Preoperative hs-CRP Linked to Postoperative Incision Complications in MOWHTO: Study
Researchers in a new study have found a strong association between elevated preoperative high-sensitivity C-reactive protein (hs-CRP) levels and increased risk of incision-related complications after medial opening wedge high tibial osteotomy (MOWHTO) for varus knee osteoarthritis (KOA). However, wide confidence intervals suggest the need for further validation in larger, multicenter studies.
Inflammatory and markers have a vital role in the development and prediction of adverse events following surgical procedures. This study aims to examine the relationship between high-sensitivity C-reactive protein to lymphocyte ratio (hs-CLR) and incision complications (ie, poor healing of superficial incisions, wound infection) following medial opening-wedge high tibial osteotomy (MOWHTO) for unicompartmental knee osteoarthritis (KOA). This retrospective study analyzed patients who underwent MOWHTO for varus KOA between January 2021 and June 2024 in two tertiary referral hospitals. Baseline characteristics and laboratory test results were obtained through a review of inpatient medical records. The primary outcome measure was the incidence of incision complications occurring within 30 days postoperatively, determined by examining both inpatient records and outpatient follow-up documentation after discharge. To explore the relationship between hs-CLR and incision complications, we employed restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) curves, as well as univariate and multivariate logistic regression models. Results: There were 528 participants, including 190 males and 338 females, with a mean age of 56.2 ± 6.5 years. Within the 30 days following surgery, 48 patients (9.1%; 95% CI, 6.6% to 11.5%) experienced incision complications. Both the unadjusted and adjusted RCS analyses revealed the consistently significant nonlinear relationship (P < 0.05). ROC curve analysis identified an optimal hs-CLR cut-off value of 1.83, accordingly categorizing patients into low hs-CLR (n = 298) and high hs-CLR (n = 230) groups. Multivariate analyses employing two adjustment techniques demonstrated a significant relationship between a hs-CLR ≥ 1.83 and an increased risk of incision complications, with an odds ratio of 8.08 (95% CI, 3.16 to 20.63; P < 0.001) for “fully adjusted model” and of 8.99 (95%CI, 3.92 to 20.63; P < 0.001) for “backward elimination model”. This study demonstrated a robust association between preoperative hs-CLR and the risk of postoperative incision complications following MOWHTO for varus KOA. Although the observed odds ratios were substantial, the wide confidence intervals highlight the need for validation through larger, multicenter studies.
Reference:
Ji, C., Cheng, J., Su, H. et al. Relationship between high-sensitivity C-reactive protein to lymphocyte ratio (hs-CLR) and incision complications following medial opening-wedge high tibial osteotomy for knee osteoarthritis. BMC Surg 25, 230 (2025). https://doi.org/10.1186/s12893-025-02968-9
Keywords:
Preoperative, hs-CRP, Linked, Postoperative, Complications, MOWHTO, Varus, KOA, Study, Ji, C., Cheng, J., Su, H, Knee osteoarthritis, Medial opening-wedge, high tibial, osteotomy, Inflammatory, Immune, Incision complications
