Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2023

17-08-2023 | Knee Osteoarthritis | KNEE

Bone mineral density around the knee after open wedge high tibial osteotomy measured up to 24 months in 51 patients

Authors: Yasushi Akamatsu, Hideo Kobayashi, Shota Mitsuhashi, Yoshihiro Kusayama

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2023

Login to get access

Abstract

Purpose

To evaluate bone mineral density (BMD) and radiographic and clinical outcomes of patients with varus knee osteoarthritis treated with open wedge high tibial osteotomy (OWHTO). We hypothesised that medial condyle BMD would decrease and lateral condyle BMD would increase after OWHTO.

Methods

Overall, 51 patients (mean age: 65.3 years; female: 40, male: 11) treated with OWHTO were prospectively enrolled. Several angles using whole single-leg radiographs were measured preoperatively and up to 24 months postoperatively. Five square tibial regions of interest (ROI) located below the proximal tibia as T1–T5 from medial to lateral regions and two square femoral ROI as F1 and F2 from medial and lateral regions, respectively, were defined. M/L BMD ratio was used to define the medial-to-lateral condyle BMD ratio. Femoral condyle BMD (F1 and F2) around the knee, as well as lumbar spine, and ipsilateral and contralateral femoral neck BMD, were measured before OWHTO and 3, 6, 12 and 24 months after OWHTO using dual-energy X-ray absorptiometry. Furthermore, tibial condyle BMD (T1–T5) around the knee was measured before and 24 months after OWHTO. Clinical outcomes were evaluated using the Knee Society knee and function scores, the Knee Injury and Osteoarthritis Outcome Score, and the Lysholm score preoperatively and 24 months postoperatively. A power analysis was performed.

Results

F1 BMD decreased by 19.2% from before to 3 months postoperatively. F2 BMD did not change up to 24 months after OWHTO. Femoral M/L BMD ratio decreased by 22.2% 3 months after OWHTO. T1 BMD and tibial M/L BMD ratio decreased, whilst T3, T4 and T5 BMD increased 24 months after OWHTO. Mean hip–knee–ankle angle (HKA) and weight-bearing line ratio were corrected from − 6.8° to 4.5° and 14.7 to 60.7%, respectively, postoperatively. Lumbar spine BMD did not change up to 12 months postoperatively. Ipsilateral femoral neck BMD decreased up to 6 months after OWHTO.

Conclusion

Medial femoral condyle BMD decreased rapidly within 3 months and continued to decrease up to 12 months, but lateral femoral condyle BMD did not change after OWHTO. BMD measurements around the knee condyle enabled the evaluation of the changes in stress distribution before and after OWHTO with accelerated rehabilitation.

