Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10-16 years.
OBJECTIVE
High tibial valgus osteotomy (HTO) is a well-accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment in relatively young and active patients. Controversies about the factors affecting survival of HTO still exist. We assessed preoperative risk factors for failure of closing-wedge HTO at long-term follow-up.


METHODS
A cohort of 100 patients with a mean age of 49 (24-67) years, who had closing-wedge HTO performed between January 1991 and December 1996, were analyzed retrospectively. A survival analysis was carried out according to the Kaplan-Meier method. Logistic regression analysis was used to assess the association between failure of the osteotomy and known potential preoperative risk factors.


RESULTS
The probability of survival for HTO was 75% (SD 4%) at 10 years with knee replacement as the endpoint. Female sex and osteoarthritis of grade > or = 2 were identified as preoperative risk factors for conversion to arthroplasty 10 years after HTO.


CONCLUSIONS
Our findings suggest that ideal candidates for corrective osteotomy are men with symptomatic medial compartmental osteoarthritis of Ahlback grade 1, who, 10 years after surgery, have an almost tenfold lower probability of failure of HTO than women with more advanced osteoarthritis.
van Raaij
Tom
T
Department of Orthopedics, Erasmus University Medical Centre, Rotterdam, the Netherlands. t.vanraaij@erasmusmc.nl
Reijman
Max
M
Brouwer
Reinoud W
RW
Jakma
Tijs S
TS
Verhaar
Jan N
JN
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013977:Tibia / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome