Predictive factors for knee stiffness after open-wedge high tibial osteotomy in patients with knee osteoarthritis

doi:10.3877/cma.j.issn.2096-0263.2025.05.003

Abstract

Abstract:

Objective

Postoperative knee stiffness following open-wedge high tibial osteotomy (OW-HTO) can significantly compromise surgical outcomes. However, there is a paucity of research investigating the predictive factors for knee stiffness after OW-HTO.

Methods

This was a retrospective cohort study involving patients who underwent primary OW-HTO between 2023 and 2024. Demographic data, Kellgren-Lawrence grade, hip-knee-ankle (HKA) angle, medial tibial plateau settlement value, size of internal fixation, type of bone graft, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected. The primary outcome was "postoperative knee stiffness," defined as a worsening of the WOMAC stiffness score at 1 year postoperatively combined with the presence of stiffness symptoms during follow-up evaluations. Univariate analysis and multivariate logistic regression analysis were used to identify independent predictive factors for postoperative stiffness.

Results

A total of 527 patients were included, with 193 males and 334 females, and a mean age of 59.5 years. At 1 year postoperatively, 91 (17.3%) patients developed postoperative knee stiffness. Univariate analysis showed that sex, body mass index (BMI), history of diabetes mellitus, preoperative HKA angle, preoperative medial tibial plateau settlement value, preoperative WOMAC stiffness score, size of internal fixation, and type of bone graft were associated with postoperative stiffness. After including variables in the multivariate logistic regression and applying backward stepwise regression for selection, BMI (OR=1.23, 95% CI: 1.14, 1.32, P<0.001), medial tibial plateau settlement value (OR=1.23, 95% CI: 1.12, 1.35, P<0.001), size of internal fixation (OR=1.02, 95% CI: 1.01, 1.03, P<0.001), and advancement bone flap grafting (OR=0.24, 95% CI: 0.13, 0.41, P<0.001) were identified as independent predictive factors for postoperative stiffness.

Conclusions

In patients undergoing OW-HTO, higher BMI and a larger medial tibial plateau settlement value are risk factors for postoperative knee stiffness, while using smaller-sized internal fixations and advancement bone flap grafting can reduce the risk of postoperative stiffness. Strengthening perioperative management in high-risk populations and optimizing surgical techniques and internal fixation selection may reduce the progression of stiffness and improve functional outcomes.

Key words: Knee osteoarthritis, High tibial osteotomy, Stiffness, Predictive factors

Yuening Han, Chengsi Li, Xin Xing, Tengbo Yu, Kuo Zhao, Zhengwei Yang, Minghui Liu, Qian Geng. Predictive factors for knee stiffness after open-wedge high tibial osteotomy in patients with knee osteoarthritis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2025, 11(05): 280-286.

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References 25

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变量	总例数（527例）	僵硬恢复组（436例）	术后僵硬组（91例）	t/U/χ²值	P值
年龄（岁，±s）	59.52±6.73	59.53±6.69	59.51±6.97	19 745.5	0.944
性别[例（%）]				7.341	0.007*
男	193（36.6）	171（39.2）	22（24.2）
女	334（63.4）	265（60.8）	69（75.8）
BMI（kg/m²，±s）	26.54±3.76	26.14±3.71	28.45±3.42	-5.464	<0.001*
慢性合并症[例（%）]
心血管疾病	50（9.5）	43（9.9）	7（7.7）	0.413	0.521
脑血管疾病	43（8.2）	37（8.5）	6（6.6）	0.360	0.549
肺部疾病	42（8.0）	37（8.5）	5（5.5）	0.919	0.338
肝脏疾病	54（10.2）	43（9.9）	11（12.1）	0.405	0.524
肾脏疾病	39（7.4）	35（8.0）	4（4.4）	1.449	0.229
糖尿病	49（9.3）	36（8.3）	13（14.3）	3.245	0.072*
癌症	61（11.6）	50（11.5）	11（12.1）	0.028	0.866
贫血	63（12.0）	52（11.9）	11（12.1）	0.002	0.966
HKA角（°，±s）	171.88±2.97	172.02±2.88	171.20±3.28	2 2741.5	0.027*
沉降值（mm，±s）	8.56±2.80	8.31±2.63	9.80±3.24	15 336.0	< 0.001*
WOMAC指数（±s）	63.01±12.28	62.71±12.14	64.45±12.86	-1.228	0.220
疼痛	72.73±9.37	72.57±9.41	73.48±9.19	18 018.5	0.169
僵硬	73.36±17.51	72.61±17.62	76.96±16.55	17 013.5	0.033*
功能	63.51±9.13	63.19±8.83	65.04±10.35	18 041.0	0.174
手术时间（min，±s）	105.00±35.22	105.28±35.73	103.66±32.82	20 260.5	0.749
术中出血量（mL，±s）	90.74±36.12	90.88±36.50	90.08±34.45	0.193	0.988
内固定物尺寸（mm，±s）	120[60,130]	60[60,130]	130[60，140]	14 131.0	<0.001*
切口长度（cm，±s）	5.78±1.51	5.73±1.50	6.02±1.56	17 735.0	0.111
植骨类型[例（%）]				23.202	<0.001*
异体骨	267（50.7）	200（45.9）	67（73.6）
推进骨瓣	260（49.3）	236（54.1）	24（26.4）

