RESUMEN
BACKGROUND: This prospective cohort study was designed to evaluate the survivorship and functional outcomes associated with long-term results of medial open-wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in the Chinese population. Although MOWHTO is a well-established procedure in the management of medial osteoarthritis of the knee, the long-term outcome in the Chinese population has not been reported in current literature. We hypothesised that MOWHTO would result in long-term preservation of knee function in Chinese, similar to that reported in the Caucasian population. METHODS: A cohort of 22 young adult patients (age < 55 years old) undergoing MOWHTO for the treatment of symptomatic medial compartment knee osteoarthritis between 2002 and 2008 was retrospectively surveyed with a minimum follow-up of 10 years. Kaplan-Meier survival analysis was performed, and the failure modes were investigated. The outcomes on survival (not requiring arthroplasty), clinical outcome (Knee Society Knee Score and Knee Society Function Score) and range of motion (numeric rating scale) at preoperative, 1-year postoperative follow-up and at last follow-up (>10 years) were evaluated. In addition, the mechanical tibiofemoral angle was also measured. The Wilcoxon signed-rank test was used for statistical evaluation of nonparametric data in these related samples. RESULT: A total of 31 knees in these 22 cases were included. The follow-up rate was 100% at 13.4 ± 1.9 years (11-17). Mean age at time of surgery was 45.8 ± 9.5 years (18-53). At 10-year follow-up, four knees converted to require total knee arthroplasty (survival: 87.1%). Preoperative varus alignment with mechanical tibiofemoral angle of -9.26 ± 2.83 was corrected to 2.58 ± 2.46 after surgery and remained 2.01 ± 3.52 at the latest follow-up. Knee Society Knee Score increased significantly from 53.7 ± 11.1 preoperatively to 93.8 ± 6.8 at 1-year follow-up and 91.8 ± 9.7 at latest follow-up. Similarly, the functional score also increased significantly from 67.4 ± 21.0 preoperatively to 86.3 ± 14.5 at 1-year follow-up and 82.1 ± 16.6 at latest follow-up (p < 0.01). Whereas, the range of motion significantly decreased from 122.7 ± 6.6 preoperatively to 116.1 ± 15.5 at the latest follow-up. CONCLUSION: Even in cases of severe medial osteoarthritis and varus malalignment, MOWHTO would be a good treatment option for management in active Chinese population less than 55 years. Although the long-term survival and functional outcome after MOWHTO was proven to be satisfactory in our cohort during the 10-year follow-up, a larger cohort to illustrate the long-term functional outcome is still warranted. TRANSLATIONAL POTENTIAL: The finding in this study indicated MOWHTO is a feasible treatment option for young adult patients with osteoarthritis to achieve long-term satisfactory results.
RESUMEN
OBJECTIVES: To introduce the practice of a nurse-led orthopaedic clinic for managing stable patients after total hip or knee replacement and to evaluate its efficacy. DESIGN: Case series. SETTING: A public hospital in Hong Kong. PATIENTS: Patients who had stable primary total knee replacement or total hip replacement done for longer than 2 years were managed in a nurse-led total joint replacement pilot clinic. RESULTS: From July 2012 to March 2014, 431 patients (including 317 with total knee replacement and 114 with total hip replacement) were handled, and 408 (94.7%) nurse assessments were independently performed. Six cases of prosthesis-related complications were diagnosed. One patient was hospitalised for prosthetic complications within 3 months after follow-up. The satisfaction rate was 100%. From November 2012 to April 2013, an advanced practice nurse, one resident specialist, and one associate consultant independently charted Knee Society Knee Score or Harris Hip Score for the patients attending preoperative assessment clinic to check the inter-observer reliability. Overall, 23 patients with 37 knees and 11 patients with 17 hips were examined. The mean correlation coefficient between assessments by the associate consultant and advanced practice nurse was 0.912 for Knee Society Knee Score, and 0.761 for Harris Hip Score. The advanced practice nurse could achieve better or equally good correlation with associate consultant when compared with the correlation between resident specialist and associate consultant (0.866 and 0.521 for Knee Society Knee Score and Harris Hip Score, respectively) and with international standard. CONCLUSION: Nurse-led total joint replacement clinic was safe, reliable, and well accepted by patients.
