Higher conversion rate to knee arthroplasty in female patients following medial open-wedge high tibial osteotomy.

Autor: Ahrend MD; Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany.; Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany., Petzold D; Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany., Schuster P; Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany.; Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany.; Department of Orthopedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany., Herbst M; Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany., Ihle C; Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany., Mayer P; Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany.; Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany., Schröter S; Department of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2024 Oct; Vol. 32 (10), pp. 2562-2572. Date of Electronic Publication: 2024 Feb 28.
DOI: 10.1002/ksa.12083
Abstrakt: Purpose: Most studies about medial open-wedge high tibial osteotomy (HTO) reported outcomes without focusing on gender differences. Therefore, the study compared the long-term survival rate and postoperative subjective knee function after HTO in female versus male patients with symptomatic medial compartment knee osteoarthritis.
Methods: The data of three cohorts with long-term outcomes were analysed (n = 245; 32% females; age: 49 ± 7 years; Kellgren Lawrence Grade I 6.1%, II 32.7%, III 42.4%; IV 18.8%). The minimum follow-up was at least 6 years or an earlier conversion to total knee arthroplasty (TKA). The gender-specific survival rate after HTO was calculated after 5 and 10 years and compared using Kaplan-Meier analysis and the logrank test. Baseline characteristics and subjective knee function (International Knee Documentation Committee [IKDC]/Lysholm) were analysed between both genders.
Results: Forty of 78 (51.3%) women and 41 of 167 men (24.5%) underwent TKA. HTO survival in females was significantly lower (p = 0.0010). The 5- and 10-year survival rates were 85.9% and 62.6% for females and 93.4% and 77.7% for males. In females and males, from preoperative to the last follow-up, the IKDC (43 ± 15 to 58 ± 17; 47 ± 14 to 67 ± 18) and the Lysholm (42 ± 18 to 72 ± 18; 55 ± 22 to 77 ± 23) improved significantly (all p < 0.0001). Females had significantly lower preoperative and postoperative IKDC (p = 0.0438; p = 0.0035) and Lysholm scores (p = 0.0002; p = 0.0323). But the absolute improvements of the IKDC and Lysholm were not significantly different between genders.
Conclusions: Females had higher conversion rates to TKA and lower knee function at the last follow-up. However, preoperative knee function was lower in females and the absolute improvement following HTO was similar for both genders. In general, females benefit from HTO to treat medial knee arthritis, and TKA could be postponed for half of female patients for more than 10 years. However, surgeons must be aware of the described inferior outcomes in females for realistic patient expectation management.
Level of Evidence: Level II.
(© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
Databáze: MEDLINE
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