Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Haojie ¹ , WANG Bin ¹ , CHEN Xu ¹ ,  YU Jinwei ¹ , GUO Jiarui ¹ , LI Derong ¹ , LI Wenjing ¹ ,  HUANG Xiaoqiang ²

1. Department of Orthopedics, Jiaozuo Second People’s Hospital, Jiaozuo Henan, 454100, P. R. China;
2. Department of Orthopedics, Xi’an Fifth People’s Hospital, Xi’an Shaanxi, 710082, P. R. China;

Corresponding?author：

YU Jinwei, Email: zxy2838@126.com; HUANG Xiaoqiang, Email: huangxq73@163.com

Keywords：

High tibial osteotomy; varus knee arthritis; body mass index; short-term effectiveness

DOI：

10.7507/1002-1892.202302021

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Objective To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. Methods The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m²), overweight group (27 patients in group B, BMI>30 kg/m²), and obese group (25 patients in group C, BMI>30 kg/m²). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m², respectively. There was no significant difference (P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. Results All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups (P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) (P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation (P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation (P>0.05). Conclusion BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.

Citation： CHEN Haojie, WANG Bin, CHEN Xu, YU Jinwei, GUO Jiarui, LI Derong, LI Wenjing, HUANG Xiaoqiang. Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 670-674. doi: 10.7507/1002-1892.202302021 Copy

1.	Bichsel D, Liechti FD, Schlapbach JM, et al. Cross-sectional analysis of recommendations for the treatment of hip and knee oeoarthritis in clinical guidelines. Arch Phys Med Rehabil, 2022, 103(3): 559-569.
2.	Belsey J, Yasen SK, Jobson S, et al. Return to physical activity after high tibial osteotomy or unicompartmental knee arthroplasty: A systematic review and pooling data analysis. Am J Sports Med, 2021, 49(5): 1372-1380.
3.	Loia MC, Vanni S, Rosso F, et al. High tibial osteotomy in varus knees: indications and limits. Joints, 2016, 4(2): 98-110.
4.	王承祥, 趙振文, 柳海平, 等. 膝關節骨性關節炎并膝內翻行脛骨高位截骨術臨床療效與人體質量指數關系的研究. 中國骨傷, 2004, 17(12): 711-713.
5.	Kim MS, Koh IJ, Sohn S, et al. Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. Int Orthop, 2019, 43(11): 2493-2501.
6.	Sabzevari S, Ebrahimpour A, Roudi MK, et al. High tibial osteotomy: A systematic review and current concept. Arch Bone Jt Surg, 2016, 4(3): 204-212.
7.	許康永, 童也, 趙鵬, 等. 兩種截骨術式治療膝關節內側間室骨關節炎的療效比較. 中國修復重建外科雜志, 2021, 35(11): 1440-1448.
8.	Jin C, Song EK, Santoso A, et al. Survival and risk factor analysis of medial open wedge high tibial osteotomy for unicompartment knee osteoarthritis. Arthroscopy, 2020, 36(2): 535-543.
9.	Tuhanioğlu Ü, Oğur HU, Seyfettinoğlu F, et al. High tibial osteotomy in obese patients: Is successful surgery enough for a good outcome? J Clin Orthop Trauma, 2019, 10(Suppl 1): S168-S173.
10.	Can A, Erdoğan F, Erdoğan AO, et al. What determines the success of closed-wedge high tibial osteotomy: Severity of malalignment, obesity, follow-up period, or age? Sisli Etfal Hastan Tip Bul, 2018, 52(1): 6-12.
11.	Bouguennec N, Mergenthaler G, Gicquel T, et al. Medium-term survival and clinical and radiological results in high tibial osteo-tomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthop Traumatol Surg Res, 2020, 106(8S): S223-S230.
12.	Cotic M, Vogt S, Hinterwimmer S, et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc, 2015, 23(7): 2032-2040.
13.	Herbst M, Ahrend MD, Grünwald L, et al. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results. Knee Surg Sports Traumatol Arthrosc, 2022, 30(3): 907-917.

1. Bichsel D, Liechti FD, Schlapbach JM, et al. Cross-sectional analysis of recommendations for the treatment of hip and knee oeoarthritis in clinical guidelines. Arch Phys Med Rehabil, 2022, 103(3): 559-569.
2. Belsey J, Yasen SK, Jobson S, et al. Return to physical activity after high tibial osteotomy or unicompartmental knee arthroplasty: A systematic review and pooling data analysis. Am J Sports Med, 2021, 49(5): 1372-1380.
3. Loia MC, Vanni S, Rosso F, et al. High tibial osteotomy in varus knees: indications and limits. Joints, 2016, 4(2): 98-110.
4. 王承祥, 趙振文, 柳海平, 等. 膝關節骨性關節炎并膝內翻行脛骨高位截骨術臨床療效與人體質量指數關系的研究. 中國骨傷, 2004, 17(12): 711-713.
5. Kim MS, Koh IJ, Sohn S, et al. Unicompartmental knee arthroplasty is superior to high tibial osteotomy in post-operative recovery and participation in recreational and sports activities. Int Orthop, 2019, 43(11): 2493-2501.
6. Sabzevari S, Ebrahimpour A, Roudi MK, et al. High tibial osteotomy: A systematic review and current concept. Arch Bone Jt Surg, 2016, 4(3): 204-212.
7. 許康永, 童也, 趙鵬, 等. 兩種截骨術式治療膝關節內側間室骨關節炎的療效比較. 中國修復重建外科雜志, 2021, 35(11): 1440-1448.
8. Jin C, Song EK, Santoso A, et al. Survival and risk factor analysis of medial open wedge high tibial osteotomy for unicompartment knee osteoarthritis. Arthroscopy, 2020, 36(2): 535-543.
9. Tuhanioğlu Ü, Oğur HU, Seyfettinoğlu F, et al. High tibial osteotomy in obese patients: Is successful surgery enough for a good outcome? J Clin Orthop Trauma, 2019, 10(Suppl 1): S168-S173.
10. Can A, Erdoğan F, Erdoğan AO, et al. What determines the success of closed-wedge high tibial osteotomy: Severity of malalignment, obesity, follow-up period, or age? Sisli Etfal Hastan Tip Bul, 2018, 52(1): 6-12.
11. Bouguennec N, Mergenthaler G, Gicquel T, et al. Medium-term survival and clinical and radiological results in high tibial osteo-tomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthop Traumatol Surg Res, 2020, 106(8S): S223-S230.
12. Cotic M, Vogt S, Hinterwimmer S, et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc, 2015, 23(7): 2032-2040.
13. Herbst M, Ahrend MD, Grünwald L, et al. Overweight patients benefit from high tibial osteotomy to the same extent as patients with normal weights but show inferior mid-term results. Knee Surg Sports Traumatol Arthrosc, 2022, 30(3): 907-917.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis

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