Clinical outcomes and patient satisfaction following implant removal after open wedge high tibial osteotomy

Abstract

Purpose Symptoms of implant-associated irritation have been reported as a complication of open wedge high tibial osteotomy (OWHTO). While some centers perform implant removal only when such complications occur, others routinely perform implant removal. However, the benefits of implant removal after OWHTO have not yet been clarified. The purpose of this study was to evaluate patient satisfaction with implant removal after OWHTO and to investigate the benefits of implant removal. Methods We prospectively enrolled 40 consecutive patients who underwent implant removal after OWHTO between August 2021 and December 2023. We compared radiographic findings, clinical scores, and the answers to a questionnaire created by our center before and 3 months after the implant removal. Postoperatively, patients were asked to rate their satisfaction with the implant removal on a 5-point scale. Results The visual analogue scale (VAS) for pain showed significant improvement at 3 months after implant removal. There were also significant improvements in the total Knee injury and Osteoarthritis Outcome Score (KOOS), KOOS for pain, KOOS for function, Japanese Orthopaedic Association score, and Medical Outcomes Study Short Form-36 scores at 3 months after implant removal. A questionnaire created at our center about symptoms in the region surrounding the implant wound showed improvements in irritation symptoms with implant removal. Thirty-nine of 40 patients (97.5%) were satisfied or very satisfied with the results of implant removal. The postoperative VAS and satisfaction with the procedure were negatively correlated, and the postoperative VAS influenced the level of patient satisfaction. Conclusion Implant removal after OWHTO was associated with improvements in pain, clinical scores, and patient satisfaction. Furthermore, the frequency of complications after implant removal was very low. These findings suggest that implant removal after OWHTO may be beneficial. Level of evidence LevelⅢ, prospective cohort study.