Changes in knee joint line orientation after high tibial osteotomy are the result of adaptation of the lower limb to the new alignment

Bartholomeeusen, Stijn; Bempt, Maxim Van den; Beek, Nathalie van; Claes, Toon; Claes, Steven

doi:10.1016/j.knee.2020.04.018

Cited by 23 publications

(24 citation statements)

References 27 publications

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“…If the mechanical axis from hip to ankle does not change, then a valgising high tibial osteotomy will lead to femoral adduction and, hence, a more lateral JLO. 7 However, these comments are not supported by data on the effects of specific tissue contact pressures on long-term degeneration that would validate clinical recommendations. It is desirable that long-term level 1 studies of osteotomy are conducted and that among many important factors, JLO should be measured to ascertain the clinical effect of this variable.…”

Section: Discussionmentioning

confidence: 99%

Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

et al. 2021

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Background: Little scientific evidence is available regarding the effect of knee joint line obliquity (JLO) before and after coronal realignment osteotomy. Hypotheses: Higher JLO would lead to abnormal relative position of the femur on the tibia, a shift of the joint contact areas, and elevated joint contact pressures. Study Design: Descriptive laboratory study. Methods: 10 fresh-frozen human cadaveric knees (age, 59 ± 5 years) were axially loaded to 1500 N in a materials testing machine with the joint line tilted 0°, 4°, 8°, and 12° varus (“downhill” medially) and valgus, at 0° and 20° of knee flexion. The mechanical compression axis was aligned to the center of the tibial plateau. Contact pressure and contact area were recorded by pressure sensors inserted between the tibia and femur below the menisci. Changes in relative femoral and tibial position in the coronal plane were obtained by an optical tracking system. Results: Both medial and lateral JLO caused significant tibiofemoral subluxation and pressure distribution changes. Medial (varus) JLO caused the femur to subluxate medially down the coronal slope of the tibial plateau, and vice versa for lateral (valgus) downslopes ( P < .01), giving a 6-mm range of subluxation. The areas of peak pressure moved 12 mm and 8 mm across the medial and lateral condyles, onto the downhill meniscus and the “uphill” tibial spine. Changes in JLO had only small effects on maximum contact pressures. Conclusion: A 4° change of JLO during load bearing caused significant mediolateral tibiofemoral subluxation. The femur slid down the slope of the tibial plateau to abut the tibial eminence and also to rest on the downhill meniscus. This caused large movements of the tibiofemoral contact pressures across each compartment. Clinical Relevance: These results provide important information for understanding the consequences of creating coronal JLO and for clinical practice in terms of osteotomy planning regarding the effect on JLO. This information provides guidance regarding the choice of single- or double-level osteotomy. Excessive JLO alteration may cause abnormal tibiofemoral joint articulation and chondral or meniscal loading.

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Section: Discussionmentioning

confidence: 99%

Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

et al. 2021

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“…Most studies supporting the negative effect of excessive JLO on outcomes and survivorship did not exclude overcorrected valgus knees or they omitted regression analyses, raising the question of whether these patients performed poorly because of the excessive JLO or the excessive valgus correction. We can also speculate regarding some other factors potentially affecting the outcomes: first, the ankle and subtalar joints could be responsible for some degrees of compensation in case of JLO, but this aspect is still poorly understood 5 ; second, in all studies, including the present one, the JLO evaluation is performed in a static manner, and the role of an oblique joint line during gait is still unclear. In the present study, we tried to avoid some of the limitations described earlier.…”

Section: Discussionmentioning

confidence: 93%

Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up

et al. 2021

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Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176° and 185° were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz–joint line angle (MJL) ≥94° or a mechanical medial proximal tibial angle (mMPTA) ≥95°. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores ( P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores ( P = .0024). A good preoperative range of motion was associated with better knee score ( P = .0399) and function score ( P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores ( P = .0317). MJL ≥94° and mMPTA ≥95° were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL ≥94° or mMPTA ≥95°) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.

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“…In this study, the position of the lower-limb mechanical axis had a significant impact on the Tinetti assessment score, the VAS score, and the KSS score of the patients. Adjustment of the lower-limb mechanical axis to the lateral side in patients with osteoarthritis combined with varus deformity in the knee helped to shift the pressure of the knee joint to the lateral compartment; thus achieving the purpose of the treatment [ 20 , 21 ]. If the degree of adjustment of the lower-limb mechanical axis to the lateral side was under-correction, the pressure load of the medial compartment would not be fully relieved, and the postoperative pain and the postoperative knee joint function of the patients would not achieve satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Influence of lower-limb mechanical axis on the curative effect of medial high tibial osteotomy for knee osteoarthritis

et al. 2022

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Purpose To investigate the effect of the ratio of the medial tibial plateau width to the total tibial plateau width on the therapeutic efficacy of high tibial osteotomy (HTO) on the medial side for the treatment of knee osteoarthritis. Methods In this study, we retrospectively analyzed information of 278 patients who underwent medial HTO for knee osteoarthritis with varus deformity. The Tinetti Gait and Balance Assessment Tool, the Visual Analog Scale (VAS), and the Knee Society Scoring System (KSS) were used to comprehensively evaluate the function of the knee joint after HTO. Results After adjusting for potential confounding factors (i.e., age, gender, body mass index/BMI, and surgical site), the Tinetti assessment score was optimized when the degree of correction was 53.67%, with the β-value on the left and right sides of the inflection point of 0.49 (confidence interval, CI: 0.20, 0.78, P = 0.0009) and− 0.26 (95% CI: − 0.30, − 0.22, P < 0.0001), respectively. The KSS score was optimized when the degree of correction was 55.45%, with the β-value on the left and right sides of the inflection point of 2.77 (95% CI: 1.64, 3.90, P < 0.0001) and − 1.18 (95% CI: − 1.46, − 0.91, P < 0.0001), respectively. The VAS score was the lowest when the degree of correction was 55.00%, with the β-value on the left and right sides of the inflection point of − 0.16 (95% CI: − 0.29, − 0.03, P = 0.0146) and 0.08 (95% CI: 0.05, 0.10, P < 0.0001), respectively. Stratified analysis showed that the BMI affected the Tinetti assessment score (β = − 0.14, 95% CI: − 0.24, − 0.04, P = 0.0071). According to the smooth-curve fitting results, when the BMI was > 28, the Tinetti assessment score showed a negative trend. Conclusion The degree of lower-limb mechanical axis correction correlated with the functional status of the knee joint after MOW HTO. When the ratio of the medial tibial plateau width to the total tibial plateau width was approximately 55%, the post-MOW HTO outcomes were optimized and the patients experienced the highest satisfaction. In addition, very high BMI was not conducive for the postoperative recovery of the knee joint function. Level of evidence: III Case–control study/Retrospective comparative study.

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Changes in knee joint line orientation after high tibial osteotomy are the result of adaptation of the lower limb to the new alignment

Cited by 23 publications

References 27 publications

Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading

Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up

Influence of lower-limb mechanical axis on the curative effect of medial high tibial osteotomy for knee osteoarthritis

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