North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia.
School of Medicine, University of Notre Dame, Sydney, Australia.
Am J Sports Med. 2024 Feb;52(2):344-351. doi: 10.1177/03635465231217742. Epub 2024 Jan 20.
High tibial osteotomy (HTO) is a successful joint-preserving procedure for the treatment of medial compartment osteoarthritis. Long-term survivorship of HTO ranges from 40% to 85%. There are consistent factors that predict failure.
To determine the 20-year survival of HTO and identify predictors of failure.
Case series; Level of evidence, 4.
A total of 100 consecutive patients with medial bone-on-bone arthritis were prospectively studied to provide long-term patient-reported outcome measures after lateral closing-wedge HTO and determine the time to failure. Failure was defined as conversion to arthroplasty (total knee arthroplasty or unicompartmental knee arthroplasty) or revision HTO.
At 20 years, HTO survival was determined in 95 patients, and 5 were lost to follow-up. The overall survivorship of HTO at 20 years was 44%. The significant factors that were associated with better survivorship were age <55 years, body mass index <30, and Western Ontario and McMaster Universities Osteoarthritis Index pain score >45. These factors were used to define the favorable candidates. In the favorable candidates, survivorship was 100% at 5 years, after which there was a gradual decline to 62% survival at 20 years. Of those with HTO survival, 32 of 33 (97%) reported satisfaction with surgery, with a mean Knee injury and Osteoarthritis Outcome Score Pain score of 91 and Activities of Daily Living score of 97.
HTO is a successful surgical option to treat medial compartment osteoarthritis and prevent the need for arthroplasty in young patients. The most suitable candidates for HTO are aged <55 years, are not obese, and have not progressed to severe symptomatic disability.
胫骨高位截骨术（HTO）是一种治疗内侧间室骨关节炎的成功保关节手术。HTO 的长期存活率为 40%至 85%。有一些一致的因素可以预测失败。
确定 HTO 的 20 年存活率，并确定失败的预测因素。
病例系列；证据水平，4 级。
前瞻性研究了 100 例连续的内侧骨关节炎患者，提供了外侧闭合楔形 HTO 后长期的患者报告结局测量，并确定了失败的时间。失败定义为转换为关节置换术（全膝关节置换术或单髁膝关节置换术）或 HTO 翻修。
20 年后，95 例患者确定了 HTO 的存活率，5 例失访。HTO 的总体 20 年存活率为 44%。与更好的存活率相关的显著因素是年龄<55 岁、体重指数<30 和西安大略和麦克马斯特大学骨关节炎指数疼痛评分>45。这些因素被用来定义合适的候选人。在合适的候选人中，5 年时的存活率为 100%，之后逐渐下降至 20 年时的 62%。在 HTO 存活的患者中，33 例中有 32 例（97%）对手术表示满意，膝关节损伤和骨关节炎结果评分疼痛评分平均为 91，日常生活活动评分平均为 97。
HTO 是治疗内侧间室骨关节炎和预防年轻患者需要关节置换的成功手术选择。最适合 HTO 的候选者是年龄<55 岁、不肥胖且没有进展到严重症状性残疾的患者。
