Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement
Sánchez-Soler, Juan (Institut Hospital del Mar d'Investigacions Mèdiques)
Coelho, Alexandre ![ORCID Identifier](/img/uab/orcid.ico)
(Hospital del Mar (Barcelona, Catalunya))
Torres-Claramunt, Raúl ![ORCID Identifier](/img/uab/orcid.ico)
(Hospital Universitari Dexeus (Barcelona, Catalunya))
Gasol, Berta (Hospital del Mar (Barcelona, Catalunya))
Fontanellas Fes, Albert ![ORCID Identifier](/img/uab/orcid.ico)
(Hospital del Mar (Barcelona, Catalunya))
Perelli, Simone ![ORCID Identifier](/img/uab/orcid.ico)
(Hospital del Mar (Barcelona, Catalunya))
Hinarejos Gómez, Pedro
(Universitat Autònoma de Barcelona. Departament de Cirurgia)
Monllau García, Joan Carles
(Universitat Autònoma de Barcelona. Departament de Cirurgia)
Date: |
2021 |
Abstract: |
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. |
Rights: |
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Language: |
Anglès |
Document: |
Article ; recerca ; Versió publicada |
Subject: |
Closing-wedge osteotomy ;
Knee stability ;
Tibiofibular dislocation ;
Fibular osteotomy ;
High tibial osteotomy ;
Osteotomy survival rate ;
Total knee replacement ;
Knee |
Published in: |
Journal of clinical medicine, Vol. 10 (june 2021) , ISSN 2077-0383 |
DOI: 10.3390/jcm10132743
PMID: 34206331
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Record created 2022-03-06, last modified 2022-03-30