What Determines the Success of Closed-Wedge High Tibial Osteotomy: Severity of Malalignment, Obesity, Follow-up Period, or Age?

Ata Can; Fahri Erdoğan; Ayse Ovul Erdoğan; İlker Abdullah Sarıkaya; Necip Selçuk Yontar

doi:10.14744/SEMB.2017.38257

What Determines the Success of Closed-Wedge High Tibial Osteotomy: Severity of Malalignment, Obesity, Follow-up Period, or Age?

Sisli Etfal Hastan Tip Bul. 2018 Mar 23;52(1):6-12. doi: 10.14744/SEMB.2017.38257. eCollection 2018.

Authors

Ata Can¹, Fahri Erdoğan², Ayse Ovul Erdoğan¹, İlker Abdullah Sarıkaya³, Necip Selçuk Yontar¹

Affiliations

¹ Nisantasi Orthopedic Center, İstanbul, Turkey.
² Department of Orthopaedics and Traumatology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.
³ Ortopediatri Child Orthopedic Academy, İstanbul, Turkey.

Abstract

Objectives: High tibial osteotomy (HTO) is a well-established procedure for the treatment of medial knee osteoarthritis originating from malalignment of the lower extremity. The current study was designed to evaluate the clinical and radiographic results of closed-wedge HTO for the treatment of medial knee osteoarthritis and to reveal factors affecting the outcome.

Methods: A retrospective study was conducted with 138 patients who were operated on for medial knee osteoarthritis between 2000 and 2007 using closed-wedge HTO. Preoperative and follow-up physical examination findings, body mass index (BMI) values, and Hospital for Special Surgery (HSS) and Lysholm knee scores were reviewed. Radiographic evaluation included measurement of the mechanical axis preoperatively and the most recent follow-up orthoroentgenograms. The follow-up knee scores were evaluated according to preoperative mechanical axis, obesity, age, follow-up period, and gender of the patient. The mechanical axis measurement was assessed based on obesity, age, and follow-up period.

Results: The mean preoperative and latest follow-up mechanical axis was 4.92^o±4.24^o varus and 3.43^o±3.74^o valgus, respectively (p=0.0001). Improvement in the Lysholm (p=0.0001) and HSS (p=0.0001) knee scores was significant. The preoperative mechanical axis, obesity, follow-up period, and gender had no negative effect on the follow-up knee scores, whereas a preoperative age over 50 years had a negative effect on the follow-up knee score. Obesity and the length of the postoperative follow-up period did not have a negative effect on the postoperative mechanical axis, whereas a preoperative age over 50 had a negative effect on the postoperative mechanical axis.

Conclusion: The results of this study suggest that medial knee osteoarthritis may be treated successfully with closed-wedge HTO. The analysis indicated that factors such as obesity, the degree of preoperative deformity, and gender do not adversely affect the success of treatment. However, a preoperative age over 50 adversely affected the outcome.

Keywords: Age; closed wedge; high tibial osteotomy; malalingment.