Medial Opening Wedge High Tibial Osteotomy: A Prospective Cohort Study of Gait, Radiographic, and Patient-Reported Outcomes
Medial Opening Wedge High Tibial Osteotomy: A Prospective Cohort Study of Gait, Radiographic, and Patient-Reported Outcomes
复制标题
DOI：
10.1002/art.24466
复制
发表时间：
2009-05-15
期刊：
影响因子：
--
通讯作者：
Fowler, Peter J.
中科院分区：
文献类型：
--
作者：
Birmingham, Trevor B.;Giffin, J. Robert;Fowler, Peter J.
目标。评价胫骨内侧开口楔形高位截骨术的选择对内翻排列和膝关节内侧室骨关节炎患者术后2年步态、放射学和患者报告结果的影响，并找出有意义的预后预测因素。我们采用观察性队列研究设计，前瞻性地实施三维定量步态分析、髋关节到踝关节的负重X线片，以及患者报告的手术前和术后6、12、18和24个月的结果。计算观察到的变化的95%可信区间(95%CLS)。采用多元线性回归和聚类分析方法评价患者特征与膝关节动态负荷(步态中膝关节外收瞬间)和膝关节损伤及骨性关节炎预后评分(KoOS)之间的关系。共有126名患者(平均年龄47.48岁)被纳入研究。平均变化提示在排列不良(机械轴角的变化8.04度[95%可信区间7.16度，8.93度])、步态中的内收室负荷(膝关节内收力矩的变化-1.38[95%可信区间-1.53，-1.22]体重x身高百分比)和所有Koos领域评分(疼痛的变化23.19[95%可信区间19.49，26.89)Koos分的变化)方面有临床上重要的改善。术后6~24个月，膝关节内收力矩略有增加(13%)。在基线评估的术前临床和/或步态特征很少与2年的结果显著相关。内侧开口楔形胫骨高位截骨术矫正为近中性排列，术后2年，膝关节动态负荷和患者报告的疼痛、功能和生活质量指标发生了实质性和临床上重要的变化。术后头两年观察到的膝关节内收力矩的变化应作为长期成功和预后较差的患者亚组的潜在预测指标。
Objective. To evaluate the elect of medial opening wedge high tibial osteotomy on gait, radiographic, and patient-reported outcomes over a 2-year postoperative period in patients with varus alignment and medial compartment knee osteoarthritis, and to identify significant predictors of outcome.Methods. We used an observational cohort study design and prospectively administered 3-dimensional quantitative gait analysis, hip to ankle weight-bearing radiographs, and patient-reported outcomes preoperatively and 6, 12, 18, and 24 months postoperatively. Observed changes with 95% confidence intervals (95% Cls) were calculated. Multivariate linear regression and cluster analysis were used to evaluate associations between patient characteristics and 2-year outcomes in dynamic knee joint load (external knee adduction moment during gait) and Knee Injury and Osteoarthritis Outcome Scores (KOOS).Results. A total of 126 patients (mean age 47.48 years) were included in the study. Mean changes suggested clinically important improvements in malalignment (change in mechanical axis angle 8.04 degrees [95% CI 7.16 degrees, 8.93 degrees]), medial compartment load during gait (change in knee adduction moment -1.38 [95% CI -1.53, -1.22] percentage body weight x height), and all KOOS domain scores (change in pain 23.19 [95% CI 19.49, 26.89) KOOS points). A small (13%) increase in knee adduction moment was observed from 6 to 24 months postoperatively. Few preoperative clinical and/or gait characteristics assessed at baseline were significantly associated with 2-year outcomes.Conclusion. A medial opening wedge high tibial osteotomy with correction to approximately neutral alignment produces substantial and clinically important changes in dynamic knee joint load and patient-reported measures of pain, function, and quality of life 2 years postoperatively. Changes in knee adduction moment observed in the first 2 years postoperatively should be explored as potential predictors of longer-term success and subgroups of patients with poor outcomes.