Management of medial femorotibial osteoarthritis: Epidemiology, and survival of unicompartmental knee arthroplasty versus valgus high tibial osteotomy in France. Study of 108,007 cases from the French National Hospitals Database

Effect of preoperative medial meniscus status on the outcomes of high tibial osteotomy with human umbilical cord-derived mesenchymal stem cells cartilage regeneration

BACKGROUND

The effect of medial meniscus (MM) status on outcomes following high tibial osteotomy (HTO) combined with cartilage regeneration using human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) remains unclear.

PURPOSE

This study aimed to evaluate the effect of preoperative MM status on the outcomes of HTO combined with cartilage regeneration using hUCB-MSCs. Specifically, clinical and radiological outcomes were compared between two groups of patients, which were divided according to their preoperative MM status. We hypothesized that patients with preserved meniscal integrity or those who underwent meniscal root repair would show better clinical and radiological outcomes compared to those with significant meniscal loss or untreated root tears.

METHODS

A retrospective analysis was performed on 47 patients who underwent HTO with hUCB-MSC implantation. Patients were divided into group P (preserved MM integrity or medial meniscal root repair) and group L (loss of MM integrity, defined as a peripheral rim width <3 mm, unable to maintain hoop function). Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores after a minimum follow-up of 2 years. Cartilage regeneration was evaluated with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score and International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) score from second-look arthroscopy. Correlation analyses were conducted to examine the relationship between preoperative MM extrusion and cartilage repair.

RESULTS

Both groups demonstrated significant improvements in IKDC and WOMAC scores (p < 0.01). No significant differences were observed between groups in IKDC and WOMAC scores at final follow-up (p = 0.21, p = 0.42, respectively). MOCART 2.0 and ICRS CRA scores showed no significant differences between groups (p = 0.35, p = 0.08, respectively). Group P showed higher proportions of favorable outcomes compared to group L, including no major subchondral changes or only minor marrow edema (56% vs. 31.8%) and ICRS CRA grades I or II (84% vs. 72.7%). While these findings suggest potential differences in outcomes, neither comparison reached statistical significance (p = 0.09 and p = 0.48, respectively). Preoperative MM extrusion negatively correlated with MOCART 2.0 and subchondral bone changes (r = -0.24, p = 0.03; r = -0.29, p = 0.02, respectively).

CONCLUSION

HTO with hUCB-MSC implantation provided significant clinical improvements and effective cartilage regeneration regardless of preoperative MM status. However, preoperative MM extrusion may influence subchondral bone changes, emphasizing the need to consider MM status for long-term outcomes.

LEVEL OF EVIDENCE

III; retrospective comparative study.

Chiba osteotomy (Tibial condylar valgus osteotomy) for a large tibial varus deformity: Technical note

Chiba osteotomy is an effective technique for advanced knee osteoarthritis (KOA). The principle of the osteotomy is to correct both varus deformity and intra-articular joint congruity through an L-shaped osteotomy from the medial tibial condyle to the lateral intercondylar eminence. Previous studies have demonstrated that Chiba osteotomy is an effective method for alignment correction surgery for severe knee osteoarthritis. However, these reports slightly differ from the original concept of Chiba osteotomy. This report describes the pre-operative planning and surgical technique of Chiba osteotomy for patients with large tibial varus deformity, focusing on the management of early knee osteoarthritis following conditions such as post-traumatic Blount disease and "Pagoda" like proximal tibia varus deformities, as originally described. LEVEL OF EVIDENCE: IV.

Spacer-type tibial osteotomy versus open wedge high tibial osteotomy and unicompartmental knee arthroplasty for Kellgren-Lawrence grade 3-4 medial unicompartmental knee osteoarthritis in patients younger than 65 years

BACKGROUND

Spacer-type tibial osteotomy have been proven a novel and effective osteotomy to treat osteoarthritis, while lack of comparison with other surgical methods in younger patients. This study aims to evaluate the short-term clinical outcomes of spacer-type tibial osteotomy versus open wedge high tibial osteotomy (OWHTO) and unicompartmental knee arthroplasty (UKA) for Kellgren-Lawrence (K-L) grade 3-4 osteoarthritis (OA) in patients younger than 65 years.

