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Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine the classification scheme for osteoarthritis severity grading that most closely correlates with postoperative clinical outcomes and to identify the positive and negative prognostic factors for medial open-wedge high-tibial osteotomy (OWHTO).

Methods

Seventy-nine consecutive patients with primary varus osteoarthritis were treated using OWHTO. Arthritic grading was determined by arthroscopic assessment according to the modified Outerbridge classification and by radiographic classification according to the Kellgren–Lawrence (KL) grading scale on standing anteroposterior (AP) and 45° posteroanterior (PA) flexion weight-bearing radiography. Clinical outcome was assessed using the Oxford Knee Score (OKS), which was evaluated both preoperatively and at the postoperative 2-year follow-up after OWHTO. Multivariate regression analyses were used to explore and quantify the influence of baseline patient demographics, variables related to arthroscopic and radiological grades of arthritis, as well as postoperative alignment changes on the OKS.

Results

At the 2-year follow-up, the mean OKS had improved from 20 ± 4 to 39 ± 5 points (p < 0.001). The average mechanical femorotibial and mechanical medial proximal tibial angle (MPTA) changed from 6.9° ± 3.4° to valgus 2.7° ± 2.8° and from 85.6° ± 2.4° to 92.9° ± 3.7° (all p < 0.001). The osteoarthritis severity grade based on the KL scale was 2.4 ± 0.9 on standing AP radiography, 2.8 ± 0.9 on 45° PA flexion weight-bearing radiography (p = 0.003), and 3.4 ± 0.7 according to the modified Outerbridge classification. In the multivariate analyses, the KL grade on 45° PA flexion weight-bearing radiography (p = 0.01) and postoperative MPTA (p = 0.01) showed significant negative correlations with postoperative OKS at the 2-year follow-up.

Conclusion

The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest significant negative correlation with postoperative OKS after the OWHTO procedure using three different common OA classification schemes, which should be considered to determine the surgical indication of HTO. The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest correlation with high-tibial osteotomy-surgical indications and the counselling of patients with advanced osteoarthritis.

Level of evidence

IV.

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Funding

None of the authors received financial support for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, South Korea

    Kyung Wook Nha, Seung Min Oh & Yoon Won Ha

  2. Department of Orthopaedic Surgery, St. Stephens Hospital, New Delhi, India

    Manoj Kumar Patel

  3. Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical School, 134-701, Gil-dong, Seoul, South Korea

    Ji Hyun Seo & Byung Hoon Lee

Authors
  1. Kyung Wook Nha
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  2. Seung Min Oh
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  4. Manoj Kumar Patel
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Contributions

Dr. KWN and BHL participated in the study design and helped to draft the manuscript. SMO and YWH as a consultant for statistical analysis performed the statistical analysis. MKP conceived the study, and participated in its design and coordination and helped to draft the manuscript. JHS participated in the interpretation of data for the work. All authors participated in (1) substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; (2) drafting the work or revising it critically for important intellectual content; (3) final approval of the version to be published; (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Byung Hoon Lee.

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All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or the national research committee and in adherence with the Declaration of Helsinki adopted in 1964 and its later amendments or comparable ethical standards.

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The authors have no conflict of interest to declare.

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Nha, K.W., Oh, S.M., Ha, Y.W. et al. Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27, 2021–2029 (2019). https://doi.org/10.1007/s00167-018-5121-1

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  • DOI: https://doi.org/10.1007/s00167-018-5121-1

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