Changes in biomechanical risk factors for knee osteoarthritis and their association with 5-year clinically important improvement after limb realignment surgery.
Osteoarthritis Cartilage
; 25(12): 1999-2006, 2017 12.
Article
em En
| MEDLINE
| ID: mdl-28888904
ABSTRACT
OBJECTIVE:
To evaluate 5-year outcomes after lower limb realignment and test the hypothesis that surgery-induced changes in selected biomechanical risk factors for medial knee osteoarthritis (OA) are associated with clinically important improvements.DESIGN:
We prospectively evaluated patient-reported outcomes, full-limb standing radiographs and gait biomechanics before, 6 months (surgery-induced change) and 5 years after medial opening wedge high tibial osteotomy (HTO) in 170 patients (46.4 ± 8.9 years, 135 males) with knee OA and varus alignment. Logistic regression tested the associations of 6-month changes in mechanical axis angle and knee adduction moment with achieving an increase of ≥10 points in the Knee injury and Osteoarthritis Outcome Score (KOOS)4 at 5 years, with and without adjusting for covariates. Gait data were also compared to existing data from healthy controls.RESULTS:
Mean 5-year changes (95% confidence interval (CI)) were KOOS4 +14.2 (10.8, 17.6); mechanical axis angle +8.21° (7.58, 8.83); knee adduction moment -1.49 %BW*Ht (-1.35, -1.63). The postoperative knee adduction moments were typically lower than values for healthy controls. When divided into quartiles, although all strata improved significantly, patients with reductions in knee adduction moment of 1.14-1.74 %BW*Ht (neither largest nor smallest changes) had highest 5-year KOOS4 scores. The 6-month change in knee adduction moment (odds ratios (OR) = 0.38; 95% CI 0.22, 0.67), preoperative KOOS4 (OR = 0.96; 95% CI 0.94, 0.99) and preoperative medial tibiofemoral narrowing grade (OR = 0.62; 95% CI 0.37, 1.00) were negatively associated with having a 5-year clinically important improvement (C-statistic = 0.70).CONCLUSIONS:
Substantial improvements in biomechanical risk factors and patient-reported outcomes are observed 5 years after medial opening wedge HTO. The surgery-induced change in load distribution during walking is significantly associated with long-term clinically important improvement.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Osteotomia
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Tíbia
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Mau Alinhamento Ósseo
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Osteoartrite do Joelho
/
Genu Varum
/
Marcha
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Patient_preference
Limite:
Adult
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Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Osteoarthritis Cartilage
Ano de publicação:
2017
Tipo de documento:
Article