METHODS

This retrospective study analyzed a total of 224 patients with K-L grade 3-4 knee OA treated from March 2018 to November 2020. Three groups were created according to the operation type. The clinical outcomes recorded preoperatively and at 6, 12 and 24 months postoperatively were the range of motion (ROM), visual analogue scale (VAS), American Knee Society Score (KSS), Western Ontario and McMaster Universities Global (WOMAC) score, operation time, length of incision, relevant complications and failures. Radiographic parameters were measured to evaluate the correction of varus deformity.

RESULTS

The cohort comprised 224 patients; 70 underwent spacer-type tibial osteotomy, 73 underwent OWHTO, and 81 underwent UKA. The spacer group had the shortest incision (P = 0.000), least amount of bleeding (P = 0.000), and shortest operation time (P = 0.000). UKA achieved the most significant pain relief based on VAS (P = 0.014), KSS pain score (0.030), and WOMAC score (P = 0.000) at 6 months postoperatively, but there were no differences between three groups at 12 and 24 months postoperatively. The spacer and OWHTO groups achieved significantly greater ROM changes compared with the UKA group (all P = 0.000). The complication rate did not significantly differ between the three groups. No surgical failures were identified in HTO but two spacer dislocations in spacer group and three polyethylene dislocations in UKA.

CONCLUSION

For younger patients with K-L grade 3-4 OA, OWHTO seems to be the most appropriate method through clinical comparisons. Although spacer-type tibial osteotomy offers shorter operation time and comparable clinical outcomes, it also has extended recovery phase, additional fibular incision and the risk of spacer dislocation, which did not appear to be superior to OWHTO and UKA under the indications outlined in this study.

TRIAL REGISTRATION

Retrospectively registered, QYFY WZLL 27,021.

Is there a relationship between recurrence and obesity in the three-year mid-term follow-up of patients who underwent high tibial osteotomy due to medial gonarthrosis?

OBJECTIVES

This study aimed to radiologically evaluate the possible relationship between the body mass index (BMI) and recurrence of varus deformity during the mid-term follow-up of patients treated for medial gonarthrosis.

PATIENTS AND METHODS

Fifty-six patients (11 males, 45 females; mean age: 53.8±7.2 years; range, 29 to 64 years) who underwent medial opening wedge osteotomy for the treatment of isolated medial varus gonarthrosis between January 1, 2020, and June 1, 2021, were retrospectively reviewed. Patients were categorized according to BMI values as having a healthy weight (18.5-24.9 kg/m2), being overweight (25.0-29.9 kg/m2), or being obese (≥30 kg/m2). Mechanical medial proximal tibial angle, hip-knee-ankle angle, joint line convergence angle, and knee adduction moment calculations were performed based on radiographs.

RESULTS

Among the 56 patients, the mean age of those with healthy weight was 42.5±13.2 years, that of the overweight group was 53.3±6.4 years, and that of the obese group was 54.0±5.8 years. Radiological evaluations were statistically improved postoperatively compared to preoperative scores across BMI groups (p<0.05). There were no correlations between age and radiological scores or BMI (p>0.05). Similarly, no correlation was found between BMI and radiological scores (p>0.05).

CONCLUSION

Body mass index is not of significance in medial opening wedge osteotomy radiological scores in short- and mid-term follow-up.

Is severe medial knee osteoarthritis a risk factor for dissatisfaction following medial open-wedge high tibial osteotomy in patients 55 years of age or younger?

INTRODUCTION

Although previous studies have shown that severe medial knee osteoarthritis (OA) (Kellgren-Lawrence grade IV) is a risk factor for patient dissatisfaction following medial open-wedge high tibial osteotomy (MOWHTO), it is uncommon to perform arthroplasty as a primary surgical option in patients 55 years of age or younger. Thus, the purpose of our study was to evaluate whether severe medial knee OA is a risk factor for dissatisfaction following MOWHTO depending on patient age based on a cutoff of 55 years.

MATERIAL AND METHODS

We retrospectively reviewed the data of 270 consecutive patients who underwent MOWHTO with a minimum of 2 years of follow up. Patients were divided into 2 groups based on satisfaction following surgery, a Satisfied group (new Knee Society Score satisfaction subscore >20) and a Dissatisfied group (≤20). In order to assess risk factors for patient dissatisfaction depending on the age range, a subgroup analysis was conducted based on a cutoff age of 55 years. Preoperative demographics, OA grade, articular cartilage and meniscus status, severity of varus deformity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and surgical factors were compared.

