Satisfactory long-term survival, functional and radiological outcomes of open-wedge high tibial osteotomy for managing knee osteoarthritis: Minimum 10-year follow-up study

Abstract

Background: This prospective cohort study was designed to evaluate the survivorship and functional outcomes associated with long-term results of medial open-wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in the Chinese population. Although MOWHTO is a well-established procedure in the management of medial osteoarthritis of the knee, the long-term outcome in the Chinese population has not been reported in current literature. We hypothesised that MOWHTO would result in long-term preservation of knee function in Chinese, similar to that reported in the Caucasian population.

Methods: A cohort of 22 young adult patients (age < 55 years old) undergoing MOWHTO for the treatment of symptomatic medial compartment knee osteoarthritis between 2002 and 2008 was retrospectively surveyed with a minimum follow-up of 10 years. Kaplan-Meier survival analysis was performed, and the failure modes were investigated. The outcomes on survival (not requiring arthroplasty), clinical outcome (Knee Society Knee Score and Knee Society Function Score) and range of motion (numeric rating scale) at preoperative, 1-year postoperative follow-up and at last follow-up (>10 years) were evaluated. In addition, the mechanical tibiofemoral angle was also measured. The Wilcoxon signed-rank test was used for statistical evaluation of nonparametric data in these related samples.

Result: A total of 31 knees in these 22 cases were included. The follow-up rate was 100% at 13.4 ± 1.9 years (11-17). Mean age at time of surgery was 45.8 ± 9.5 years (18-53). At 10-year follow-up, four knees converted to require total knee arthroplasty (survival: 87.1%). Preoperative varus alignment with mechanical tibiofemoral angle of -9.26 ± 2.83 was corrected to 2.58 ± 2.46 after surgery and remained 2.01 ± 3.52 at the latest follow-up. Knee Society Knee Score increased significantly from 53.7 ± 11.1 preoperatively to 93.8 ± 6.8 at 1-year follow-up and 91.8 ± 9.7 at latest follow-up. Similarly, the functional score also increased significantly from 67.4 ± 21.0 preoperatively to 86.3 ± 14.5 at 1-year follow-up and 82.1 ± 16.6 at latest follow-up (p < 0.01). Whereas, the range of motion significantly decreased from 122.7 ± 6.6 preoperatively to 116.1 ± 15.5 at the latest follow-up.

Conclusion: Even in cases of severe medial osteoarthritis and varus malalignment, MOWHTO would be a good treatment option for management in active Chinese population less than 55 years. Although the long-term survival and functional outcome after MOWHTO was proven to be satisfactory in our cohort during the 10-year follow-up, a larger cohort to illustrate the long-term functional outcome is still warranted.

Translational potential: The finding in this study indicated MOWHTO is a feasible treatment option for young adult patients with osteoarthritis to achieve long-term satisfactory results.

Keywords: Chinese; High tibial osteotomy; Knee alignment; Knee osteoarthritis; Open-wedge osteotomy; Survival.

Figure 1

Long leg standing anteroposterior (AP) radiographs at 1-year and 10-years after MOWHTO. (A) MOWHTO failure correlated with neutral alignment at 1-year postop radiograph. (B) MOWHTO failure at 10-year postop showing progressive varus deformity and medial compartmental osteoarthritic changes. (C) MOWHTO success significantly correlated with valgus alignment at 1-year postop. (D) MOWHTO success at 10-year postop showing preservation of alignment, medial and lateral compartmental joint spaces. MOWHTO = medial open-wedge high tibial osteotomy.

Figure 2

Kaplan–Meier curve illustrates the survival of the MOWHTO. Ten-year survival rate was 87.1%. MOWHTO = medial open-wedge high tibial osteotomy

Figure 3

Kaplan–Meier survival curve on the types of plates used (L-buttress plate, T-plate, Tomofix). Five-year survival rate for L-buttress plate, T-plate and tomofix plate were 94.1% ± 5.7%, 90.0% ± 9.5% and 100%, respectively. MOWHTO = medial open-wedge high tibial osteotomy