Clinical and radiological results of high tibial of osteotomy over the age of 65 are comparable to that of under 55 at minimum 2‑year follow‑up: a propensity score matched analysis
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Purpose: The results of medial open-wedge high tibial osteotomy (MOWHTO) according to age is inconclusive. This study aimed to compare the clinical outcomes and failure of MOWHTO in patients <55 years and >65 years. Methods: Consecutive patients who underwent MOWHTO from July 2009 to August 2020 were retrospectively analyzed. 205 patients were considered for analysis. A 1-to-1 propensity score matched analysis to assess clinical outcomes scores including International Knee Documentation Committee (IKDC) subjective score and Lysholm score, radiologic outcomes, complication, and Total Knee Arthroplasty (TKA) conversion between patients > 65years and patients < 55years was performed. Radiologic outcomes included Hip-Knee-Ankle (HKA) angle, Weight Bearing Line ratio (WBLR), posterior tibial slope (PTS), and Insall-Salvati (IS) ratio before and after surgery. Results: The follow-up period was 50.4 months in patients > 65years and 55.3 months in patients < 55years. There was no significant difference in the preoperative and postoperative HKA angle, WBLR, PTS, IS ratio, IKDC score and Lysholm score between the two groups. The arthroscopic evaluation of cartilage did not show any statistically significant differences between the two groups. Regarding Minimal clinically important differences (MCID), in the 26% of the older group exceeded MCID of IKDC score; 45% of the older group exceeded MCID of Lysholm score. In the younger group, 24% exceeded MCID of IKDC score and 35% exceeded MCID of Lysholm score. In older group, there were 7 (11.3%) cases of TKA conversion while no TKA conversion was recorded in the younger group. (P=0.007) The average time to TKA conversion was 67 months. (42 months to 90 months) Kaplan-Meier analysis revealed that the survival rate was 95.2% at 4 years in the older group. Conclusion: Similar clinical results were obtained in patients over 65 years of age that were eligible for MOWHTO at minimum 2-year follow-up as in patients under 55 years of age. MOWHTO may be a viable option in older patients if proper indications are met. However, the risk of TKA conversion must be considered preoperatively and discussed with patients.
Abstract
Purpose: The results of medial open-wedge high tibial osteotomy (MOWHTO) according to age is inconclusive. This study aimed to compare the clinical outcomes and failure of MOWHTO in patients <55 years and >65 years. Methods: Consecutive patients who underwent MOWHTO from July 2009 to August 2020 were retrospectively analyzed. 205 patients were considered for analysis. A 1-to-1 propensity score matched analysis to assess clinical outcomes scores including International Knee Documentation Committee (IKDC) subjective score and Lysholm score, radiologic outcomes, complication, and Total Knee Arthroplasty (TKA) conversion between patients > 65years and patients < 55years was performed. Radiologic outcomes included Hip-Knee-Ankle (HKA) angle, Weight Bearing Line ratio (WBLR), posterior tibial slope (PTS), and Insall-Salvati (IS) ratio before and after surgery. Results: The follow-up period was 50.4 months in patients > 65years and 55.3 months in patients < 55years. There was no significant difference in the preoperative and postoperative HKA angle, WBLR, PTS, IS ratio, IKDC score and Lysholm score between the two groups. The arthroscopic evaluation of cartilage did not show any statistically significant differences between the two groups. Regarding Minimal clinically important differences (MCID), in the 26% of the older group exceeded MCID of IKDC score; 45% of the older group exceeded MCID of Lysholm score. In the younger group, 24% exceeded MCID of IKDC score and 35% exceeded MCID of Lysholm score. In older group, there were 7 (11.3%) cases of TKA conversion while no TKA conversion was recorded in the younger group. (P=0.007) The average time to TKA conversion was 67 months. (42 months to 90 months) Kaplan-Meier analysis revealed that the survival rate was 95.2% at 4 years in the older group. Conclusion: Similar clinical results were obtained in patients over 65 years of age that were eligible for MOWHTO at minimum 2-year follow-up as in patients under 55 years of age. MOWHTO may be a viable option in older patients if proper indications are met. However, the risk of TKA conversion must be considered preoperatively and discussed with patients.
