OUTCOME FOLLOWING MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY IN PATIENTS OVER THE AGE OF 55 YEARS.

Abstract

Purpose: To clinically and radiologically evaluate medium term outcome of a patient cohort age 55 years or older at the time of medial opening wedge high tibial osteotomy (MOWHTO).

Methods: Between January 1997 and January 2003, 60 patients (52 males) underwent 66 MOWHTOs. Following a systematic chart review 56 returned for follow up. Outcomes measures were KOOS, LEFS, SF-12, Cincinnati, Tegner scores, a new activity score and physical examination. Routine knee and long leg standing radiographs were compared to pre and early postoperative radiographs.

Results: Thirteen patients were not assessed further, 6 (7 MOWHTOs) had undergone total knee arthroplasty (TKA), 3 had passed away and 4 were lost to follow up. Thus the probability of survival (not converting MOWHTO to TKA) was 0.966 at 3 years, 0.927 at 4 years and 0.878 at 5 years. Quality of life, functional status and general health of the remaining 47 patients (52 HTOs) with a mean age of 62 years (55–75) at the time of surgery were assessed. At a mean follow up of 62 months (26–98), on the author’s activity score, 83% performed at least one high impact activity at moderate to high intensity an average of 4–7 times weekly and 6% did not participate in any sport. Average participation in activities/sports was 3 per person at a participation level of 4.6 (Tegner). The mean Cincinnati score was 75% (SD=23, 14–95%). Mean scores for the KOOS and LEFS were 66% (SD=22,7–99%) and 49 (SD=18, 5–80) respectively. The mean physical component score of the SF-12 was 42 (SD=11, 21.7–60.4) and the mean mental component score, 54 (SD=11, 26–68). Seventy–two percent were fully weight bearing by 3 months. There were 6 revisions performed for a combination of delayed and non-unions.

Conclusions: MOWHTO remains a viable alternative for patients over the age of 55 with knee osteoarthritis and varus malalignment who would otherwise be candidates for arthroplasty and particularly for those wishing to maintain or regain a high level of activity.