5 years ago

Changes in biomechanical risk factors for knee osteoarthritis and their association with 5-year clinically important improvement after limb realignment surgery

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 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±8.9yrs, 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 (KOOS4) 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%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-to-1.74%BW*Ht (neither largest nor smallest changes) had highest 5-year KOOS4 scores. The 6-month change in knee adduction moment (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 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.

Publisher URL: www.sciencedirect.com/science

DOI: S1063458417311706

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