Kiminari Kataoka1, Shu Watanabe1, Kanto Nagai2, Jeffrey Kay3, Takehiko Matsushita1, Ryosuke Kuroda1, Darren de Sa3. 1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. 2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. Electronic address: nagaik@kobe-u.ac.jp. 3. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, ON, Canada.
Abstract
PURPOSE: To investigate the progression of patellofemoral (PF) osteoarthritis (OA) after medial open wedge high tibial osteotomy (OWHTO), and whether PF OA progression has an influence on clinical outcomes. METHODS: According to Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA), EMBASE, PubMed and Cochrane Library were searched in June 2020 for English-language studies that presented data on PF OA or cartilage degeneration before and after OWHTO. Descriptive statistics are presented. RESULTS: Twenty studies comprising 1,173 patients were included. The mean age was 57.1 years (range, 18-84) with 826 (70.4%) female. The mean follow-up was 27.1 months (range, 7-144). Ten studies reported the trochlear International Cartilage Research Society (ICRS) scores, with each of these studies reporting a higher proportion of patients with grades 2-4 OA post-operatively compared to pre-operatively (relative risks=1.19 to 2.76, I2=1.9%). Similarly, seven studies reported patellar ICRS scores and found a higher proportion with grades 2-4 OA post-operatively (relative risks=1.08 to 2.44, I2=0%). Four studies assessed PF Kellgren-Lawrence (K-L) grade each of which reported a higher proportion of patients with grades 2-4 OA post-operatively (relative risks=1.25 to 21.0, I2=31%). The PF OA assessments were heterogenous, and studies using classifications except ICRS score or K-L grade were not included in statistical analysis. Fifteen studies assessed patellar height; ten studies reported significant decrease in patellar height after OWHTO. Only three studies reported clinical outcomes for patients with and without PF OA progression. Outcome reporting was variable across these studies, and relationship between PF OA progression and clinical outcome could not be definitively determined. CONCLUSION: Patients appear to have progression of PF OA after medial OWHTO. However, there are currently insufficient studies with inconsistent measurements of outcomes to make meaningful conclusions for the impact of PF OA on clinical outcomes.
PURPOSE: To investigate the progression of patellofemoral (PF) osteoarthritis (OA) after medial open wedge high tibial osteotomy (OWHTO), and whether PF OA progression has an influence on clinical outcomes. METHODS: According to Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA), EMBASE, PubMed and Cochrane Library were searched in June 2020 for English-language studies that presented data on PF OA or cartilage degeneration before and after OWHTO. Descriptive statistics are presented. RESULTS: Twenty studies comprising 1,173 patients were included. The mean age was 57.1 years (range, 18-84) with 826 (70.4%) female. The mean follow-up was 27.1 months (range, 7-144). Ten studies reported the trochlear International Cartilage Research Society (ICRS) scores, with each of these studies reporting a higher proportion of patients with grades 2-4 OA post-operatively compared to pre-operatively (relative risks=1.19 to 2.76, I2=1.9%). Similarly, seven studies reported patellar ICRS scores and found a higher proportion with grades 2-4 OA post-operatively (relative risks=1.08 to 2.44, I2=0%). Four studies assessed PF Kellgren-Lawrence (K-L) grade each of which reported a higher proportion of patients with grades 2-4 OA post-operatively (relative risks=1.25 to 21.0, I2=31%). The PF OA assessments were heterogenous, and studies using classifications except ICRS score or K-L grade were not included in statistical analysis. Fifteen studies assessed patellar height; ten studies reported significant decrease in patellar height after OWHTO. Only three studies reported clinical outcomes for patients with and without PF OA progression. Outcome reporting was variable across these studies, and relationship between PF OA progression and clinical outcome could not be definitively determined. CONCLUSION:Patients appear to have progression of PF OA after medial OWHTO. However, there are currently insufficient studies with inconsistent measurements of outcomes to make meaningful conclusions for the impact of PF OA on clinical outcomes.