Overweight patients benefit from high tibial osteotomy but s
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The purpose of this prospective study was to analyze the impact of obesity on the clinical and radiological outcomes 6 years after open-wedge high tibial osteotomy (HTO).

A total of 120 prospectively recorded patients with medial compartment osteoarthritis underwent open-wedge HTO. The study cohort was frequently examined over a minimum of a 6-year follow-up. The cohort was divided into three groups according to body mass index (BMI):
1) Normal weight patients (BMI less than 25 kg/m2),
2) Pre-obese patients (BMI 25–30 kg/m2) and
3) Obese patients (BMI more than 30 kg/m2).

Clinical and functional outcomes (Oxford Knee Score, Hospital for Special Surgery Score, Lequesne Score, Tegner Activity Scale), subjective health-related quality of life (SF-36), change in mechanical limb alignment (mTFA) as well as conversion to unicompartmental or total knee arthroplasty (TKA) were evaluated. Changes in outcome variables over time were analyzed with dependent t tests.

Results:
--From 120 patients, 85 were followed-up over a 6.7-year period on average (6–11.8 years) after HTO. The mean BMI was 28.6±4.6 kg/m2.

--Each group showed a significant pre- to postoperative increase in all recorded scores.

--In absolute terms, both mental and clinical scores of overweight patients did not reach the peak values of the normal weighted population during the period of observation.

--There was a conversion to TKA in 10.5% after an average of 50.1±25.0 months following surgery.

--A total of 5 complications occurred without significant differences (BMI less than 25: n=1, BMI 25–30: n=2, BMI more than 30: n=2; n.s.).

--There was a mean pre- to postoperative (6 weeks after surgery) correction difference of 6.9°±3.2° (mTFA) with higher loss of correction over time in overweight patients.

Conclusively, in terms of clinical outcome and health-related quality of life, overweight patients may derive a gain from open-wedge HTO to the same degree as patients with average weights and display comparable complication rates. However, they have poorer preoperative clinical and functional outcomes and mid-term results after open-wedge HTO relative to patients with normal weights.

Source: https://link.springer.com/article/10.1007/s00167-021-06457-3
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