Long-Term Survival of High Tibial Osteotomy for Medial Compartment Osteoarthritis of the Knee
Long-Term Survival of High Tibial Osteotomy for Medial Compartment Osteoarthritis of the Knee
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DOI：
10.1177/0363546510377445
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发表时间：
2011-01-01
影响因子：
4.8
通讯作者：
Pinczewski, Leo A.
中科院分区：
文献类型：
--
作者：
Hui, Catherine;Salmon, Lucy J.;Pinczewski, Leo A.
背景：年轻活跃患者膝关节退行性关节炎的治疗对骨科医生提出了挑战。手术治疗选择包括胫骨高位截骨术（HTO）、单间室膝关节置换术和全膝关节置换术。目的：在大量患者中检查闭合楔形HTO手术后长达19年的长期生存率。研究设计：病例系列;证据等级，4.方法：1990年至2001年间，455例连续患者接受外侧闭合楔形HTO治疗内侧间室骨关节炎。在2008年至2009年期间，通过电话联系患者，评估包括进一步手术的发生率、当前体重指数（BMI）、牛津膝关节评分和英国骨科协会患者满意度量表。失败定义为需要翻修HTO或转为单髁膝关节置换术或全膝关节置换术。生存分析使用Kaplan-Meier方法完成。结果：胫骨高位截骨术生存率为413例（91%）。在最终审查时剩余的397例存活患者中，通过电话访谈联系了394例（99%）进行随访。HTO的5年、10年和15年生存率分别为95%、79%和56%。多变量回归分析显示，年龄小于50岁（P = 0.001）、BMI小于25（P = 0.006）和ACL缺陷（P = 0.03）与更好的生存率相关。平均牛津膝关节评分为40/48（范围：17-48）。总体而言，85%的患者是热情或满意，84%将再次接受HTO在平均12年的follow-up.Conclusion：胫骨高位截骨术可以有效的时间超过15年，但是，随着时间的推移，结果恶化。年龄小于50岁、BMI正常和ACL缺陷是与HTO长期生存率改善相关的独立因素。
Background: The management of degenerative arthritis of the knee in the younger, active patient presents a challenge to the orthopaedic surgeon. Surgical treatment options include high tibial osteotomy (HTO), unicompartmental knee arthroplasty, and total knee arthroplasty.Purpose: To examine the long-term survival of closing wedge HTO in a large series of patients up to 19 years after surgery.Study Design: Case series; Level of evidence, 4.Methods: Four hundred fifty-five consecutive patients underwent lateral closing wedge HTO for medial compartment osteoarthritis between 1990 and 2001. Between 2008 and 2009, patients were contacted via telephone, and assessment included incidence of further surgery, current body mass index (BMI), Oxford Knee Score, and British Orthopaedic Association Patient Satisfaction Scale. Failure was defined as the need for revision HTO or conversion to unicompartmental knee arthroplasty or total knee arthroplasty. Survival analysis was completed using the Kaplan-Meier method.Results: High tibial osteotomy survival was determined in 413 patients (91%). Of the 397 remaining living patients at the time of final review, 394 (99%) were contacted for follow-up via telephone interview. The probability of survival for HTO at 5, 10, and 15 years was 95%, 79%, and 56%, respectively. Multivariate regression analysis showed that age under 50 years (P = .001), BMI less than 25 (P = .006), and ACL deficiency (P = .03) were associated with better odds of survival. Mean Oxford Knee Score was 40 of 48 (range, 17-48). Overall, 85% of patients were enthusiastic or satisfied, and 84% would undergo HTO again at a mean 12 years of follow-up.Conclusion: High tibial osteotomy can be effective for periods longer than 15 years; however, results do deteriorate over time. Age less than 50 years, normal BMI, and ACL deficiency were independent factors associated with improved long-term survival of HTO.