Preoperative symptom duration does not affect clinical outcomes after high tibial osteotomy at a minimum of 2-year follow-up

J ISAKOS. 2022 Aug;7(4):60-65. doi: 10.1016/j.jisako.2022.03.003. Epub 2022 Apr 5.


Objectives: To determine if patients with preoperative symptom durations greater than two-years' experience inferior patient-reported and clinical outcomes at a minimum of two years after high tibial osteotomy.

Methods: An institutional registry was retrospectively queried for patients treated with high tibial osteotomy for symptomatic medial knee overload/arthritis and varus malalignment between February 2006 and March 2018. Demographic characteristics, clinical outcomes, patient-reported outcomes (PROs), including the International Knee Documentation Committee ​score, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement ​and Patient-Reported Outcome Measurement Information System Pain Interference ​and Physical Function ​scores, were assessed at a minimum of two-years postoperatively. Patients were compared based on preoperative symptom duration greater than or less than two years. Correlation coefficients were used to analyse the association between patient demographics and postoperative outcomes for the overall patient sample.

Results: A total of 41 patients were included in the analysis with a mean age (± standard deviation) of 37.0 ​± ​8.2 years and body mass index of 27.6 ​± ​4.2 ​kg/m2. The median (interquartile range) follow-up time for the entire study sample was 48.5 (24-100.5) months. There were no significant differences in delta (pre-to-post improvement) or postoperative PRO scores, number or time-to-reoperation ​or conversion to TKA (all P ​> ​0.05) based on the preoperative duration of symptoms. A statistically significant but weak correlation was observed between greater age (r ​= ​0.344, P ​= ​0.027) and BMI (r ​= ​0.320, P ​= ​0.044) with conversion to TKA.

Conclusion: Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. Greater age and BMI were weakly correlated with conversion to TKA. Greater age was negatively correlated with undergoing at least one reoperation.

Level of evidence: IV; Retrospective case series.

Keywords: Arthritis; Knee; Lower extremity; Osteotomy.

MeSH terms

  • Adult
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Osteoarthritis, Knee* / surgery
  • Osteotomy / adverse effects
  • Retrospective Studies
  • Tibia* / surgery
  • Treatment Outcome