1. Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors.
- Author
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Primeau CA, Birmingham TB, Leitch KM, Willits KR, Litchfield RB, Fowler PJ, Marsh JD, Chesworth BM, Dixon SN, Bryant DM, and Giffin JR
- Subjects
- Age Factors, Body Mass Index, Female, Humans, Incidence, Male, Middle Aged, Pain Measurement, Proportional Hazards Models, Prospective Studies, Severity of Illness Index, Sex Factors, Arthroplasty, Replacement, Knee statistics & numerical data, Osteoarthritis, Knee surgery, Osteotomy, Tibia surgery
- Abstract
Background: An important aim of high tibial osteotomy (HTO) is to prevent or delay the need for total knee replacement (TKR). We sought to estimate the frequency and timing of conversion from HTO to TKR and the factors associated with it., Methods: We prospectively evaluated patients with osteoarthritis (OA) of the knee who underwent medial opening wedge HTO from 2002 to 2014 and analyzed the cumulative incidence of TKR in July 2019. The presence or absence of TKR on the HTO limb was identified from the orthopedic surgery reports and knee radiographs contained in the electronic medical records for each patient at London Health Sciences Centre. We used cumulative incidence curves to evaluate the primary outcome of time to TKR. We used multivariable Cox proportional hazards analysis to assess potential preoperative predictors including radiographic disease severity, malalignment, correction size, pain, sex, age, body mass index (BMI) and year of surgery., Results: Among 556 patients who underwent 643 HTO procedures, the cumulative incidence of TKR was 5% (95% confidence interval [CI] 3%-7%) at 5 years and 21% (95% CI 17%-26%) at 10 years. With the Cox proportional hazards multivariable model, the following preoperative factors were significantly associated with an increased rate of conversion: radiographic OA severity (adjusted hazard ratio [HR] 1.96, 95% CI 1.12-3.45), pain (adjusted HR 0.85, 95% CI 0.75-0.96)], female sex (adjusted HR 1.67, 95% CI 1.08-2.58), age (adjusted HR 1.50 per 10 yr, 95% CI 1.17-1.93) and BMI (adjusted HR 1.31 per 5 kng/m
2 , 95% CI 1.12-1.53)., Interpretation: We found that 79% of knees did not undergo TKR within 10 years after undergoing medial opening wedge HTO. The strongest predictor of conversion to TKR is greater radiographic disease at the time of HTO., Competing Interests: Competing interests: Trevor Birmingham, Bert Chesworth, Dianne Bryant and J. Robert Giffin have received grants from the Canadian Institutes of Health Research and The Arthritis Society during the conduct of the study. Kevin Willits has received grants from Smith & Nephew outside of the submitted work. Robert Litchfield has received personal fees from ConMed Linvatec, Smith & Nephew, DePuy and Arthrosurface, and grants from Smith & Nephew and DePuy outside the submitted work. No other competing interests were declared., (© 2021 Joule Inc. or its licensors.)- Published
- 2021
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