Medium-term clinical and radiological results after high tibial osteotomy - a prospective evaluation

Status:

completed 11/2018

Aims:

The research project "FR 240 Lebensqualität nach Tibiakopfumstellungsosteotomie" shows the six years outcome of the already successfully concluded research project "FR 150 Navigation OrthoPilot® der DGUV". For this initial research project 120 patients were prospectively recorded and watched for 18 months after open wedge HTO with regards to clinical and radiological outcome. The subjective quality of life presents itself as a decisive factor for the valuation of treatment-quality, respectively quality of results, especially in the domain of degenerative joint diseases. In addition to the achieved quality of life, the changes in clinical and radiological parameters were also evaluated over a period of at least six years after open wedge HTO surgery.

Activities/Methods:

Due to the continuation of the follow-ups of the study collective from the initial research project "FR 150 Navigation OrthoPilot® der DGUV", it is guaranteed that every single patient has received an open wedge HTO previously. In addition to common clinical scores (Lequesne score, modified Lysholm and Gillquist score, HSS score, Oxford knee score), the subjective quality of life was examined and analysed on the basis of the SF-36-questionary. Full-weight bearing long-leg a.p. radiographs as well as a.p. and lateral radiographs of the knee in 0° extension were recorded. Subsequently every patient was clinically examined. The question if it is possible to achieve a comparable quality of life (SF-36) six years after surgical open wedge HTO was defined as primary outcome.

Results:

104 patients agreed once again to participate in the study and were averagely examined after 81.2±11.3 months after open wedge HTO.

• It has been determined that six years after open wedge HTO there was a comparable subjective quality of life, in several subscales of the SF-36 and the mental health component summary score (MCS). The physical health component summary score (PCS) showed a significant improvement and approximation to values of the standard population.
• All evaluated clinical scores showed a significant improvement for the whole collective.
• 8.7% of the evaluated patients received a knee endoprosthesis, after averagely 50.1±25.0 months.
• 23.5% of the evaluated patients obtained a reduction in earning capacity at the entry date. 9.1% of the cases were related to knee osteoarthritis respectively the consequences therefrom. - 6.9% were, either at the entry date or during the observation period, knee-conditioned on sick leave after the initial postoperative period.

Conclusions: Compared with knee-endoprosthesis-implantation, the open wedge HTO could be a decent possibility for patients with medial stressed gonarthrosis in the middle term. The subjective satisfaction and achieved quality of life are key factors for returning to work. Therefore, a cost reduction could be achieved through lower costs of follow-up treatments and pension entitlements where appropriate. The gained insights could be incorporated immediately into the treatment concept of the BG Unfallklinik Tübingen and the individual treatment recommendation for each patient.

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