Bone Mineral Density Around the Knee After Open Wedge High Tibial Osteotomy Measured Up to 24 months in 51 Patients

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2023 Aug 17

PMID 37589767

Authors

Yasushi Akamatsu

Hideo Kobayashi

Shota Mitsuhashi

Yoshihiro Kusayama

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate bone mineral density (BMD) and radiographic and clinical outcomes of patients with varus knee osteoarthritis treated with open wedge high tibial osteotomy (OWHTO). We hypothesised that medial condyle BMD would decrease and lateral condyle BMD would increase after OWHTO.

Methods: Overall, 51 patients (mean age: 65.3 years; female: 40, male: 11) treated with OWHTO were prospectively enrolled. Several angles using whole single-leg radiographs were measured preoperatively and up to 24 months postoperatively. Five square tibial regions of interest (ROI) located below the proximal tibia as T1-T5 from medial to lateral regions and two square femoral ROI as F1 and F2 from medial and lateral regions, respectively, were defined. M/L BMD ratio was used to define the medial-to-lateral condyle BMD ratio. Femoral condyle BMD (F1 and F2) around the knee, as well as lumbar spine, and ipsilateral and contralateral femoral neck BMD, were measured before OWHTO and 3, 6, 12 and 24 months after OWHTO using dual-energy X-ray absorptiometry. Furthermore, tibial condyle BMD (T1-T5) around the knee was measured before and 24 months after OWHTO. Clinical outcomes were evaluated using the Knee Society knee and function scores, the Knee Injury and Osteoarthritis Outcome Score, and the Lysholm score preoperatively and 24 months postoperatively. A power analysis was performed.

Results: F1 BMD decreased by 19.2% from before to 3 months postoperatively. F2 BMD did not change up to 24 months after OWHTO. Femoral M/L BMD ratio decreased by 22.2% 3 months after OWHTO. T1 BMD and tibial M/L BMD ratio decreased, whilst T3, T4 and T5 BMD increased 24 months after OWHTO. Mean hip-knee-ankle angle (HKA) and weight-bearing line ratio were corrected from - 6.8° to 4.5° and 14.7 to 60.7%, respectively, postoperatively. Lumbar spine BMD did not change up to 12 months postoperatively. Ipsilateral femoral neck BMD decreased up to 6 months after OWHTO.

Conclusion: Medial femoral condyle BMD decreased rapidly within 3 months and continued to decrease up to 12 months, but lateral femoral condyle BMD did not change after OWHTO. BMD measurements around the knee condyle enabled the evaluation of the changes in stress distribution before and after OWHTO with accelerated rehabilitation.

Level Of Evidence: II.

References

Akamatsu Y, Mitsugi N, Taki N, Takeuchi R, Saito T . Relationship between low bone mineral density and varus deformity in postmenopausal women with knee osteoarthritis. J Rheumatol. 2009; 36(3):592-7. DOI: 10.3899/jrheum.080699. View

Akamatsu Y, Mitsugi N, Taki N, Kobayashi H, Saito T . Medial versus lateral condyle bone mineral density ratios in a cross-sectional study: a potential marker for medial knee osteoarthritis severity. Arthritis Care Res (Hoboken). 2012; 64(7):1036-45. DOI: 10.1002/acr.21651. View

Bennell K, Creaby M, Wrigley T, Hunter D . Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology. Arthritis Rheum. 2008; 58(9):2776-85. DOI: 10.1002/art.23795. View

Clarke S, Wakeley C, Duddy J, Sharif M, Watt I, Ellingham K . Dual-energy X-ray absorptiometry applied to the assessment of tibial subchondral bone mineral density in osteoarthritis of the knee. Skeletal Radiol. 2004; 33(10):588-95. DOI: 10.1007/s00256-004-0790-x. View

Dordevic M, Hirschmann M, Rechsteiner J, Falkowski A, Testa E, Hirschmann A . Do Chondral Lesions of the Knee Correlate with Bone Tracer Uptake by Using SPECT/CT?. Radiology. 2015; 278(1):223-31. DOI: 10.1148/radiol.2015141714. View

Dore D, Quinn S, Ding C, Winzenberg T, Jones G . Correlates of subchondral BMD: a cross-sectional study. J Bone Miner Res. 2009; 24(12):2007-15. DOI: 10.1359/jbmr.090532. View

Faul F, Erdfelder E, Buchner A, Lang A . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4):1149-60. DOI: 10.3758/BRM.41.4.1149. View

Hirschmann M, Davda K, Rasch H, Arnold M, Friederich N . Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc Rev. 2011; 19(2):174-81. DOI: 10.1097/JSA.0b013e3181ec8707. View

Iwasaki K, Kondo E, Matsubara S, Matsuoka M, Endo K, Yokota I . Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis. Am J Sports Med. 2021; 49(6):1561-1569. DOI: 10.1177/03635465211002537. View

10.

Kellgren J, Lawrence J . Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502. PMC: 1006995. DOI: 10.1136/ard.16.4.494. View

11.

Koh Y, Lee J, Lee H, Chun H, Kim H, Kang K . Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J Orthop Surg Res. 2019; 14(1):219. PMC: 6636153. DOI: 10.1186/s13018-019-1269-8. View

12.

Koshino T, Ranawat N . Healing process of osteoarthritis in the knee after high tibial osteotomy. Through observation of strontium-85 scintimetry. Clin Orthop Relat Res. 1972; 82:149-56. View

13.

Kosior P, Czuraszkiewicz L, Tarczynska M, Mazurkiewicz T, Gaweda K . The evaluation of knee bone mineral density following open-wedge high tibial osteotomy. J Appl Biomech. 2011; 28(4):359-65. DOI: 10.1123/jab.28.4.359. View

14.

Lo G, Hunter D, Zhang Y, McLennan C, LaValley M, Kiel D . Bone marrow lesions in the knee are associated with increased local bone density. Arthritis Rheum. 2005; 52(9):2814-21. DOI: 10.1002/art.21290. View

15.

Lo G, Schneider E, Driban J, Price L, Hunter D, Eaton C . Periarticular bone predicts knee osteoarthritis progression: Data from the Osteoarthritis Initiative. Semin Arthritis Rheum. 2018; 48(2):155-161. PMC: 6853601. DOI: 10.1016/j.semarthrit.2018.01.008. View

16.

Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold M . Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc. 2014; 23(8):2315-2323. DOI: 10.1007/s00167-014-3053-y. View

17.

Roos E, Roos H, Lohmander L, Ekdahl C, Beynnon B . Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998; 28(2):88-96. DOI: 10.2519/jospt.1998.28.2.88. View

18.

Schelker B, Moret C, Dogan O, Amsler F, Rasch H, Hugli R . Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome. Knee Surg Sports Traumatol Arthrosc. 2021; 30(2):397-406. PMC: 8866278. DOI: 10.1007/s00167-021-06717-2. View

19.

Schon S, Afifi F, Rasch H, Amsler F, Friederich N, Arnold M . Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT. Knee Surg Sports Traumatol Arthrosc. 2013; 22(12):3039-46. DOI: 10.1007/s00167-013-2698-2. View

20.

Shiraishi K, Chiba K, Okazaki N, Yokota K, Nakazoe Y, Kidera K . In vivo analysis of subchondral trabecular bone in patients with osteoarthritis of the knee using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone. 2019; 132:115155. DOI: 10.1016/j.bone.2019.115155. View