Clinical Outcomes of Closing- and Opening-Wedge High Tibial Osteotomy for Treatment of Anteromedial Unicompartmental Knee Osteoarthritis

Abstract

This article compares the long-term outcomes of closing-wedge osteotomy (CWO) and opening-wedge osteotomy (OWO) in the treatment of unicompartmental medial osteoarthritis with varus deformity. This study included 79 patients who underwent high tibial osteotomy (HTO) between 2002 and 2008. Pre- and postoperative radiography and computed tomography were used to evaluate the posterior tibial slope, the patellar height, the tibiofemoral angle, and the lateral and medial tibiofemoral joint space. Pre- and postoperative severity of arthritis was assessed with the Kellgren-Lawrence grading system. Pre- and postoperative American Knee Society (AKS) score and Lysholm Knee Score (LKS) were determined to evaluate functional outcomes. The duration of follow-up was 86.1 ± 6.2 months. Postoperatively, at the most recent follow-up, there was a slight increase in the size of the medial tibiofemoral joint space after CWO and OWO, which reflected a decrease in stress on the medial compartment and manifested as a significant improvement in the AKS knee and function scores and the LKS. OWO increased the posterior tibial slope as compared with the preoperative value, while CWO reduced the posterior tibial slope. CWO and OWO for HTO resulted in similar functional outcomes. OWO was associated with patella infera and more severe patellofemoral arthritis, while CWO was associated with a greater severity of lateral tibiofemoral arthritis.

Evaluation of the “Minimal Clinically Important Difference” (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy

“…The most important finding of this study was the identification of the MCID regarding the KOOS, KSS and SF12 scores in patients undergoing owHTO for primary and isolated medial knee osteoarthritis (OA). For this procedure, MCID values were 15.4 Although some of the literature reporting on outcomes after owHTO estimated long-term clinical success as it relates to HTO survivorship, with failure defined by the need for revision procedure or conversion to total knee replacement [7,11,16,24] much of publications focus on short and mid-term outcomes through knee-specific PROMs, without providing MCIDs [4,12,20,29]. Yet, the target population is most often young (less than 60 years-old), able to deal with pain and to be more likely to prefer non-operative option [13].…”

The effect of distal tibial tuberosity high tibial osteotomy on postoperative patellar height and patellofemoral joint degeneration

“…Open-wedge high tibial osteotomy (OWHTO) is an effective treatment for medial compartment knee osteoarthritis and has been reported to yield good long-term clinical outcomes [1]. OWHTO can cure genu varum by adjusting the weight-bearing line, thereby transferring the pressure from the medial compartment to the lateral compartment.…”

Patient Characteristics Related to Blood Loss in High Tibial Osteotomy in Novel Multiple Linear Regression Analysis

“…High tibial osteotomy (HTO) is an effective procedure for knee osteoarthritis with varus malalignment in young people [1,2]. As joint preservation surgery, the procedure moderates the mechanical axis of the lower limb to relieve pain [3][4][5][6][7][8].…”