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Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis.

ABSTRACT: This meta-analysis was designed to compare the longevity of the survivorship of opening versus closing wedge high tibial osteotomy (HTO). All studies reporting survival rates in patients who underwent open or closed wedge HTO with more than 5-year follow-up duration were included in the meta-analysis. Survival time was considered as time to conversion to TKA. Twenty three studies were included in meta-analysis, 20 of which were of level IV evidence. The pooled 5-year survival rates were 95.1% (95% CI: 93.1 to 97.1%) in open wedge HTO and 93.9% (95% CI: 93.1 to 94.6%) in closed wedge HTO. Although there was 1.2% greater survival rate in open wedge HTO than in closed wedge HTO, this difference did not reach statistical significance (P?=?0.419). Pooled 10-year survival rates were 91.6% (95% CI: 88.5 to 94.8%) in open wedge HTO and 85.4% (95% CI: 84.0 to 86.7%) in closed wedge HTO, indicating that open wedge HTO had 6.2% greater survival rate 10 years after surgery than did closed wedge HTO (P?=?0.002). No difference in 5-year survivorship was found between open- and closed-wedge HTO. However, the survival rate was higher in open-wedge HTOs than in closed wedge HTO at 10 years.

SUBMITTER: Kim JH

PROVIDER: S-EPMC5544741 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis.

Kim Jun-Ho JH Kim Hyun-Jung HJ Lee Dae-Hee DH

Scientific reports 20170804 1

This meta-analysis was designed to compare the longevity of the survivorship of opening versus closing wedge high tibial osteotomy (HTO). All studies reporting survival rates in patients who underwent open or closed wedge HTO with more than 5-year follow-up duration were included in the meta-analysis. Survival time was considered as time to conversion to TKA. Twenty three studies were included in meta-analysis, 20 of which were of level IV evidence. The pooled 5-year survival rates were 95.1% (9 ...[more]

PMID: 28779084

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Project description:Purpose:To evaluate the short-term clinical outcomes, complications, hospitalization time, and readmission rate related to day-case opening wedge high tibial osteotomy (OWHTO) with intraosseous PEEK (polyether ether ketone) implant, in the treatment of knee osteoarthritis. Methods:An observational study on patients treated with OWHTO using intraosseous PEEK implant was performed with a period of 12 months follow-up. Grade of Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed preoperatively, at 6 months, and at 12 months postoperatively. A simple t test was used to analyze the outcomes. P values <.05 were considered significant. Complications and revision surgeries were registered. Results:In the period from 2016 to 2017, a consecutive group of 40 patients (13 female, 27 male) with symptomatic medial knee osteoarthritis and varus malalignment were included in the study. The average age of the patients was 54.9 (± 7.6) years. In total, 30 (77%) patients met the criterion for minimal clinically important difference in KOOS scores. The KOOS symptoms improved from 58.1 ± 20 to 78.5 ± 16.5 (P < .0001), pain from 48.1 ± 18.2 to 78.6 ± 18.5 (P < .0001), activities of daily living from 59.0 ± 19.5 to 84.1 ± 15.2 (P < .0001), sport from 23.2 ± 17.6 to 55.6 ± 26.3 (P < .0001), and quality of life from 28.4 ± 12.8 to 61.5 ± 22.5 (P < .0001) at 1-year follow-up. The average hospitalization time at the Day Surgery Unit was 5.6 ± 0.7 hours, and 4 (10%) patients had to be readmitted to the hospital within 2 weeks postoperatively. The overall complication rate was 18%. Complications that required revision surgery were registered in 4 patients (10%), including 2 non-unions and 2 progressions of osteoarthritis. Conclusions:The day-case OWHTO with intraosseous PEEK implant was a success in 77% of the cases. The results and complications were comparable with other published studies. Despite a short hospitalization time, the readmission rate was low. Level of Evidence:IV, therapeutic case series.

Project description:Study Design Systematic review. Study Rationale To seek out and assess the best quality evidence available comparing opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with ankylosing spondylitis to determine whether their results differ with regard to several different subjective and objective outcome measures. Objective The aim of this study is to determine whether there is a difference in subjective and objective outcomes when comparing CWO and OWO in patients with ankylosing spondylitis suffering from clinically significant thoracolumbar kyphosis with respect to quality-of-life assessments, complication risks, and the amount of correction of the spine achieved at follow-up. Methods A systematic review was undertaken of articles published up to July 2012. Electronic databases and reference lists of key articles were searched to identify studies comparing effectiveness and safety outcomes between adult patients with ankylosing spondylitis who received closing wedge versus opening wedge osteotomies. Studies that included pediatric patients, polysegmental osteotomies, or revision procedures were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results From a total of 67 possible citations, 4 retrospective cohorts (class of evidence III) met our inclusion criteria and form the basis for this report. No differences in Oswestry Disability Index, visual analog scale for pain, Scoliosis Research Society (SRS)-24 score, SRS-22 score, and patient satisfaction were reported between the closing and opening wedge groups across two studies. Regarding radiological outcomes following closing versus opening osteotomies, mean change in sagittal vertical axis ranged from 8.9 to 10.8 cm and 8.0 to 10.9 cm, respectively, across three studies; mean change in lumbar lordosis ranged from 36 to 47 degrees and 19 to 41 degrees across four studies; and mean change in global kyphosis ranged from 38 to 40 degrees and 28 to 35 degrees across two studies. Across all studies, overall complication risks ranged from 0 to 16.7% following CWO and from 0 to 23.6% following OWO. Conclusion No statistically significant differences were seen in patient-reported or radiographic outcomes between CWO and OWO in any study. The risks of dural tear, neurological injury, and reoperation were similar between groups. Blood loss was greater in the closing wedge compared with the opening wedge group, while the risk of paralytic ileus was less. The overall strength of evidence for the conclusions is low.

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Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis.

Publications

Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis.

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