Background:Although high tibial osteotomy (HTO) has emerged as a powerful intervention for treating symptomatic medial osteoarthritis and varus malalignment, it can result in an increase in knee joint line obliquity (KJLO) in the frontal plane. Limited current evidence hinders understanding of the effect of increased KJLO on HTO survivorship.Purpose:To investigate the influence of KJLO and other potential risk factors on the survivorship of lateral closing-wedge HTO.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with symptomatic medial knee osteoarthritis and varus malalignment treated with lateral closing-wedge HTO at a single hospital were screened with a minimum follow-up of 5 years. HTO survival rate was assessed using Kaplan-Meier survival analysis. The influence of postoperative increased KJLO (medial proximal tibial angle ≥95°), age (≥55 years), sex (female), preoperative malalignment (hip-knee-ankle angle ≥10° of varus), postoperative untargeted alignment (hip-knee-ankle angle <2° or >6° of valgus), and preoperative osteoarthritis severity (Kellgren-Lawrence grade ≥3) on survivorship of HTO was evaluated using Cox regression analysis. A failure of HTO was defined as a conversion to total knee arthroplasty (TKA).Results:A total of 410 patients (463 knees) were included, with a mean follow-up of 13.0 years (range, 5.0-18.1 years) and a mean survival time of 11.2 years (range, 1.2-18.1 years) for patients who reached the endpoint of TKA. HTO survival rates at 5, 10, and 15 years postoperatively were 91%, 78%, and 60%, respectively. Multivariate Cox regression analysis showed no significant difference in survivorship between patients with increased KJLO and those with acceptable KJLO (178 vs 285 knees; hazard ratio [HR], 0.8; 95% CI, 0.6-1.1; P = .148), with no significant between-group difference observed in the mean follow-up length (12.9 ± 3.0 years vs 13.1 ± 3.3 years; P = .105). Female sex (HR, 2.0; P < .001) and postoperative untargeted alignment (HR, 1.6; P = .003) were risk factors for a conversion to TKA.Conclusion:Increased postoperative KJLO (medial proximal tibial angle ≥95°) had no significant influence on the survivorship of lateral closing-wedge HTO. Men demonstrated superior survival outcomes compared with women, and it was important to achieve a targeted postoperative alignment (HKA 2°-6° of valgus) to ensure favorable HTO survivorship.

中文翻译：

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胫骨外侧闭合楔形高位截骨术后关节线倾斜度增加对生存率的影响


背景：尽管胫骨高位截骨术（HTO）已成为治疗有症状的内侧骨关节炎和内翻畸形的有力干预措施，但它可能导致额状面膝关节线倾斜度（KJLO）增加。目前有限的证据阻碍了对增加 KJLO 对 HTO 存活率影响的理解。目的：调查 KJLO 和其他潜在危险因素对侧向闭合楔形 HTO 存活率的影响。证据级别，3。方法：对在同一家医院接受外侧闭合楔形 HTO 治疗的有症状的内侧膝骨关节炎和内翻畸形患者进行筛选，随访时间至少为 5 年。使用 Kaplan-Meier 生存分析评估 HTO 生存率。术后KJLO增加（胫骨近端内侧角≥95°）、年龄（≥55岁）、性别（女）、术前对线不正（髋膝踝内翻角≥10°）、术后非目标对线（髋-膝-踝角度≥10°）的影响使用 Cox 回归分析评估 HTO 存活率的膝踝角 <2° 或 >6° 外翻）和术前骨关节炎严重程度（Kellgren-Lawrence 等级≥3）。 HTO 失败定义为转为全膝关节置换术 (TKA)。 结果：共纳入 410 名患者（463 个膝关节），平均随访时间为 13.0 年（范围为 5.0-18.1 年），达到 TKA 终点的患者平均生存时间为 11.2 年（范围：1.2-18.1 年）。术后5年、10年和15年的HTO存活率分别为91%、78%和60%。多变量 Cox 回归分析显示，KJLO 增加的患者和 KJLO 可接受的患者之间的生存率没有显着差异（178 膝 vs 285 膝；风险比 [HR]，0.8；95% CI，0.6-1。1; P = .148），平均随访时间没有观察到显着的组间差异（12.9 ± 3.0 年 vs 13.1 ± 3.3 年；P = .105）。女性（HR，2.0；P < .001）和术后非目标对准（HR，1.6；P = .003）是转为 TKA 的危险因素。结论：术后 KJLO 增加（胫骨近端内侧角≥95°）对侧向闭合楔形 HTO 的存活率没有显着影响。与女性相比，男性表现出更好的生存结果，并且实现有针对性的术后对齐（HKA 2°-6°外翻）以确保良好的 HTO 生存非常重要。