Evidence map›Paper›PMID 33526542›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2021

Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors.

Codie A Primeau, Trevor B Birmingham, Kristyn M Leitch, Kevin R Willits, Robert B Litchfield, Peter J Fowler, Jacquelyn D Marsh, Bert M Chesworth, Stephanie N Dixon, Dianne M Bryant and 1 more

Open access · goldAbstract read
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In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 4 pooled it
6.9field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 4 syntheses or guidelines pooled it, 48 citations in OpenAlex.

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  7. [Short-term effectiveness study and finite element analysis of high tibial osteotomy for knee varus with medial meniscus posterior root tear in middle aged and older populations].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2026
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  15. Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Codie A PrimeauFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Trevor B BirminghamFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont. tbirming@uwo.ca rgiffin@uwo.ca.
Kristyn M LeitchFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Kevin R WillitsFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Robert B LitchfieldFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Peter J FowlerFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Jacquelyn D MarshFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Bert M ChesworthFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Stephanie N DixonFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
Dianne M BryantFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont.
J Robert GiffinFowler Kennedy Sport Medicine Clinic (Primeau, Birmingham, Leitch, Willits, Litchfield, Fowler, Bryant, Giffin); School of Physical Therapy, Faculty of Health Sciences (Primeau, Birmingham, Marsh, Chesworth, Bryant); Collaborative Specialization in Musculoskeletal Health Research, Bone and Joint Institute (Primeau); Bone and Joint Institute (Birmingham, Willits, Litchfield, Marsh, Chesworth, Bryant, Giffin); Department of Surgery, Schulich School of Medicine and Dentistry (Willits, Litchfield, Giffin); Department of Epidemiology and Biostatistics (Dixon), Western University; Lawson Health Research Institute (Dixon), London, Ont. tbirming@uwo.ca rgiffin@uwo.ca.
Fowler Kennedy Sport Medicine Clinic · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn important aim of high tibial osteotomy (HTO) is to prevent or delay the need for total knee replacement (TKR). We sought to estimate the frequency and timing of conversion from HTO to TKR and the factors associated with it.

methodsWe prospectively evaluated patients with osteoarthritis (OA) of the knee who underwent medial opening wedge HTO from 2002 to 2014 and analyzed the cumulative incidence of TKR in July 2019. The presence or absence of TKR on the HTO limb was identified from the orthopedic surgery reports and knee radiographs contained in the electronic medical records for each patient at London Health Sciences Centre. We used cumulative incidence curves to evaluate the primary outcome of time to TKR. We used multivariable Cox proportional hazards analysis to assess potential preoperative predictors including radiographic disease severity, malalignment, correction size, pain, sex, age, body mass index (BMI) and year of surgery.

resultsAmong 556 patients who underwent 643 HTO procedures, the cumulative incidence of TKR was 5% (95% confidence interval [CI] 3%-7%) at 5 years and 21% (95% CI 17%-26%) at 10 years. With the Cox proportional hazards multivariable model, the following preoperative factors were significantly associated with an increased rate of conversion: radiographic OA severity (adjusted hazard ratio [HR] 1.96, 95% CI 1.12-3.45), pain (adjusted HR 0.85, 95% CI 0.75-0.96)], female sex (adjusted HR 1.67, 95% CI 1.08-2.58), age (adjusted HR 1.50 per 10 yr, 95% CI 1.17-1.93) and BMI (adjusted HR 1.31 per 5 kng/m

interpretationWe found that 79% of knees did not undergo TKR within 10 years after undergoing medial opening wedge HTO. The strongest predictor of conversion to TKR is greater radiographic disease at the time of HTO.

Indexed as

OsteotomyAge FactorsArthroplasty, Replacement, KneeBody Mass IndexFemaleHumansIncidenceMaleMiddle AgedOsteoarthritis, KneePain MeasurementProportional Hazards ModelsProspective StudiesSeverity of Illness IndexSex FactorsTibia

Identifiers

PMID33526542
PMCPMC7954572
OpenAlexW3126424697

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.