Cazor A, Schmidt A, Shatrov J, Alqahtani T, Neyret P, Sappey-Marinier Elliot, Batailler C, Lustig S, Servien E
FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.
Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1603-1613. doi: 10.1007/s00167-022-07122-z. Epub 2022 Aug 29.
The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO).
This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point.
At the time of HTO, mean age was 55 years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3 years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3 years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate.
At mean follow-up of 13 years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA.
Retrospective case series, IV.
本研究旨在评估接受初次外翻高位胫骨截骨术（HTO）治疗内侧骨关节炎（OA）的患者在至少10年随访期的临床结局和生存率，这些患者采用开放楔形HTO（OW-HTO）或闭合楔形HTO（CW-HTO）治疗。
这是一项对在单一机构接受HTO治疗孤立性内侧间室OA的连续患者进行的回顾性队列研究。2002年1月至2010年12月期间，对223例孤立性胫股内侧OA患者实施了HTO。患者若有至少10年的随访且接受了CW或OW-HTO，则符合纳入标准。15例（6.7%）患者死亡，25例（11.2%）失访。183例（82.1%）患者纳入最终分析，并分为两组：OW-HTO组（96/183；52.4%）和CW-HTO组（87/183；47.6%）。分析两组之间的活动范围、KSS、KOOS评分以及转换为全膝关节置换术（TKA）的发生率。两组在HTO时的年龄、关节病分期、性别、美国麻醉医师协会（ASA）评分和体重指数（BMI）方面具有可比性。以再次接受TKA干预作为终点进行生存分析。
在HTO时，平均年龄为55岁±7.9（27 - 73.9岁），72.7%的患者为男性。平均随访时间为13.3年±2.7（10 - 19年）。64例（34.9%）患者接受了TKA，平均延迟时间为9.3年±3（3 - 16年）。CW-HTO组转换为TKA的发生率显著高于OW-HTO组：42.5%（37/87）对28.1%（27/96）（p = 0.04）。OW-HTO组15年随访时的生存率为59.2%，而CW-HTO组为54.6%（无统计学差异）。在13年随访时，OW-HTO组的KSS功能评分显著更好（90.9对82.4；p = 0.007）。两组在KOOS评分、KSS膝关节评分和并发症发生率方面未观察到显著差异。
在平均13年的随访中，两组之间未观察到显著的临床和生存差异。OW-HTO后转换为TKA的发生率显著更低。小角度矫正与后续需要TKA的风险相关。
回顾性病例系列，IV级。
