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. 2022 Feb 23;10(2):23259671221078003.
doi: 10.1177/23259671221078003. eCollection 2022 Feb.

10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy

Lisa Bode  1 , Helge Eberbach  1 , Anna-Sophie Brenner  1 , Ferdinand Kloos  1 , Philipp Niemeyer  1   2 , Hagen Schmal  1   3 , Norbert P Suedkamp  1 , Gerrit Bode  1   4
Affiliations

10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy

Lisa Bode et al. Orthop J Sports Med. .

Abstract

Background: Good-to-excellent midterm results after high tibial osteotomy (HTO) to treat medial compartment cartilage defects or osteoarthritis (OA) have been published, but little is known about long-term survival rates in terms of conversion to total knee arthroplasty (TKA) using angular stable internal plate fixation.

Purpose: To determine TKA-free survival rates and functional and radiological outcomes at 10 years after HTO. A subgroup analysis of patients who underwent combined HTO and autologous cartilage implantation (ACI) was also performed.

Study design: Case series; Level of evidence, 4.

Methods: Included were 125 patients with a mean follow-up of 9.90 ± 2.25 years; 90 patients underwent HTO for medial OA, and 35 patients underwent ACI and HTO for medial focal cartilage defects. Functional outcome measures included visual analog scale (VAS) for pain, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and KOOS4 (average of 4 KOOS subscales: Pain, Symptoms, Sport, and Quality of Life). Radiological outcomes included lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle.

Results: Overall, 16 patients required conversion to TKA at a mean 86.75 ± 25.73 months (10-year survival rate, 87.2%). Only 2 patients in the HTO+ACI subgroup required a conversion to TKA (10-year survival rate, 94.3%). The complication rate for all patients was 8.8%. In both the HTO and HTO+ACI subgroups, VAS pain levels decreased and Lysholm scores increased significantly from pre- to postoperatively (P < .001). A higher preoperative Tegner score led to a significantly lower risk for conversion to TKA (P = .001), and a preoperative body mass index of ≥35 was associated with a significantly higher risk (P = .019), as was female sex (P = .046). Radiological parameters remained within physiological ranges. The postoperative joint line conversion angle did correlate with postoperative functional outcome but not with TKA conversion.

Conclusion: Long-term results of HTO for medial compartment OA or cartilage defects with underlying varus deformity were good to excellent. In particular, patients who underwent HTO+ACI presented excellent long-term survival rates. HTO, therefore, delays or prevents TKA implantation, especially in young, active patients with medial compartment damage.

Keywords: high tibial osteotomy; knee; osteoarthritis; varus deformity.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: the article processing charge was funded by the German Research Foundation (DFG) and the University of Freiburg in the funding program for open access publishing. H.S. has received speaking fees from Arthrex. G.B. has received speaking fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Patient flowchart. Data of patients were enrolled if HTO was performed between 2004 and 2013 matching the criteria for inclusion and exclusion. During the follow-up process, patients were lost to follow-up. Revision surgery was necessary in 11 out of 125 patients (revision rate 8.8%). OA, osteoarthritis; HTO, high tibial osteotomy.
Figure 2.
Figure 2.
Age distribution and age peaks at the time of surgery in the HTO and HTO+ACI subgroups. The patients with HTO+ACI were significantly younger. ACI, autologous cartilage implantation; HTO, high tibial osteotomy.
Figure 3.
Figure 3.
Lysholm, IKDC, and KOOS4 scores 5 and 10 years after HTO showed significant increase over the long term and significantly higher results in the group without TKA conversion (P < .001). Only 2 of the 16 patients had undergone conversion to TKA before the 5-year follow-up. High postoperative functional scores were seen in the HTO+ACI subgroup. The center bar represents the median, the shaded area represents the interquartile range, and the whiskers show minimum and maximum values except for outliers (circles) and extremes (asterisks). ACI, autologous cartilage implantation; HTO, high tibial osteotomy; IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; KOOS4, average of 4 KOOS subscales (Pain, Symptoms, Sport, and Quality of Life); Postop, postoperatively; Preop, preoperatively; TKA, total knee arthroplasty.
Figure 4.
Figure 4.
Sport and physical activity levels in patients in both subgroups without conversion to TKA. KOOS-Sport levels remained on a constant level, with a wide range at the 10-year follow-up. Tegner scores decreased significantly but remained overall at a recreational sports level (eg, recreational sports-cycling, cross-country skiing, jogging on even ground at least twice weekly). The center bar represents the median, the shaded area represents the interquartile range, and the whiskers show minimum and maximum values except for outliers (circles). ACI, autologous cartilage implantation; HTO, high tibial osteotomy; KOOS, Knee injury and Osteoarthritis Outcome Score; PostOP, postoperatively; PreOP, preoperatively; TKA, total knee arthroplasty.
Figure 5.
Figure 5.
Survival rates after HTO ± ACI showing good long-term survival rates after isolated HTO and even excellent results for combined HTO and ACI. ACI, autologous cartilage implantation; HTO, high tibial osteotomy; TKA, total knee arthroplasty.
Figure 6.
Figure 6.
Odds ratios of patient characteristics and preoperative functional scores with 95% CIs of the logistic regression for the binary outcome conversion to TKA. The vertical line at 1 represents the neutral effect. BMI, body mass index; Preop, preoperatively; TKA, total knee arthroplasty; VAS, visual analog scale.
Figure 7.
Figure 7.
Survival rates after HTO ± ACI showing a significantly lower cumulative survival of female patients (P = .046) and of patients with obesity grade 2 to 3 (P = .018).
See this image and copyright information in PMC

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