, p = 0.57). Nineteen percent of patients preferred the PTO-TKA knee, 19% preferred the contralateral TKA-only knee, and 62% stated that their knees were equivalent (p > 0.99). The final Tegner activity score was 2.5 ± 1.4.
Long-term clinical function of TKA following PTO was excellent, with patients demonstrating comparable subjective outcomes and equivalent knee preference compared with the contralateral TKA-only knees. Further, well-matched studies are needed to evaluate long-term revision and reoperation rates following PTO-TKA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
胫骨近端截骨术（PTO）是治疗冠状面畸形和局限性软骨缺损的一种成熟方法。然而，保留关节干预措施的效用必须与对后续全膝关节置换术（TKA）的潜在影响相权衡。本研究的目的是通过比较单侧PTO后行双侧TKA患者的结局，来确定PTO对后续TKA的影响。
回顾了2000年至2015年在单一机构接受双侧TKA且此前接受过单侧外翻型PTO的患者。我们评估了70例患者（24例女性，46例男性）的140例TKA，PTO时的平均年龄为50±8岁。患者在同侧PTO后平均14±7年接受TKA转换，PTO后平均随访25±7年（范围6至40年）。比较了PTO-TKA侧和对侧单纯TKA侧的膝关节协会评分（KSS）、遗忘关节评分-12（FJS-12）、主观膝关节偏好和翻修情况。
在关节置换术前，PTO侧的KSS膝关节子评分（41±16）与对侧（39±16，p = 0.67）相似。TKA后患者的KSS有显著改善（p < 0.001），在2至15年的随访中，成对比较膝关节时临床KSS值相似（p = 0.10至0.83）。5例PTO-TKA膝关节（7%）和4例单纯对照TKA膝关节（6%）在术后平均5年进行了翻修（p = 0.76）。PTO-TKA膝关节的全因再次手术数量约为单纯TKA膝关节的两倍（13%对比6%，p = 0.24）。在最终随访时，PTO-TKA膝关节的FJS-12评分（72±26）与对侧膝关节（70±28，p = 0.57）相似。19%的患者更喜欢PTO-TKA膝关节，19%更喜欢对侧单纯TKA膝关节，62%表示两侧膝关节相当（p > 0.99）。最终的Tegner活动评分为2.5±1.4。
PTO后TKA的长期临床功能良好，与对侧单纯TKA膝关节相比，患者的主观结局相当，膝关节偏好相同。此外，需要进行匹配良好的研究来评估PTO-TKA后的长期翻修和再次手术率。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
