A Retrospective Study of Predictive Factors and Functional Outcomes of Medial Opening Wedge High Tibial Osteotomy for Varus Medial Compartment Knee Osteoarthritis: Insights From a Resource-Limited Setting
Bibliographic record
Abstract
INTRODUCTION: Medial opening wedge high tibial osteotomy (MOWHTO) represents a well-established surgical intervention for varus malalignment associated with medial compartment knee osteoarthritis (KOA). Given the increasing prevalence of KOA, particularly within aging populations, a thorough evaluation of effective therapeutic strategies is paramount. This study aimed to identify predictors of MOWHTO failure and assess the functional outcomes of this procedure in a resource-limited setting, thereby informing clinical decision-making and optimizing patient care. MATERIALS AND METHODS: This retrospective study analyzed the outcomes of MOWHTO performed on adult patients diagnosed with KOA and varus deformity at two hospitals in Sana'a, Yemen, between October 2019 and April 2023. Data pertaining to demographics, preoperative characteristics, intraoperative details, radiographic findings, and postoperative parameters were meticulously collected and analyzed. Clinical outcomes were evaluated using the American Knee Society Functional Score (AKSFS), the Clinical American Knee Society Score (CAKSS), and the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Multivariate regression analysis determined the associations between patient-specific factors and MOWHTO failure, defined as conversion to unicompartmental or total knee arthroplasty. RESULTS: A cohort of 102 patients underwent MOWHTO, with a mean follow-up duration of 24.4 ± 7.0 months. The mean age of the patient population was 42.6 ± 8.2 years, with a female predominance (n=69, 67.6%). Disease severity, as per the Kellgren-Lawrence classification, was graded as follows: grade 1 in 19 (18.6%) knees, grade 2 in 48 (47.1%) knees, grade 3 in 22 (21.6%) knees, and grade 4 in 13 (12.7%) knees. Postoperatively, statistically significant improvements were observed in the mean AKSFS, CAKSS, and WOMAC scores at the final follow-up compared to preoperative values (all p<0.05). Post-surgical complications included pin-tract infections (n=5, 4.9%) and lateral cortex fractures (n=4, 3.9%). Overall, 92 (90.2%) knees demonstrated successful outcomes, while 10 (9.8%) were classified as failures. Multivariate analysis revealed that advanced age (OR: 1.89; 95% CI: 1.02-3.50, p=0.043) and higher body mass index (BMI) (OR: 2.40; 95% CI: 1.13-5.10, p = 0.022) were significant predictors of surgical failure. CONCLUSIONS: This study confirms that MOWHTO improves clinical outcomes for varus medial compartment KOA, especially in younger patients with a normal BMI, demonstrating its potential in resource-limited settings. These findings highlight the importance of considering age and BMI in treatment decisions; future prospective research is warranted to refine patient selection criteria and expand the applicability of MOWHTO.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".