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Opening Wedge High Tibial Osteotomy - The Effects of Body Mass Index on Early Clinical Results.


Michael J. Risebury, MBBS(Hons), MA(Hons), FRCS(Tr&Orth)
UNITED KINGDOM

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Opening Wedge High Tibial Osteotomy - The Effects of Body Mass Index on Early Clinical Results.

George Cox, BMedSci, BMBS, UNITED KINGDOM Matthew Brown, BMBS, UNITED KINGDOM Anthony Gould, BMBS, UNITED KINGDOM Nigel Rossiter, FRCS, UNITED KINGDOM Michael J. Risebury, MBBS(Hons), MA(Hons), FRCS(Tr&Orth), UNITED KINGDOM Neil P. Thomas, FRCS, UNITED KINGDOM Adrian J. Wilson, MBBS BSc FRCS, UNITED KINGDOM

Basingstoke & North Hants Hospital, Basingstoke, Hampshire, UNITED KINGDOM

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Anatomic Location

Knee

Diagnosis / Condition

Osteoarthritis

Treatment / Technique

Osteotomy

Summary: Obese patients (BMI >30) have worse Oxford and KOOS scores prior to opening wedge high tibial osteotomy, than their normal weight (BMI 20-25) and overweight (BMI 25-30) peers but similar results at 12 months post-surgery.

Introduction

High body-mass-index (BMI) is increasingly prevalent and it is reported to have a negative predictive effect in patients undergoing opening-wedge-high-tibial-osteotomy (OWHTO). This study evaluates the effect of BMI on early clinical results (12 months) of patients having this procedure.

Methods

A consecutive series of 121 patients undergoing OWHTO were included and divided into three groups according to their BMI. Twenty three patients were normal weight (BMI 20-25, 11 females, mean age 39); 52 overweight (BMI 25-30, 8 females, mean age 42) and 46 obese (BMI >30, 13 females, mean age 44). Osteotomies were planned following long-leg alignment films, using digital software and plate fixation performed. Oxford knee and KOOS scores were performed pre-operatively and at 12 months post-operatively in a dedicated physiotherapy clinic. Statistical analysis (one-way ANOVA, with Tukey’s post-test and paired t-test) was performed using GraphPad Prism (California, USA).

Results

Pre-operative KOOS scores were significantly worse in obese patients (mean 39.9, SD 18.2, p<0.05) when compared with those of normal-weight (mean 58.8 SD 20.6), or overweight (mean 50.3, SD 18.3). Obese patients also had significantly worse pre-operative Oxford scores (mean 22.4, SD 8.5, p<0.05) when compared with normal-weight patients (mean 31.3, SD 10.6), although no difference was seen with the overweight group (mean 26.5, SD 9.5). All groups showed improvement in KOOS and Oxford scores post-operatively with normal-weight patients improving to a mean of 73.5 (SD 15.2, p <0.02) and 38.1 (SD 8.4, p<0.08); overweight patients improving to a mean of 71.1 (SD 15.4, p<0.0002) and 36.8 (SD 8.7, p<0.0004); and obese patients improving to a mean of 71.0 (SD 17.8, p<0.0001) and 37.5 (SD 7.6, p<0.0001) respectively. No significant differences were seen between the different groups when comparing post-operative KOOS or Oxford scores. Overall, there were two DVTs (one normal-weight, one overweight); two delayed unions (one overweight, one obese); and two infections (obese group, one deep).

Conclusion

Only 19% of patients were of normal weight. Pre-operatively, obese patients had worse KOOS and Oxford scores when compared to overweight and normal-weight peers. Patients had improved at 12 months following surgery, irrespective of their weight. These early results support the use of OWHTO in patients with high BMI but further study is required at more distant time-points to ensure this observation is maintained.