Level of evidence

II.
Literature
1.
Akamatsu Y, Koshino T, Saito T, Wada J (1997) Changes in osteosclerosis of the osteoarthritic knee after high tibial osteotomy. Clin Orthop Relat Res 334:207–214CrossRef
2.
Akamatsu Y, Mitsugi N, Taki N, Takeuchi R, Saito T (2009) Relationship between low bone mineral density and varus deformity in postmenopausal women with knee osteoarthritis. J Rheumatol 36(3):592–597CrossRefPubMed
3.
Akamatsu Y, Mitsugi N, Taki N, Kobayashi H, Saito T (2012) Medial versus lateral condyle bone mineral density ratios in a cross-sectional study: a potential marker for medial knee osteoarthritis severity. Arthritis Care Res (Hoboken) 64(7):1036–1045PubMed
4.
Ahlbäck S (1968) Osteoarthritis of the knee: a radiographic investigation. Acta Radiol 277(Suppl):7–72
5.
Bennell KL, Creaby MW, Wrigley TV, Hunter DJ (2008) Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology. Arthritis Rheum 58(9):2776–2785CrossRefPubMed
6.
Blumenkrantz G, Lindsey CT, Dunn TC, Jin H, Ries MD, Link TM et al (2004) A pilot, two-year longitudinal study of the interrelationship between trabecular bone and articular cartilage in the osteoarthritic knee. Osteoarthr Cartil 12(12):997–1005CrossRef
7.
Clarke S, Wakeley C, Duddy J, Sharif M, Watt I, Ellingham K et al (2004) Dual-energy X-ray absorptiometry applied to the assessment of tibial subchondral bone mineral density in osteoarthritis of the knee. Skeletal Radiol 33(10):588–595CrossRefPubMed
8.
Dordevic M, Hirschmann MT, Rechsteiner J, Falkowski A, Testa E, Hirschmann A (2016) Do chondral lesions of the knee correlate with bone tracer uptake by using SPECT/CT? Radiology 278(1):223–231CrossRefPubMed
9.
Dore D, Quinn S, Ding C, Winzenberg T, Jones G (2009) Correlates of subchondral BMD: a cross-sectional study. J Bone Miner Res 24:2007–2015CrossRefPubMed
10.
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160CrossRefPubMed
11.
Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10(3):585–608CrossRef
12.
Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF (2011) Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc Rev 19(2):174–181CrossRefPubMed
13.
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14CrossRef
14.
Iwasaki K, Kondo E, Matsubara S, Matsuoka M, Endo K, Yokota I et al (2021) Effect of high tibial osteotomy on the distribution of subchondral bone density across the proximal tibial articular surface of the knee with medial compartment osteoarthritis. Am J Sports Med 49(6):1561–1569CrossRefPubMed
15.
16.
17.
Koshino T, Ranawat NS (1972) Healing process of osteoarthritis in the knee after high tibial osteotomy. Through observation of strontium-85 scintimetry. Clin Orthop Relat Res 82:149–156CrossRefPubMed
18.
Kosior P, Czuraszkiewicz L, Tarczynska M, Mazurkiewicz T, Gaweda K (2012) The evaluation of knee bone mineral density following open-wedge high tibial osteotomy. J Appl Biomech 28(4):359–365CrossRefPubMed
19.
Lo GH, Hunter DJ, Zhang Y, McLennan CE, Lavalley MP, Kiel DP et al (2005) (2005) Bone marrow lesions in the knee are associated with increased local bone density. Arthritis Rheum 52(9):2814–2821CrossRefPubMed
20.
Lo GH, Zhang Y, McLennan C, Niu J, Kiel DP, McLean RR et al (2006) The ratio of medial to lateral tibial plateau bone mineral density and compartment-specific tibiofemoral osteoarthritis. Osteoarthr Cartil 14(10):984–990CrossRef
21.
Lo GH, Schneider E, Driban JB, Price LL, Hunter DJ, Eaton CB, OAI Investigators Group et al (2018) Periarticular bone predicts knee osteoarthritis progression: data from the osteoarthritis initiative. Semin Arthritis Rheum 48(2):155–161CrossRefPubMedPubMedCentral
22.
Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP et al (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23(8):2315–2323CrossRefPubMed
23.
Nguyen US, Felson DT, Niu J, White DK, Segal NA, Lewis CE et al (2014) The impact of knee instability with and without buckling on balance confidence, fear of falling and physical function: the Multicenter Osteoarthritis Study. Osteoarthr Cartil 22(4):527–534CrossRef
24.
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96CrossRefPubMed
25.
Schelker BL, Moret CS, Dogan O, Amsler F, Rasch H, Hügli RW et al (2022) Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome. Knee Surg Sports Traumatol Arthrosc 30(2):397–406CrossRefPubMed
26.
Schön SN, Afifi FK, Rasch H, Amsler F, Friederich NF, Arnold MP et al (2014) Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT. Knee Surg Sports Traumatol Arthrosc 22(12):3039–3046CrossRefPubMed
27.
28.
Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K et al (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53CrossRefPubMed
29.
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49CrossRef
30.
Wada M, Maezawa Y, Baba H, Shimada S, Sasaki S, Nose Y (2001) Relationships among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis. Rheumatology (Oxford) 40(5):499–505CrossRefPubMed
31.
Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195CrossRef
32.
Yoon C, Chang MJ, Chang CB, Chai JW, Jeong H, Song MK et al (2020) Bone mineral density around the knee joint: correlation with central bone mineral density and associated factors. J Clin Densitom 23(1):82–91CrossRefPubMed
Metadata
Title
Bone mineral density around the knee after open wedge high tibial osteotomy measured up to 24 months in 51 patients
Authors
Yasushi Akamatsu
Hideo Kobayashi
Shota Mitsuhashi
Yoshihiro Kusayama
Publication date
17-08-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07539-0

Other articles of this Issue 11/2023

Knee Surgery, Sports Traumatology, Arthroscopy 11/2023 Go to the issue

KNEE

Patella scores are similar both with gap balancing and measured resection after total knee arthroplasty: a randomized single-centre study

Editorial

Osteotomies around the knee are not just space oddities

SHOULDER

Arthroscopic capsular release for frozen shoulder: when etiology matters

KNEE

Preoperative patellar bone marrow lesions with full thickness cartilage defects correlate with residual anterior knee pain in total knee arthroplasty without patellar resurfacing

KNEE

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part III—indications for different clinical scenarios using the RAND/UCLA appropriateness method

EDITORIAL

Time to focus on ACL revision: ESSKA 2022 consensus