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Knee Surgery, Sports Traumatology, Arthroscopy

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01-01-2013 | Knee

Age does not influence the clinical outcome after high tibial osteotomy

Authors: L. Kohn, M. Sauerschnig, S. Iskansar, S. Lorenz, G. Meidinger, A. B. Imhoff, S. Hinterwimmer

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2013

Abstract

Purpose

Valgus high tibial osteotomy (HTO) is an established procedure for the medial gonarthrosis. In several studies, many negative influencing factors were evaluated. However, until now, the factor “age” was examined only insufficiently. The aim of our study was to evaluate the factor age in predicting the functional outcome after HTO, and we hypothesized that valgus HTO leads to equal results in the treatment of varus osteoarthritis independent of the patient’s age.

Methods

We could generate 13 pairs of patients with a median age at operation of 57 (55–63) years (group A) versus patients 15 years younger with a median age of 42 (39–47) years (group B). The patients were matched according to the following criteria: age, gender, operation/osteosynthesis method, body mass index, same additional operations, and follow-up time. Evaluation of the patients was done by use of the Tegner and Lysholm score and visual analogue scale (VAS) as well as by subjective satisfaction of the patients.

Results

The Lysholm score showed a significant improvement in group A from 41 (SD ± 12.3) to 65 (SD ± 23.8) points (p = 0.01) and in group B from 33 (SD ± 16.7) to 70 (SD ± 31.8) points (p = 0.007). Moreover, the VAS decreased significantly in group A from 77 (SD ± 15.3) to 36 (SD ± 21.3) points (p = 0.003) and in group B from 73 (SD ± 22.7) to 41 (SD ± 33.7) points (p = 0.02). However, there was no significant difference for both groups regarding the activity of the patients evaluated by the Tegner score (group A: preop.: 5 (1–9), follow-up: 3.5 (1–6); group B: preop.: 6 (3–9), follow-up: 4 (2–7)). Furthermore, there was no significant difference between both groups in view of the Lysholm, Tegner and VAS.

Conclusion

Valgus high tibial osteotomy is an effective procedure for the treatment of medial gonarthrosis independent of the patient’s age. As a consequence, the age of the patient does not have to be taken into consideration for the indication of high tibial osteotomy.

Level of evidence

III.

Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251PubMed

Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90(5):592–596PubMedCrossRef

Cass JR, Bryan RS (1988) High tibial osteotomy. Clin Orthop Relat Res 230:196–199PubMed

Choi HR, Hasegawa Y, Kondo S, Shimizu T, Ida K, Iwata H (2001) High tibial osteotomy for varus gonarthrosis: a 10- to 24-year follow-up study. J Orthop Sci 6(6):493–497PubMedCrossRef

Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67(7):1136–1140PubMed

DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38(10):2077–2084PubMedCrossRef

Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B, Lakemeier S, Schofer MD (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46PubMedCrossRef

El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34(10):e622–e628PubMed

Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96PubMedCrossRef

10.

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 North Am 10(3):585–608PubMed

11.

Gstottner M, Pedross F, Liebensteiner M, Bach C (2008) Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 128(1):111–115PubMed

12.

Hankemeier S, Mommsen P, Krettek C, Jagodzinski M, Brand J, Meyer C, Meller R (2010) Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 18(10):1328–1333PubMedCrossRef

13.

Hassenpflug J, von Haugwitz A, Hahne HJ (1998) Long-term results of tibial head osteotomy. Z Orthop Ihre Grenzgeb 136(2):154–161PubMedCrossRef

14.

Holden DL, James SL, Larson RL, Slocum DB (1988) Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg Am 70(7):977–982PubMed

15.

Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72(2):238–244PubMed

16.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502PubMedCrossRef

17.

Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grutzner P (2009) Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 91(11):2581–2588PubMedCrossRef

18.

Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11(6):439–444PubMedCrossRef

19.

Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res 229:193–200PubMed

20.

Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res 367:18–27PubMedCrossRef

21.

Odenbring S, Tjornstrand B, Egund N, Hagstedt B, Hovelius L, Lindstrand A, Luxhoj T, Svanstrom A (1989) Function after tibial osteotomy for medial gonarthrosis below aged 50 years. Acta Orthop Scand 60(5):527–531PubMedCrossRef

22.

Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30(5):403–408PubMedCrossRef

23.

Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56PubMedCrossRef

24.

Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study. Clin Orthop Relat Res 353:185–193PubMedCrossRef

25.

Rudan JF, Simurda MA (1990) High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 255:251–256PubMed

26.

Salzmann GM, Ahrens P, Naal FD, El-Azab H, Spang JT, Imhoff AB, Lorenz S (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37(2):312–318PubMedCrossRef

27.

Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19(1):122–127PubMedCrossRef

28.

Schroter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D (2011) High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (position HTO plate) without bone substitute. Arthroscopy 27(5):644–652PubMedCrossRef

29.

Segal NA, Buckwalter JA, Amendola A (2006) Other surgical techniques for osteoarthritis. Best Pract Res Clin Rheumatol 20(1):155–176PubMedCrossRef

30.

Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartilage 14(2):190–195PubMedCrossRef

31.

Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85-A (3):469–474

32.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee injuries. Clin Orthop 198:43–49PubMed

33.

Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A (2006) Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(2):149–152PubMedCrossRef

34.

Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13(4):279–289PubMed

Title: Age does not influence the clinical outcome after high tibial osteotomy
Authors: L. Kohn
M. Sauerschnig
S. Iskansar
S. Lorenz
G. Meidinger
A. B. Imhoff
S. Hinterwimmer
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2016-4

At a glance: The STEP trials

Springer Medicine

Age does not influence the clinical outcome after high tibial osteotomy

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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