RESULTS

At 2 years after surgery, binomial logistic regression analysis showed that severe medial knee OA was associated with patient dissatisfaction following HTO in the entire cohort (odds ratio [OR] 4.557, 95% confidence interval [CI] 2.300-9.030, p < 0.001). In subgroup analysis depending on age range, severe medial OA was not a risk factor for dissatisfaction in the age ≤55 years group. However, severe medial knee OA in the age >55 years group was a significant risk factor for dissatisfaction after MOWHTO (OR 6.78, 95% CI 2.979-15.431, p < 0.001).

CONCLUSION

Severe medial OA was not a risk factor for dissatisfaction in patients age 55 years or younger who underwent MOWHTO. Therefore, surgeons can take this result into account when counseling younger patients considering MOWHTO.

LEVEL OF EVIDENCE

III.

Unicompartmental knee arthroplasty implant survival in patients with borderline indications

INTRODUCTION

In the literature, 80%-92% of patients are satisfied with their medial femorotibial unicompartmental knee arthroplasties (UKAs). These results are associated with a 10-year implant survival rates ranging from 94% to 98% in various studies. Such outcomes are generally reported after excluding patients with obesity, chronic anterior instability, frontal deformities, or preoperative knee flexion deformities exceeding 10 °. These contraindications remain controversial in the literature. The primary objective of this study was to compare the survival rates of implants used for medial femorotibial UKA performed under borderline indications with those of procedures performed under conventional indications and to identify the prognostic factors for revision surgery.

HYPOTHESIS

We hypothesized that the survival of medial femorotibial UKAs is not impacted by these contraindications.

MATERIALS AND METHODS

This was a retrospective, single-center, observational, epidemiological study. All consenting patients who underwent medial femorotibial UKA between 2009 and 2015 were included. Patients who underwent other types of arthroplasties concurrently were excluded. The primary evaluation criterion was implant survival, which was characterized by no need for revision surgery. The borderline indications were defined as follows: obesity (Body Mass index BMI > 30), anterior cruciate ligament (ACL) deficiency, preoperative lower limb frontal deviation ≥10 °, or preoperative flexion deformity ≥10 °.

RESULTS

A total of 468 patients were included, and the average follow-up duration was 8.5 years [7.1; 10.3]. Among them, 270 (57.7%) underwent UKA under at least one borderline indication, whereas 198 (42.3%) underwent UKA under conventional indications. Forty revision surgeries were recorded, and the average time to revision surgery was 26 months. No statistically significant difference in survival was observed between patients with borderline indications and those with conventional indications. Multivariate analysis revealed that obesity (HR = 3.0 [1.5-5.7]) and ACL deficiency (HR = 3.5 [1.4-8.8]) significantly increased the risk of revision surgery.

DISCUSSION

This study revealed no significant difference in survival between UKAs performed under borderline versus conventional indications. Larger studies are needed to confirm these findings.

LEVEL OF EVIDENCE

IV; retrospective observational study. Mots clés: genou, arthroplastie, obésité, ostéoarthrite, survie.

Ultrasound-guided thermal radiofrequency ablation of the genicular nerves after total knee replacement

The rate of refractory chronic pain after total knee replacement (TKR) is 20-25%, with no identifiable etiology in 6% of cases. Without an etiologic diagnosis, the surgeon is unlikely to consider revision, but pain poses a therapeutic challenge for achieving satisfaction and an acceptable quality of life. Genicular nerve radiofrequency ablation (GNRFA) was recently developed as a non-drug analgesic option. It is minimally invasive and safe, with few adverse effects, opening a new perspective for management of refractory chronic pain after TKR. LEVEL OF EVIDENCE: IV.

Unicompartmental Knee Arthroplasty Versus Opening-Wedge High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee: A Retrospective Cohort Study

Background

Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are treatment options for patients with medial spontaneous osteonecrosis of the knee (SONK).

Purpose

To compare the clinical outcomes after UKA and HTO in patients with SONK.

Study Design

Cohort study; Level of evidence, 3.

Methods

This retrospective study included 42 patients who had undergone Oxford UKA and 40 patients who had undergone opening-wedge HTO between 2014 and 2020. All patients were diagnosed with isolated medial SONK without subchondral collapse of the femoral condyle and tibial plateau. The patients were preoperatively and postoperatively evaluated using the Lysholm knee scoring system, the Western Ontario and McMaster Universities Osteoarthritis Index, and a numeric rating scale assessing patient satisfaction.

