fa9974c170732bc293df55650008b59a pmc_34206331.pdf 30121dcd9643d3d39b28f8b1f2016d8cd16d71e6 pmc_34206331.pdf 2e9c424edefc958e793a998e73fa611a2eba2638ade61408d6186344a97c9018 pmc_34206331.pdf Title: Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement Subject: Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA 180, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24–180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7 (SD 4.9) in group 1 and 179.5 (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 15.9) and group 2 (84.3 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA 180 (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study. Keywords: closing-wedge osteotomy; knee stability; tibiofibular dislocation; fibular osteotomy; high tibial osteotomy; osteotomy survival rate; total knee replacement; knee Author: Juan Sánchez-Soler, Alex Coelho, Raúl Torres-Claramunt, Berta Gasol, Albert Fontanellas, Simone Perelli, Pedro Hinarejos and Joan Carles Monllau Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jun 22 11:35:11 2021 CEST ModDate: Tue Jun 22 11:37:40 2021 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 9 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1263606 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- UEHGBQ+VnURWPalladioL Type 1 Custom yes yes no 10 0 KLXHOE+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 MKSJVI+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 UDLZYA+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 LGXVCI+CMSY10 Type 1 Builtin yes yes no 28 0 FYYAHQ+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 40 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 43 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 65 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 69 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 73 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 93 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 97 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 101 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 105 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 117 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 129 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 133 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 137 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 141 0 BCDJEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 148 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 161 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 165 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 169 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 173 0 BCDJEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 180 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2021-09-11 03:05:23 CEST RepresentationInformation: pmc_34206331.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2021-07-12 03:37:10 CEST Size: 1263606 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 285 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Children: Item: Title: Subjects Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Surgical Procedure Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Radiological Evaluation Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Clinical Evaluation Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Info: Title: Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement Author: Juan Sánchez-Soler, Alex Coelho, Raúl Torres-Claramunt, Berta Gasol, Albert Fontanellas, Simone Perelli, Pedro Hinarejos and Joan Carles Monllau Subject: Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA 180, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24 180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7 (SD 4.9) in group 1 and 179.5 (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 15.9) and group 2 (84.3 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA 180 (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study. Keywords: closing-wedge osteotomy; knee stability; tibiofibular dislocation; fibular osteotomy; high tibial osteotomy; osteotomy survival rate; total knee replacement; knee Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jun 22 11:35:11 CEST 2021 ModDate: Tue Jun 22 11:37:40 CEST 2021 ID: 0xa2e13b88ea7613459b20cfc85a438b6b, 0xa2e13b88ea7613459b20cfc85a438b6b Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: FYYAHQ+VnURWPalladioL-Bold FontSubset: true FirstChar: 161 LastChar: 243 FontDescriptor: FontName: FYYAHQ+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: MKSJVI+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 122 FontDescriptor: FontName: MKSJVI+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: QLBIEB+URWPalladioL-BoldItal FontSubset: true FirstChar: 110 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