Background:High tibial osteotomy (HTO) modifies the mechanics of the affected knee but can also affect the nonoperated knee. However, no research has reported on the prognosis and risk factors related to the nonoperated knee after unilateral HTO.Purpose:To assess the radiological parameters associated with osteoarthritis (OA) progression and the need for surgery in the nonoperated knee after unilateral HTO, with concurrent assessment of the operated knee.Study Design:Case series; Level of evidence, 4.Methods:The medical charts of 197 patients with knee OA who underwent unilateral HTO between March 2007 and December 2020 were retrospectively investigated. Radiological parameters such as the Kellgren-Lawrence grade, weightbearing line ratio, joint line convergence angle (JLCA), and joint line obliquity angle were assessed preoperatively and 1 year postoperatively.Results:The mean follow-up length for the 197 patients was 5.9 ± 3.2 years for the operated knee and 5.5 ± 3.2 years for the nonoperated knee. A smaller postoperative JLCA in the operated knee was a significant risk factor for OA progression ( P = .027) and undergoing surgery ( P = .006) in the nonoperated knee. Conversely, a larger postoperative JLCA in the operated knee was a significant risk factor for OA progression ( P = .014) and conversion to arthroplasty ( P = .027) in the operated knee. A postoperative JLCA >1.5° ( P < .001) and <3.9° ( P < .001) was needed to reduce the risk of undergoing surgery in the nonoperated knee and OA progression in the operated knee, respectively. Additionally, a pre- to postoperative change in the JLCA (ΔJLCA) between −5.6° and −1.7° ( P = .021 and P = .004, respectively) was needed to reduce the risk of OA progression in both knees.Conclusion:A large medial joint opening (a small postoperative JLCA) in the operated knee after unilateral HTO was associated with a higher risk of OA progression and surgery in the nonoperated knee. Conversely, a small medial joint opening (a large postoperative JLCA) was associated with a higher risk of OA progression and conversion to arthroplasty in the operated knee. For a balanced medial joint opening, if the postoperative JLCA was between 1.5° and 3.9° or the ΔJLCA was between −5.6° and −1.7°, a favorable prognosis in both knees could be anticipated.

中文翻译：

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单侧胫骨高位截骨术后手术膝关节内侧关节开口：手术和非手术膝关节发生骨关节炎的风险和未来手术


背景： 胫骨高位截骨术 （HTO） 改变了受影响膝关节的力学，但也会影响未手术的膝关节。然而，尚无研究报道单侧 HTO 后非手术膝关节的预后和危险因素。目的： 评估与骨关节炎 （OA） 进展相关的放射学参数和单侧 TTO 后非手术膝关节手术的必要性，同时评估手术膝关节。研究设计： 病例系列;证据水平， 4.方法： 回顾性分析 2007年3月至 2020年12月接受单侧 HTO 的 197 例膝关节 OA 患者的病历。术前和术后 1 年评估 Kellgren-Lawrence 分级、负重线比值、关节线会聚角 （JLCA） 和关节线倾斜角等放射学参数。结果： 197 例患者手术膝关节的平均随访时间为 5.9 ± 3.2 年，非手术膝关节为 5.5 ± 3.2 年。手术膝关节术后较小的 JLCA 是非手术膝关节 OA 进展 （P = .027） 和接受手术 （P = .006） 的重要危险因素。相反，手术膝关节术后 JLCA 较大是手术膝关节 OA 进展 （ P = .014） 和转为关节置换术 （P = .027） 的重要危险因素。术后需要 JLCA >1.5° （ P < .001） 和 <3.9° （ P < .001） 以分别降低非手术膝关节接受手术的风险和手术膝关节 OA 进展的风险。此外，需要在 -5.6° 和 -1.7° 之间 JLCA （ΔJLCA） 的术前到术后变化 （分别为 P = .021 和 P = .004） 以降低双膝关节 OA 进展的风险。结论： 单侧 HTO 术后膝关节内侧关节开口较大 （术后小 JLCA） 与非手术膝关节 OA 进展和手术风险较高相关。相反，小的内侧关节开口 （大的术后 JLCA） 与 OA 进展和手术膝关节转为关节置换术的风险较高相关。对于平衡的内侧关节开口，如果术后 JLCA 在 1.5° 和 3.9° 之间或 ΔJLCA 在 -5.6° 和 -1.7° 之间，则可以预期双膝预后良好。