Results

Patients in the UKA group were significantly older than those in the HTO group (median age, 71.5 years [IQR, 68.0-76.5 years] vs 65.0 years [IQR, 60.0-70.0 years], respectively; P < .001). The median follow-up time was 3.78 years (IQR, 2.45-4.53 years) for the UKA group and 3.87 years (IQR, 2.90-5.60 years) for the HTO group. Significant improvements in functional scores were observed in both the UKA and HTO groups (P < .001 for all), with no significant between-group differences in scores at the final follow-up (≥2 years after surgery). The satisfaction rate was similar (80.95% for UKA and 75.0% for HTO).

Conclusion

According to the study results, significant improvements in clinical outcomes were seen after opening-wedge HTO with microfracture for a younger group of patients with SONK without subchondral collapse, while Oxford UKA had a comparable effect on an older group of patients. Both UKA and HTO were found to be viable surgical approaches for SONK at short- to midterm follow-up.

Femoral trochlear groove cartilage damage after open-wedge high tibial osteotomy is associated with the change in patellar height relative to the femoral condyle

BACKGROUND

Medial open-wedge high tibial osteotomy (OWHTO) is performed for isolated medial compartment osteoarthritis or osteonecrosis of the knee and correction of varus deformity of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO.

HYPOTHESIS

The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes.

PATIENTS AND METHODS

Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices.

RESULTS

Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with>1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53×10-14-0.812, p=0.047). PF cartilage damage tended to progress in ΔMBI<-0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (p=0.037 and 0.038, respectively).

DISCUSSION

The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible.

LEVEL OF EVIDENCE

IV, retrospective study.

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

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.

High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review

INTRODUCTION

The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA.

METHODS

A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score.

RESULTS

A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up.

CONCLUSION

HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population.

LEVEL OF EVIDENCE

IV; systematic review of level III-IV studies.

Surgical strategy and complication management of osteotomy around the painful degenerative varus knee: ESSKA Formal Consensus Part II

PURPOSE

The purpose of the European consensus was to provide recommendations for the treatment of patients with a painful degenerative varus knee using a joint preservation approach. Part II focused on surgery, rehabilitation and complications after tibial or femoral correction osteotomy.

METHODS

Ninety-four orthopaedic surgeons from 24 countries across Europe were involved in the consensus, which focused on osteotomies around the knee. The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology. The steering group designed the questions and prepared the statements based on the experience of the experts and the evidence of the literature. The statements were evaluated by the ratings of the peer-review groups before a final consensus was released.

RESULTS

The ideal hinge position for medial opening wedge high tibial osteotomy (MOW HTO) should be at the upper level of the proximal tibiofibular joint, and for lateral closing wedge distal femoral osteotomy (LCW DFO) just above the medial femoral condyle. Hinge protection is not mandatory. Biplanar osteotomy cuts provide more stability and quicker bony union for both MOW HTO and LCW DFO and are especially recommended for the latter. Osteotomy gap filling is not mandatory, unless structural augmentation for stability is required. Patient-specific instrumentation should be reserved for complex cases by experienced hands. Early full weight-bearing can be adopted after osteotomy, regardless of the technique. However, extra caution should be exercised in DFO patients. Osteotomy patients should return to sports within 6 months.

CONCLUSION

Clear recommendations for surgical strategy, rehabilitation and complications of knee osteotomies for the painful degenerative varus knee were demonstrated. In Part 2 of the consensus, high levels of agreement were reached by experts throughout Europe, under variable working conditions. Where science is limited, the collated expertise of the collaborators aimed at providing guidance for orthopaedic surgeons developing an interest in the field and highlighting areas for potential future research.

LEVEL OF EVIDENCE

Level II, consensus.

Comparison of survival between cemented vs cementless unicompartimental knee arthroplasty: a case control study with propensity score matching

INTRODUCTION

The first results of cementless prosthesis were rather disappointing. However recent progress in methods of cementless fixation of prosthesis should lead to better results in terms of survival of these prostheses. The main objective is to compare the survival rate at last follow-up of UKA with cemented tibial or cementless.

HYPOTHESIS

We hypothesize that UKAs with uncemented tibial implants have better survival compared to UKAs with cemented tibial implants.

