Effect of High Tibial Osteotomy on the Distribution of Subchondral Bone Density Across the Proximal Tibial Articular Surface of the Knee With Medial Compartment Osteoarthritis

Abstract

Background: The effect of high tibial osteotomy (HTO) on the stress distribution across the knee joint is not completely understood. Subchondral bone density is considered to reflect the pattern of stress distribution across a joint surface. Purpose: To assess the distribution of subchondral bone density across the proximal tibia in nonarthritic knees and in the knees of patients with osteoarthritis (OA) before and after HTO. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected radiological and computed tomography data from 16 patients without OA (control group) and 17 patients with OA. Data from the OA group were collected before and 1.5 years after HTO. Subchondral bone density of the proximal tibia was assessed with computed tomography–osteoabsorptiometry. The locations and percentages represented by high-density areas (HDAs) on the articular surface were quantitatively analyzed. Results: The ratio of the HDA of the medial compartment to the total HDA (medial ratio) was significantly higher in the preoperative OA group (mean, 80.1%) than in the control group (61.3%) ( P < .001). After HTO, the medial ratio decreased significantly to 75.1% ( P = .035 in comparison with preoperative values) and was significantly correlated with the hip-knee-ankle angle in both groups: control ( r = −0.551; P = .033) and OA ( r = −0.528; P = .043). The change in medial ratio after HTO was significantly correlated with the change in hip-knee-ankle angle ( r = 0.587; P = .035). In the medial compartment, the HDA in the most lateral region of 4 subregions increased after HTO, but that in 3 medial subregions decreased. Conclusion: In this exploratory study, HTO shifted the HDA of the medial compartment of the proximal tibial articular surface toward the lateral compartment. In contrast, the HDA of the most lateral region of the medial compartment increased after HTO. This change in subchondral bone density may result from the change in stress distribution.

The Osteoarthritis Natural Progress and Changes in Intraosseous Pressure of the Guinea Pig Model in Different Degeneration Stages

“…Below the subchondral bone plate is a porous, metabolically active cancellous bone. As KOA progresses, the calcified cartilage layer continues to thicken, the volume of articular cartilage decreases, and the subchondral bone proliferates and hardens 17–20 …”

“…As KOA progresses, the calcified cartilage layer continues to thicken, the volume of articular cartilage decreases, and the subchondral bone proliferates and hardens. [17][18][19][20] The high signal zone in the subchondral bone, BMLs, refers to the edema signal located in the subchondral cancellous bone of T2 liposome phase. When the range of BMLs in the subchondral bone is limited, it is spatially identical to the subchondral bone cyst.…”

“…As KOA progresses, the calcified cartilage layer continues to thicken, the volume of articular cartilage decreases, and the subchondral bone proliferates and hardens. 17 , 18 , 19 , 20…”

Higher Association of Pelvis-Knee-Ankle Angle Compared With Hip-Knee-Ankle Angle With Knee Adduction Moment and Patient-Reported Outcomes After High Tibial Osteotomy

“…As reported in a previous study, the Miniaci method 28 was used in preoperative planning. 19 The intended angle of correction was calculated preoperatively to deliver a weightbearing line of 62.5% of the tibial width, which is based on the magnitude of malalignment and status of the articular cartilage in the lateral tibiofemoral compartment.…”

“…All surgeries were performed by a senior orthopaedic surgeon with 20 years of experience in performing knee surgery (E.K.). The surgeon used the same operative technique as described in a previous study, 19 with the open-wedge HTO system and a locking plate (Tomofix, DePuy Synthes; and TriS Medial HTO Plate System, Olympus Terumo Biomaterials). As reported in a previous study, the Miniaci method 28 was used in preoperative planning.…”