High tibial osteotomy in medial compartment osteoarthritis of knee: functional outcome of medial open wedge and lateral closing wedge osteotomies—How does the outliers fare in the medium term?

A, Shiju Majeed; Thaha, Nabeel; Varghese, Betsy

doi:10.1007/s12306-022-00756-9

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Compared to nonobese patients, obese patients' preoperative, operative correction and final follow‐up angles did not differ significantly. While the potential loss of postoperative correction in obese patients has been previously investigated, this phenomenon was not seen in this review [11, 12, 17].…”

Section: Discussionmentioning

confidence: 99%

Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review

Harris,

Nadeem,

Hargreaves

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty.MethodsMedline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including ‘obesity’, ‘BMI’, ‘osteotomy’ and ‘high tibial osteotomy (HTO)’ were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient‐reported satisfaction scores and postoperative complications.ResultsNine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening‐wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.).ConclusionObesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment.Level of EvidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review

Harris,

Nadeem,

Hargreaves

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…However, alignment correction procedures such as HTO for patients with neutral or mild varus knee alignment may be excessive and can result in inferior outcomes with postoperative valgus alignment [7]. Recently, proximal fibular osteotomy (PFO) was found to relieve pain and improve knee function in patients with medial compartment knee OA.…”

Section: Introductionmentioning

confidence: 99%

Stress Effect in the Knee Joint Based on the Fibular Osteotomy Level and Varus Deformity: A Finite Element Analysis Study

Kang,

Kim,

Sim

et al. 2023

Bioengineering

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Proximal fibular osteotomy (PFO) was found to relieve pain and improve knee function in patients with medial compartment knee osteoarthritis (OA). Therapy redistributes the load applied from the inside to the outside and alleviates the load applied on the inside through fibula osteotomy. Therefore, the clinical effect of fibular osteotomy using the finite element (FE) method was evaluated to calculate the exact change in stress inside a knee joint with varus deformity. Using CT and MRI images of a patient’s lower extremities, 3D models of the bone, cartilage, meniscus, and ligaments were constructed. The varus angle, representing the inward angulation of the knee, was increased by applying a force ratio in the medial and lateral directions. The results showed that performing proximal fibular osteotomy led to a significant reduction in stress in the medial direction of the meniscus and cartilage. The stress reduction in the lateral direction was relatively minor. In conclusion, the study demonstrated that proximal fibular osteotomy effectively relieves stress and redistributes the load in the knee joints of patients with medial compartment knee osteoarthritis. The findings emphasize the importance of considering force distribution and the position of fibular osteotomy to achieve optimal clinical outcomes.

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Medial Opening Wedge (MOW) Versus Lateral Closing Wedge (LCW) High Tibial Osteotomies for Knee Medial Compartment Osteoarthritis Show Similar Outcomes and Survivorship, While MOW Has Higher Rates of Tibial Fracture and LCW Has Higher Rates of Nerve Injury and Conversion to Total Knee

Tollefson,

Lee,

Keel

et al. 2024

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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High tibial osteotomy in medial compartment osteoarthritis of knee: functional outcome of medial open wedge and lateral closing wedge osteotomies—How does the outliers fare in the medium term?

Cited by 3 publications

References 13 publications

Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review

Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review

Stress Effect in the Knee Joint Based on the Fibular Osteotomy Level and Varus Deformity: A Finite Element Analysis Study

Medial Opening Wedge (MOW) Versus Lateral Closing Wedge (LCW) High Tibial Osteotomies for Knee Medial Compartment Osteoarthritis Show Similar Outcomes and Survivorship, While MOW Has Higher Rates of Tibial Fracture and LCW Has Higher Rates of Nerve Injury and Conversion to Total Knee

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