MATERIAL AND METHODS

This single center case-control study included 94 medial UKA with a cemented tibial component that were paired by propensity score matching to 94 medial UKA with a uncemented tibial component. The main evaluation criterion was the comparison of the survivorship of the UKA between a cemented tibial implant and those with a cementless tibial implant in terms of all-cause revision surgery at last follow-up. The secondary endpoints were the analysis of the causes of failure.

RESULTS

The mean final follow-up was 6.1years (2.3). The overall survival rate in our serie of medial UKA was 92.4% [88.7%-96.3%] at five years. The overall survival rate in cemented group was and 91.5% [86.0%-97.3%] at five years and at 93.2% [88.1%-98.7%] at five years, in the uncemented group. No differences significant were observed in the two groups (p.value = 0.6). Only the tibial preoperative deformity was a risk factor of failure (HR: 1.11 [1.02,1.20], value = 0.02).

DISCUSSION

The use of a cemented or a cementless tibial component in a medial UKA did not influence the survival rate.

LEVEL OF EVIDENCE

III; case control study.

Postoperative improvement in patient-reported outcomes after neutral alignment medial open wedge high tibial osteotomy for medial compartment knee osteoarthritis in patients aged ≥70 years versus younger patients

Purpose

To compare the postoperative clinical and radiological outcomes in patients aged ≥70 years following neutral alignment medial opening-wedge high tibial osteotomy (NA-MOWHTO) for medial compartment knee osteoarthritis (KOA) to those observed in younger patients.

Methods

The data of patients who underwent NA-MOWHTO for medial compartment KOA between September 2018 and June 2022 were retrospectively analysed. The patients were categorised into groups Y (<70 years) and O (≥70 years). Age, sex, Kellgren-Lawrence classification, pre- and postoperative mechanical axis, weight-bearing line ratio, medial proximal tibial angle, preoperative Tegner Activity Score and pre- and postoperative Lysholm scores were compared between the groups.

Results

Overall, 81 patients (60 and 21 in groups Y and O, respectively) who underwent NA-MOWHTO were included in this study. No significant differences were found in patient characteristics between the two groups, except for the preoperative Tegner Activity Score, which was significantly higher in group Y than in group O (3 [2-4] vs. 2 [2-2], respectively; p = 0.011). The two groups exhibited no significant differences in pre- and postoperative knee alignments. Postoperatively, Lysholm scores improved significantly in both groups without significant differences. Additionally, no correlation was found between age and pre- and postoperative Lysholm scores.

Conclusions

The postoperative improvement following NA-MOWHTO for medial compartment KOA is comparable in patients aged ≥70 and younger.

Level of Evidence

Level III, Retrospective comparative study.

Osteotomy around the painful degenerative varus knee has broader indications than conventionally described but must follow a strict planning process: ESSKA Formal Consensus Part I

PURPOSE

The European consensus was designed with the objective of combining science and expertise to produce recommendations that would educate and provide guidance in the treatment of the painful degenerative varus knee. Part I focused on indications and planning.

METHODS

Ninety-four orthopaedic surgeons from 24 European countries were involved in the consensus, which focused on the most common indications for osteotomy around the knee. The consensus was performed according to an established ESSKA methodology. The questions and recommendations made were initially designed by the consensus steering group. And 'best possible' answers were provided based upon the scientific evidence available and the experience of the experts. The statements produced were further evaluated by ratings and peer review groups before a final consensus was reached.

RESULTS

There is no reliable evidence to exclude patients based on age, gender or body weight. An individualised approach is advised; however, cessation of smoking is recommended. The same applies to lesser degrees of patellofemoral and lateral compartment arthritis, which may be accepted in certain situations. Good-quality limb alignment and knee radiographs are a mandatory requirement for planning of osteotomies, and Paley's angles and normal ranges are recommended when undertaking deformity analysis. Emphasis is placed upon the correct level at which correction of varus malalignment is performed, which may involve double-level osteotomy. This includes recognition of the importance of individual bone morphology and the maintenance of a physiologically appropriate joint line orientation.

CONCLUSION

The indications of knee osteotomies for painful degenerative varus knees are broad. Part I of the consensus highlights the versatility of the procedure to address multiple scenarios with bespoke planning for each case. Deformity analysis is mandatory for defining the bone morphology, the site of the deformity and planning the correct procedure.

LEVEL OF EVIDENCE

Level II, consensus.