II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy.
Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Bologna, Italy.
Arch Orthop Trauma Surg. 2024 Sep;144(9):3977-3988. doi: 10.1007/s00402-024-05254-0. Epub 2024 Mar 2.
The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA.
A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score.
A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up.
HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population.
IV; systematic review of level III-IV studies.
对于晚期膝关节骨关节炎（OA），行内翻矫正高位胫骨截骨术（HTO）的作用仍存在争议。本系统评价的目的是评估放射学晚期内侧膝关节 OA 患者行高位胫骨截骨术的生存率和患者报告的结局（PROM）。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，于 2023 年 7 月对 PubMed、Cochrane 和 EMBASE 数据库进行了系统检索。应用纳入和排除标准，以确定研究患者接受放射学晚期内侧膝关节 OA 患者行内翻矫正高位胫骨截骨术的生存率和 PROM 的研究。在至少 2 年的随访中，内侧间室的 X 线评估中，高级放射学 OA 定义为 Kellgren-Lawrence（K-L）≥3 或 Ahlbäch≥2。生存率定义为随访时免于全膝关节置换术（TKA）的患者百分比。根据文献中报告的最小临床重要差异（MCID）和患者可接受症状状态（PASS）目标值，对提供的 PROM 进行临床解释。提取生存率数据和 PROM 评分，并根据所选研究特征对研究进行分层。使用改良 Coleman 评分评估纳入研究的质量。
共纳入 18 项研究，共 1296 例膝关节，平均年龄 46.9-67 岁。10 年随访时的平均生存率为 74.6%（范围 60-98.1%）。主观评分系统根据 MCID 和 PASS 显示出良好的结果，术后改善部分维持至最终随访。
即使在放射学晚期内侧膝关节骨关节炎患者中，HTO 也值得考虑作为治疗选择。在这一人群中，可以预期长期的生存率和良好的患者报告的临床结局。
IV；三级和四级研究的系统评价。
