2015 ISAKOS Biennial Congress ePoster #1705

The Ability of High Tibial Osteotomy to Improve Function and Delay Total Knee Replacement in Patients With Medial Compartment Knee Osteoarthritis

Corey Scholes, PhD, Crows Nest, NSW AUSTRALIA
David A. Parker, MBBS, BMedSc, FRACS, Sydney, NSW AUSTRALIA
Sydney Orthopaedic Research Institute, Sydney, NSW, AUSTRALIA

FDA Status Not Applicable

Summary: High tibial osteotomy can improve function and could delay the need for knee replacement in suitable patients

Abstract:

Introduction

Management of knee osteoarthritis in the younger patient remains challenging, with limited surgical options available other than total knee replacement. High tibial osteotomy may be preferable in these patients as it retains the biological joint structures and potentially delays the need for TKR until later in life. However, there remains controversy regarding the efficacy of HTO to restore function and enhance joint longevity that justifies the surgery and prolonged rehabilitation. Therefore the purpose of this study was to examine the survivorship of HTO for medial knee OA and determine the effect of the procedure on patient--reported function

Methods

A prospective database was examined for all patients (N = 210) that received a primary opening-wedge high-tibial osteotomy for osteoarthritis or chondral defects with concomitant varus deformity between November 2002 to August 2013 by one of 3 consultant orthopaedic surgeons. Survivorship will be analysed using National Joint Registry data to confirm conversion to total knee replacement subsequent to the HTO and a Kaplan-Meier curve presented. Patient outcomes including KOOS and Tegner activity scale will be collected and compared with pre-operative scores where available. Analysis of factors such as age, gender and follow-up delay will be examined for their correlation with post-operative outcomes.

Results

The results of this study will build on previous work by our group that reported 83% survival to 10years in a series of 142 knees, with low post-operative activity (Tegner 3.8+1.5). The addition of KOOS scores will also help to identify patients that may be considered ‘near-conversion’, which has not been reported in the literature previously.

Conclusion

Opening-wedge high tibial osteotomy for medial compartment knee OA remains limited by a lack of quality evidence. The present study will add data to the current available information and guidelines for this procedure, from a large series at mid to long-term follow-up (10yrs). This work will help provide clearer guidelines on the potential benefit of HTO in improving function and delay arthroplasty, as well as the selection of those patients who should benefit most from the procedure.