变量	总例数（527例）	僵硬恢复组（436例）	术后僵硬组（91例）	t/U/χ²值	P值
年龄（岁，±s）	59.52±6.73	59.53±6.69	59.51±6.97	19 745.5	0.944
性别[例（%）]				7.341	0.007*
男	193（36.6）	171（39.2）	22（24.2）
女	334（63.4）	265（60.8）	69（75.8）
BMI（kg/m²，±s）	26.54±3.76	26.14±3.71	28.45±3.42	-5.464	<0.001*
慢性合并症[例（%）]
心血管疾病	50（9.5）	43（9.9）	7（7.7）	0.413	0.521
脑血管疾病	43（8.2）	37（8.5）	6（6.6）	0.360	0.549
肺部疾病	42（8.0）	37（8.5）	5（5.5）	0.919	0.338
肝脏疾病	54（10.2）	43（9.9）	11（12.1）	0.405	0.524
肾脏疾病	39（7.4）	35（8.0）	4（4.4）	1.449	0.229
糖尿病	49（9.3）	36（8.3）	13（14.3）	3.245	0.072*
癌症	61（11.6）	50（11.5）	11（12.1）	0.028	0.866
贫血	63（12.0）	52（11.9）	11（12.1）	0.002	0.966
HKA角（°，±s）	171.88±2.97	172.02±2.88	171.20±3.28	2 2741.5	0.027*
沉降值（mm，±s）	8.56±2.80	8.31±2.63	9.80±3.24	15 336.0	< 0.001*
WOMAC指数（±s）	63.01±12.28	62.71±12.14	64.45±12.86	-1.228	0.220
疼痛	72.73±9.37	72.57±9.41	73.48±9.19	18 018.5	0.169
僵硬	73.36±17.51	72.61±17.62	76.96±16.55	17 013.5	0.033*
功能	63.51±9.13	63.19±8.83	65.04±10.35	18 041.0	0.174
手术时间（min，±s）	105.00±35.22	105.28±35.73	103.66±32.82	20 260.5	0.749
术中出血量（mL，±s）	90.74±36.12	90.88±36.50	90.08±34.45	0.193	0.988
内固定物尺寸（mm，±s）	120[60,130]	60[60,130]	130[60，140]	14 131.0	<0.001*
切口长度（cm，±s）	5.78±1.51	5.73±1.50	6.02±1.56	17 735.0	0.111
植骨类型[例（%）]				23.202	<0.001*
异体骨	267（50.7）	200（45.9）	67（73.6）
推进骨瓣	260（49.3）	236（54.1）	24（26.4）

变量	β（log-OR）	SE	Z值	OR	95% CI	P值
BMI（kg/m²）	0.203	0.037	5.54	1.23	1.14，1.32	<0.001
沉降值（mm）	0.207	0.049	4.23	1.23	1.12，1.35	<0.001
内固定物尺寸（mm）	0.019	0.0037	5.12	1.02	1.01，1.03	<0.001
植骨类型（推进骨瓣）	−1.448	0.285	−5.08	0.24	0.13，0.41	<0.001

变量	β（log-OR）	SE	Z值	OR	95% CI	P值
BMI（kg/m²）	0.203	0.037	5.54	1.23	1.14，1.32	<0.001
沉降值（mm）	0.207	0.049	4.23	1.23	1.12，1.35	<0.001
内固定物尺寸（mm）	0.019	0.0037	5.12	1.02	1.01，1.03	<0.001
植骨类型（推进骨瓣）	−1.448	0.285	−5.08	0.24	0.13，0.41	<0.001

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