참고문헌 (22)
- Lee SJ, "Factors related to the early outcome of medial open wedge high tibial osteotomy : coronal limb alignment affects more than cartilage degeneration state", Arch Orthop Trauma Surg, 141(8), pp.1339~1348 (2021)[DOI]
- Ryu SM, "High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis with kissing lesions in relatively young patients", Knee Surg Relat Res, 30(1), pp.17~22 (2018)[DOI]
- Na B-R, "Effect of medial open wedge high tibial osteotomy on progression of patellofemoral osteoarthritis", Knee Surg Related Res, 34(1), pp.42~ (2022)[DOI]
- Song I-S, "Analysis of changes in tibial torsion angle on open-wedge high tibial osteotomy depending on the osteotomy level", Knee Surg Related Res, 34(1), pp.17~ (2022)[DOI]
- Brinkman JM, "Osteotomies around the knee : patient selection, stability of fixation and bone healing in high tibial osteotomies", J Bone Joint Surg Am, 90(12), pp.1548~1557 (2008)[DOI]
- Takeuchi R, "Medial opening wedge high tibial osteotomy with early full weight bearing", Arthroscopy, 25(1), pp.46~53 (2009)[DOI]
- Goshima K, "Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy", KSSTA, 25(3), pp.918~923 (2017)[DOI]
- Song JH, "Cartilage status, rather than chronologic age, determines the outcomes of open wedge high tibial osteotomy : a cartilage status-matched cohort study", Arthroscopy, 37(9), pp.2915~2922 (2021)[DOI]
- Hui C, "Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee", Am J Sports Med, 39(1), pp.64~70 (2011)[DOI]
- Niinimäki TT, "Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee : Finnish registry-based study of 3195 knees", J Bone Joint Surg Am, 94(11), pp.1517~1521 (2012)[DOI]
- Won HH, "Coronal limb alignment and indications for high tibial osteotomy in patients undergoing revision ACL reconstruction", Clin Orthop Relat Res, 471(11), pp.3504~3511 (2013)[DOI]
- Keenan OJF, "Older age and female gender are independent predictors of early conversion to total knee arthroplasty after high tibial osteotomy", Knee, 26(1), pp.207~212 (2019)[DOI]
- Sakai M, "Similar short-term KOOS between open-wedge high tibial osteotomy and total knee arthroplasty in patients over age 60 : a propensity score-matched cohort study", Mod Rheumatol, 33(3), pp.623~628 (2023)[DOI]
- Kohn L, "Age does not influence the clinical outcome after high tibial osteotomy", KSSTA, 21(1), pp.146~151 (2013)[DOI]
- Holden DL, "Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study", J Bone Joint Surg Am, 70(7), pp.977~982 (1988)
- Odenbring S, "Function after tibial osteotomy for medial gonarthrosis below aged 50 years", Acta Orthop Scand, 60(5), pp.527~531 (1989)[DOI]
- Trieb K, "Age predicts outcome of high-tibial osteotomy", KSSTA, 14(2), pp.149~152 (2006)[DOI]
- Kleemann RU, "Altered cartilage mechanics and histology in knee osteoarthritis : relation to clinical assessment(ICRS Grade)", Osteoarthr Cartil, 13(11), pp.958~963 (2005)[DOI]
- Patel S, "Defining clinically significant outcomes following high tibial osteotomy with or without concomitant procedures", JCJP, 1(2), pp.100014~ (2021)
- Khoshbin A, "The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty : a population-based study", KSSTA, 25(3), pp.887~894 (2017)[DOI]
- Yoon JR, "Risk of revision following total knee arthroplasty or high tibial osteotomy : a nationwide propensity-score-matched study", J Bone Joint Surg Am, 101(9), pp.771~778 (2019)[DOI]
- Kim DH, "Evaluation of appropriateness of the reimbursement criteria of Korean health insurance review and assessment service for total knee arthroplasty", Clin Orthop Surg, 15(2), pp.241~248 (2023)[DOI]