Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4851-4860. doi: 10.1007/s00167-023-07532-7. Epub 2023 Aug 10.
To analyze the association between change in knee joint line obliquity (KJLO) and patient-reported outcome, radiological progression of osteoarthritis, and surgical survival after lateral closing-wedge high tibial osteotomy (HTO).
A cohort of 180 patients treated in one single hospital with lateral closing-wedge HTO was examined. KJLO was defined by the medial proximal tibial angle (MPTA). To assess the association between KJLO and patient-reported outcome, radiological progression of osteoarthritis, and surgical survival, patient groups were defined: I, postoperative MPTA < 95.0°; II, postoperative MPTA ≥ 95.0°; A, MPTA change < 8.0°; B, MPTA change ≥ 8.0°. Propensity score matching was used for between-groups (I and II, A and B) covariates matching, including age, gender, preoperative lower limb alignment, preoperative medial joint space width (mJSW), preoperative Western Ontario and McMaster Universities osteoarthritis Index (WOMAC) score, wedge size, and postoperative follow-up time. Patient-reported outcome was assessed by the WOMAC questionnaire, radiological progression of osteoarthritis by mJSW and Kellgren-Lawrence (KL) grade progression (≥ 1) preoperatively and at follow-ups (> 2 years). Failure was defined as revision HTO or conversion to knee arthroplasty.
After propensity score matching, groups I and II contained 58 pairs of patients and groups A and B contained 50 pairs. There were no significant differences in postoperative WOMAC score or surgical failure rate between groups I and II or between groups A and B (p > 0.05). However, the postoperative mJSW was significantly lower in group I than group II (3.2 ± 1.6 mm vs 3.9 ± 1.8 mm; p = 0.018) and in group A than group B (3.0 ± 1.7 mm vs 3.7 ± 1.5 mm; p = 0.040). KL grade progression rate was significantly higher in group I than group II (53.4% vs 29.3%; p = 0.008) and in group A than group B (56.0% vs 28.0%; p = 0.005).
Increased KJLO (postoperative MPTA ≥ 95.0°) or MPTA change ≥ 8.0° after lateral closing-wedge HTO does not adversely affect patient-reported outcome, radiological progression of osteoarthritis, or surgical survival at an average 5-year follow-up.
III, retrospective cohort study.
分析膝关节线倾斜度（KJLO）变化与患者报告的结果、骨关节炎放射学进展和外侧闭合楔形胫骨高位截骨术（HTO）后手术生存率之间的关系。
对在一家医院接受外侧闭合楔形 HTO 治疗的 180 例患者进行了检查。KJLO 通过内侧胫骨近端角（MPTA）来定义。为了评估 KJLO 与患者报告的结果、骨关节炎的放射学进展以及手术生存率之间的关系，将患者分为以下几组：I 组，术后 MPTA<95.0°；II 组，术后 MPTA≥95.0°；A 组，MPTA 变化<8.0°；B 组，MPTA 变化≥8.0°。使用倾向评分匹配进行组间（I 组和 II 组、A 组和 B 组）协变量匹配，包括年龄、性别、术前下肢对线、术前内侧关节间隙宽度（mJSW）、术前西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分、楔形大小和术后随访时间。通过 WOMAC 问卷评估患者报告的结果，通过 mJSW 和 Kellgren-Lawrence（KL）分级进展（术前和随访时≥1）评估骨关节炎的放射学进展（>2 年）。失败定义为翻修 HTO 或转换为膝关节置换术。
在进行倾向评分匹配后，I 组和 II 组各包含 58 对患者，A 组和 B 组各包含 50 对患者。I 组和 II 组或 A 组和 B 组之间的术后 WOMAC 评分或手术失败率无显著差异（p>0.05）。然而，与 II 组相比，I 组的术后 mJSW 显著更低（3.2±1.6mm 比 3.9±1.8mm；p=0.018），与 B 组相比，A 组的术后 mJSW 也显著更低（3.0±1.7mm 比 3.7±1.5mm；p=0.040）。与 II 组相比，I 组的 KL 分级进展率显著更高（53.4%比 29.3%；p=0.008），与 B 组相比，A 组的 KL 分级进展率也显著更高（56.0%比 28.0%；p=0.005）。
外侧闭合楔形 HTO 术后 KJLO（术后 MPTA≥95.0°）增加或 MPTA 变化≥8.0°不会对患者报告的结果、骨关节炎的放射学进展或平均 5 年随访时的手术生存率产生不利影响。
III 级，回顾性队列研究。
