Arthritic changes did not affect outcomes after medial open-wedge high tibial osteotomy
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Published results showed arthritic changes in the patellofemoral joint did not affect clinical outcomes or survivorship after medial open-wedge high tibial osteotomy.
“As in several previous studies when we assessed the patellofemoral joint through an arthroscopic procedure, it seems true that arthritic changes on the patellofemoral joint develops even in a relatively short postoperative period, such as 2 years, after open-wedge high tibial osteotomy,” Kang-Il Kim, MD, PhD, professor and chair in the department of orthopedic surgery at Kyung Hee University in Seoul, Korea, told Healio. “However, as a result of long-term follow-up of these patients, the degenerative changes in the patellofemoral joint as seen in arthroscopic findings rarely lead to anterior knee pain clinically.”
Kim and colleagues retrospectively evaluated serial postoperative changes in the patellofemoral joint compared with the preoperative status on the Merchant view according to the Kellgren-Lawrence grade among 170 knees that underwent medial open-wedge high tibial osteotomy and had a minimum 5-year follow-up. Researchers also used the American Knee Society score, the KOOS score, incidence of anterior knee pain and survivorship to assess clinical outcomes. To evaluate whether radiologic progression of patellofemoral arthritis affected long-term clinical outcomes and survivorship after medial open-wedge high tibial osteotomy, researchers used radiologic assessment of the patellofemoral joint to categorize patients into either a radiologic progression group or a radiologic non-progression group.
Results showed arthritic progression of the patellofemoral joint on the Merchant view occurred in 44.9% of patients at 5 years, 56.3% at 7 years, 66% at 9 years and 84% at 11 years. At the latest follow-up, researchers found significant improvements in the American Knee Society score and KOOS score after medial open-wedge high tibial osteotomy. Researchers also noted a 5.3% incidence of anterior knee pain. At a mean follow-up of 96.3 months, patients had a survival rate of 99.4%, with one knee undergoing conversion to total knee arthroplasty due to progression medial osteoarthritis, according to results. Researchers found no significant differences in clinical outcomes or survivorship between patients with and those without radiologic progression at the latest follow-up, despite patellofemoral degeneration over time.
“Overall, open-wedge high tibial osteotomy has been clinically and radiographically proven that the weight concentration on the already damaged medical compartment is distributed to the lateral side,” Kim said. “Hence, the possibility of occurrence of significant anterior knee pain related to the open-wedge high tibial osteotomy seems to have a negligible effect, even in the long-term outcomes.”
Perspective
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Wan-Keun Yoon, MD, and colleagues have produced an excellent study with long-term follow-up focusing on both patellofemoral axial X-ray findings and symptoms after medial opening-wedge tibial osteotomy. At mean follow-up of 96 months, only one patient (0.6%) needed arthroplasty surgery for progression of medial osteoarthritis and none for progression of symptoms related to patellofemoral deterioration. Although there was radiographic progression of patellofemoral OA in their patients during the 9-year follow-up, it was not associated with anterior knee pain symptoms. Although patellofemoral X-ray progression was common in their study, there were no grade 4 X-ray findings and, as they pointed out, it may not differ much from expected progression of OA in this age group. I share their conclusion that well-done medial opening-wedge tibial osteotomy does not put the patellofemoral joint at significant risk and remains an excellent treatment option for varus OA in the population studied.
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