High tibial osteotomy: Long term survival analysis and patients' perspective
Introduction
High tibial osteotomy has been used for treatment of medial compartment osteoarthritis of the knee for a long time with success. However, it has also been shown that the results deteriorate with time. Most studies demonstrate a satisfactory result in approximately 80% of patients at 5 years and 60% at 10 years after a valgus high tibial osteotomy [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. A more recent study demonstrated a survival rate of 39% at 15 years and 30% at 20 years [12].
Because of this and the constantly growing long term survival rate of total knee arthroplasty, enthusiasm for this procedure has declined over the past decade. However, with the current growing interest in autologous chondrocyte implantation technology, it is expected that the role of high tibial osteotomy will increase again, as correction of axial alignment will influence the outcome and survival of the biological resurfacement. [13], [14].
Nowadays high tibial osteotomy is mainly reserved for patients less than 60 years old. Proponents of this procedure claim that it offers this younger group of patients an opportunity to have a higher level of function or to lead a more active lifestyle for a variable period of time than they would have if a total knee arthroplasty was carried out. It is not uncommon to have a discrepancy between the patients' and surgeons' perception on the success of the surgery. The surgeon may be happy with the procedure but the patient may be dissatisfied. Various factors may influence the patients' level of satisfaction. These include physical, psychological and socioeconomic factors. Patient satisfaction is the main priority in this procedure as the main aim is to improve the quality of life. This study aims to look at this procedure from the perspective of the patient and to examine whether patients who undergo high tibial osteotomy truly achieve a desirable level of active lifestyle.
Section snippets
Materials and methods
From 1982 to 2003, 67 high tibial osteotomies were carried out on 62 patients (five females and 57 males), five patients had bilateral knee surgery. There were 41 right knees and 26 left knees. The average age of the patients was 49 years (range 22 to 74). The mean follow up time was 6.5 years (range 1 to 21 years). All patients had osteoarthritis limited to the medial compartment of the knee.
The senior author performed all the surgeries. Desired correction was calculated preoperatively on a
Results
Using the Kaplan–Meier survival analysis [16], the probability of survival for high tibial osteotomy was 89.5% at five years, 74.7 at 10 years and 66.9 % at 15 and 20 years. Six patients had a total knee replacement at an average of 9.5 years (range 2 to 21 years). Six patients had no improvement in pain level after surgery.
The average time to union was 2.9 months (range 2 to 9 months). There were five cases of delayed union (7.5%) in which the delay was arbitrarily defined as absence of
Discussion
The advantage of using a survival analysis is that it allows inclusion of patients with different duration of follow up, therefore increasing the strength of the study by having a bigger sample size. Coventry et al [1] reported a survival of 87% at five years and 66% at 10 years using total knee arthroplasty as the end point. Naudie et al [12] reported 73% survival at 5 years, 51% at 10 years, 39% at 15 years and 30% at 20 years using an end point of the need for conversion to total knee
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