Change of joint-line convergence angle should be considered for accurate alignment correction in high tibial osteotomy

Abstract

Background The alignment correction after high tibial osteotomy (HTO) is made both by bony correction and soft-tissue correction around the knee. Change of the joint-line convergence angle (JLCA) represents the soft-tissue correction after HTO, which is the angle made by a tangential line between the femoral condyles and the tibial plateau. We described the patterns of JLCA change and related factors after HTO and investigated the appropriate preoperative planning method. Methods Eighty patients who underwent HTO between 2013 and 2016 were included for this retrospective study. Standing, whole-limb radiograph, supine knee anteroposterior (AP) and lateral were measured on the preoperative and postoperative radiographs. The patterns of JLCA changes and related factors were analyzed. Results JLCA decreased by a mean of 0.9° ± 1.2° (P < 0.001) after HTO. Sixteen patients (20%, group II) showed a greater JLCA decrease ≥ 2°, while 64 (80%, group I) patients remained in a narrow range of JLCA change < 2°. Group II showed more varus deformity (varus 8.1° vs. varus 4.7° in the mechanical femorotibial angle, P < 0.001), greater JLCA on standing (4.9° vs. 2.1°, P < 0.001), and the difference of JLCA in the standing and supine positions (2.8° vs. 0.7°, P < 0.001) preoperatively compared to group I. The risk of a greater JLCA decrease ≥ 2° was associated with greater preoperative JLCA in the standing position and the difference between the JLCA in the standing and supine positions. Postoperative JLCA correlated better with preoperative JLCA in the supine position than those in the standing position. A preoperative JLCA ≥ 4° or the difference of preoperative JLCA in the standing and supine positions ≥ 1.7° was the cut-off value to predict a large JLCA decrease ≥ 2° after HTO in the receiver operating characteristic (ROC) curve analysis. Conclusions Surgeons should consider the effect of the JLCA change during the preoperative planning and intraoperative procedure to avoid unintended overcorrection.

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

“…9 Most of these correction errors may be due to changes in soft tissue laxity. 20,21 Lee et al 16 investigated the disparity between the preoperative target correction amount and postoperative correction amount. They concluded that if the planned osteotomy gap was large, there was a mismatch between the targeted alignment and corrected alignment, and this mismatch did not deviate toward over- or undercorrection.…”

Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial

“…High tibial osteotomy (HTO) is an established and proven surgical method for medial compartmental OA with varus deformity [ 1 , 2 ]. Among HTO techniques, medial opening wedge HTO (MOWHTO) has become more popular than closing wedge HTO in recent years because of the simplicity of surgery [ 3 , 4 , 5 ].…”

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

“…This procedure has been reported to have good long-term clinical outcomes such as reduced pain and improved knee joint function [ 5 , 6 , 7 ]. Previous studies on MOWHTO tended to focus mainly on the change of alignment in the coronal plane regarding correction angle and postoperative coronal realignment [ 8 , 9 , 10 ]. However, MOWHTO is the three-dimensional (3D) surgical procedure.…”