Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy

Kim, Man Soo; Koh, In Jun; Choi, Keun Young; Kim, Bo Seoung; In, Yong

doi:10.1007/s00402-021-03876-2

Cited by 8 publications

(6 citation statements)

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“…Patients with increased KJLO appear to maintain the mJSW at follow-ups. It has been reported that mJSW can continuously increase up to 3 years post-HTO [ 21 ]. However, the clinical interpretation of mJSW is still under debate.…”

Section: Discussionmentioning

confidence: 99%

Joint line obliquity after lateral closing‐wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5‐year follow‐up study

Xie

Huizinga

Akker‐Scheek

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To analyze the association between change in knee joint line obliquity (KJLO) and patient-reported outcome, radiological progression of osteoarthritis, and surgical survival after lateral closing-wedge high tibial osteotomy (HTO). Methods A cohort of 180 patients treated in one single hospital with lateral closing-wedge HTO was examined. KJLO was defined by the medial proximal tibial angle (MPTA). To assess the association between KJLO and patient-reported outcome, radiological progression of osteoarthritis, and surgical survival, patient groups were defined: I, postoperative MPTA < 95.0°; II, postoperative MPTA ≥ 95.0°; A, MPTA change < 8.0°; B, MPTA change ≥ 8.0°. Propensity score matching was used for between-groups (I and II, A and B) covariates matching, including age, gender, preoperative lower limb alignment, preoperative medial joint space width (mJSW), preoperative Western Ontario and McMaster Universities osteoarthritis Index (WOMAC) score, wedge size, and postoperative follow-up time. Patient-reported outcome was assessed by the WOMAC questionnaire, radiological progression of osteoarthritis by mJSW and Kellgren–Lawrence (KL) grade progression (≥ 1) preoperatively and at follow-ups (> 2 years). Failure was defined as revision HTO or conversion to knee arthroplasty. Results After propensity score matching, groups I and II contained 58 pairs of patients and groups A and B contained 50 pairs. There were no significant differences in postoperative WOMAC score or surgical failure rate between groups I and II or between groups A and B (p > 0.05). However, the postoperative mJSW was significantly lower in group I than group II (3.2 ± 1.6 mm vs 3.9 ± 1.8 mm; p = 0.018) and in group A than group B (3.0 ± 1.7 mm vs 3.7 ± 1.5 mm; p = 0.040). KL grade progression rate was significantly higher in group I than group II (53.4% vs 29.3%; p = 0.008) and in group A than group B (56.0% vs 28.0%; p = 0.005). Conclusion Increased KJLO (postoperative MPTA ≥ 95.0°) or MPTA change ≥ 8.0° after lateral closing-wedge HTO does not adversely affect patient-reported outcome, radiological progression of osteoarthritis, or surgical survival at an average 5-year follow-up. Level of evidence III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Joint line obliquity after lateral closing‐wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5‐year follow‐up study

Xie

Huizinga

Akker‐Scheek

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…Open-wedge high tibial osteotomy (OWHTO) is commonly conducted to preserve the knee joint and to correct alignment for medial compartment knee osteoarthritis 1 – 3 . This operation is an effective surgery with positive long-term results if corrections of the medial tibial angle and lower extremity mechanical alignment are appropriate by passing the mechanical alignment through Fujisawa point 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

Hip abduction angle after open-wedge high tibial osteotomy is associated with the timed up & go test and recurrence of varus alignment

Kim

Kubota

Sato

et al. 2023

Sci Rep

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The aim of this study is to investigate the association between the hip abduction angle (HAA) and lower limb alignment as well as the clinical assessments in open-wedge high tibial osteotomy (OWHTO) patients. A total of 90 patients who underwent OWHTO were included. The demographic characteristics and clinical assessments (the Visual Analogue Scale for activities of daily living, the Japanese knee osteoarthritis measure, the Knee injury and Osteoarthritis Outcome Score, the Knee Society score, the Timed Up & Go (TUG) test, the single standing (SLS) test and muscle strength) were recorded. The patients were divided into two groups according to the HAA at 1 month after operation: the HAA (−) group (HAA < 0°) and the HAA (+) group (HAA ≥ 0°). Clinical scores except for the SLS test and radiographic parameters except for the posterior tibia slope (PTS), lateral distal femoral angle (LDFA) and lateral distal tibial angle (LDTA) were significantly improved at 2 years postoperatively. Regarding the two groups, scores on the TUG test in the HAA (−) group were significantly lower than those in the HAA (+) group (p = 0.011). The hip-knee-ankle angle (HKA), weight bearing line (WBLR) and knee joint line obliquity (KJLO) in the HAA (−) group were significantly higher than those in the HAA (+) group (p < 0.001, 0.001 and p = 0.025). In contrast, the LDFA in the HAA (−) group were significantly lower than those in the HAA (+) group (p < 0.001). The TUG test and the LDFA were weakly positively correlated with the HAA (r = 0.34, 0.42, p < 0.001 and 0.001). In contrast, the HKA, WBLR and KJLO had a weak negative correlation with the HAA (r = − 0.43, − 0.38 and − 0.37, p < 0.001, 0.001 and 0.001). This study showed the postoperative HAA was significantly associated with the TUG test and the HKA, WBLR, LDFA, and KJLO. A higher postoperative HAA might induce varus recurrence and poor outcomes of the gait parameter.

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“…[11][12][13] Bone healing and prevention of correction loss are two problems that attract attention from surgeons both related to osteotomy gap filling. [14][15][16][17][18] However, the necessity of filling the void remains debatable continuously. Although some studies have showed acceptable gap union without bone grafting after MOWHTO with a small correction (opening height <14mm).…”

Section: Introductionmentioning

confidence: 99%

“…The main surgical principle of MOWHTO is opening a gap in the medial proximal tibia by osteotomy to shift the weight‐bearing line (WBL) of the knee joint laterally in order to decompress the degenerated compartment and delay osteoarthritis 11–13 . Bone healing and prevention of correction loss are two problems that attract attention from surgeons both related to osteotomy gap filling 14–18 …”

Section: Introductionmentioning

confidence: 99%

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Bone Healing and Clinical Outcome Following Medial Opening‐wedge High Tibial Osteotomy Using Wedge‐Shaped Cancellous Allograft

Chen,

Li,

Zhang

et al. 2023

Orthopaedic Surgery

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ObjectiveMedial opening‐wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge‐shaped cancellous allograft after MOWHTO and its effect on clinical outcomes.MethodsAll patients who underwent MOWHTO using a novel wedge‐shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip‐knee‐ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre‐operative and post‐operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow‐up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow‐up. A paired student's t test was conducted for comparison of differences of the relevant data pre‐operatively and post‐operatively.ResultsA total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from −6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above‐mentioned parameters at last follow‐up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow‐up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS‐Knee score and KSS‐Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow‐up, respectively. Nevertheless, there was no significant difference in ROM between pre‐operation and last follow‐up (p > 0.05).ConclusionFor MOWHTO, the wedge‐shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.

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Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy

Cited by 8 publications

References 58 publications

Joint line obliquity after lateral closing‐wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5‐year follow‐up study

Joint line obliquity after lateral closing‐wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5‐year follow‐up study

Hip abduction angle after open-wedge high tibial osteotomy is associated with the timed up & go test and recurrence of varus alignment

Bone Healing and Clinical Outcome Following Medial Opening‐wedge High Tibial Osteotomy Using Wedge‐Shaped Cancellous Allograft

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