Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy

Abstract

Purpose This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO).

Methods From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL).

Results No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (− 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01).

Conclusion SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.

Zusammenfassung

Einleitung Diese Studie verglich die funktionellen und radiologischen Ergebnisse und Komplikationen der einzeitigen (SS) und zweizeitigen (TS) bilateralen hohen Tibiaosteotomie (HTO).

Methoden Von 2014 bis 2018 unterzog sich 48 Patienten einer bilateralen HTO-Operation wegen Arthrose. Die Ergebnisse von SS bei 28 Knien und TS bei 32 Knien wurden mit dem Knee Injury and Osteoarthritis Outcome Score (KOOS) und Oxford Knee Score (OKS) als funktionellen Ergebnissen und dem medialen proximalen Tibia (MPTA), Hüft-Knie-Knöchel verglichen (HKA), Tibiaslope-Winkel (TSA) und mechanische Achsenabweichung (MAD) als radiologische Ergebnisse. Wir haben auch den geschätzten Blutverlust (EBL) ausgewertet.

Ergebnisse Zwischen den Gruppen wurden keine signifikanten Unterschiede im prä- und postoperativen Mittelwert OKS und KOOS gefunden. Im letzten postoperativen HKA-Winkel zeigte sich ein signifikanter Unterschied zwischen den Gruppen (− 0,9 ± 3,9 bzw. 1,8 ± 4,3°). Bei SS und TS betrug die jeweilige durchschnittliche Gesamtchirurgiezeit 108 ± 28 bzw. 143 ± 36 min (p < 0,001). Das durchschnittliche berechnete EBL betrug 612 ± 267 bzw. 544 ± 357 ml (p = 0,5) und die mittlere Verweildauer (LOS) betrug 2,2 ± 0,83 bzw. 3,5 ± 1,0 Tage (p = 0,01).

Schlussfolgerungen SS bilaterale HTO ist eine sichere und vernünftige Option für bestimmte Patienten mit bilateraler Kniearthrose, da sie einen einmaligen Krankenhausaufenthalt, eine einmalige Exposition gegenüber Anästhesierisiken, eine beschleunigte Rehabilitation, eine frühere Rückkehr zum erwarteten Lebensstatus, eine reduzierte Gesamtverweildauer im Krankenhaus und eine wahrscheinliche Verringerung der Gesamtkosten.

Key words

knee osteoarthritis - high tibial osteotomy - bilateral - single-stage - two-stage

Schlüsselwörter

Knie-Arthrose - hohe tibiale Osteotomie - bilateral - einstufig - zweistufig

Publication History

Article published online:
15 November 2021

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