Hybrid closed wedge high tibial osteotomy improves patellofemoral joint congruity compared with open wedge high tibial osteotomy

Abstract

Purpose To evaluate clinical outcomes and radiographic changes in patellofemoral (PF) joint congruity between open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge HTO (HCWHTO). Methods From 2011 to 2013, 36 knees in 31 patients who underwent OWHTO and 21 knees in 17 patients who underwent HCWHTO were evaluated in this retrospective study with a minimum 5-year follow-up. Radiological outcomes including hip-knee-ankle angle (HKA), femoral patellar height index (FPHI), preoperative PF osteoarthritis (OA) grade, medial and lateral joint spaces of the PF joint, and congruence angle were measured. Clinical parameters including the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee Score (OKS) were also evaluated. Preoperative and final follow-up values for each procedure were compared in outcome analyses. Results Mean preoperative HKA and the degree of PF-OA were significantly more severe for patients treated with HCWHTO compared with those treated with OWHTO (p = 0.001, p = 0.0001). Mean postoperative FPHI was significantly decreased with proximalization of the patella in HCWHTO (p = 0.01) but showed no significant change in OWHTO (n.s.). Regarding PF joint congruity after HCWHTO, lateral joint space and congruence angle were significantly improved (p = 0.0001, p = 0.005), while medial joint space was not significantly changed (n.s.). After OWHTO, congruence angle showed no significant difference (n.s.), but medial and lateral joint spaces were significantly decreased (p = 0.0001, p = 0.018). There were no significant differences in KOOS and OKS between the groups (n.s., n.s.). Conclusions Although degrees of varus knee and PF-OA were more severe in HCWHTO than those in OWHTO, HCWHTO led to improved PF joint congruity, and its mid-term clinical outcomes were equivalent to those of OWHTO. Therefore, in patients with varus knee combined with PF-OA preoperatively, HCWHTO is a more effective treatment than OWHTO. Level of evidenceTherapeutic level III. Keywords Open wedge high tibial osteotomy • Hybrid closed wedge high tibial osteotomy • Patellofemoral joint congruity • Osteoarthritis • Knee * Tetsuro Ishimatsu

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

“…Patellar infera leads to an increase in patellofemoral contact pressure, anterior knee pain, and patellar locking and a decreased range of motion. These changes eventually lead to the progression of patellofemoral joint OA [ 3 , 16 , 17 ]. Kim et al [ 8 ] reported the prevalence of the progression of patellofemoral OA to be 41.2% in the femoral trochlea and 21.9% in the patella articular surface after more than 2 years in 114 patients who underwent OWHTO.…”

“…In addition, the patellofemoral joint on the sagittal plane is also influenced by the operation [ 2 ]. Several studies have shown that OWHTO causes patellar infera, increases patellofemoral joint pressure pain, increases the risk of patellofemoral OA progression, and makes it more difficult for total knee arthroplasty to be performed in the future [ 3 – 8 ]. Kim et al [ 8 ] reported the prevalence of the progression of patellofemoral OA to be 41.2% in the femoral trochlea and 21.9% in the patella articular surface after more than 2 years in 114 patients who underwent OWHTO.…”

Changes in patellar height and patellofemoral alignment following double level osteotomy performed for osteoarthritic knees with severe varus deformity

“…Although it is not clear whether the postoperative changes observed in this study induce osteoarthritic progression of the patellofemoral joint, 10 , 11 it can be stated that correction of severe varus deformity by either DLO or isolated MOWHTO induces similar changes in the biomechanical environment of the patellofemoral joint. Since it has been reported that knees with severe varus deformity is generally combined with severe patellofemoral arthritis, 32 osteotomy procedures that exert less influence on the patellar position such as distal-tuberosity osteotomy, 33 , 34 closed wedge HTO, 8 , 28 and hybrid HTO 35 , 36 , 37 should be considered as alternative surgical options on the tibial side.…”

The Effect of Distal Tibial Tuberosity High Tibial Osteotomy on Postoperative Patellar Height and Patellofemoral Joint Degeneration

“…Patella infra leads to an increase in patellofemoral contact pressure, anterior knee pain, patellar locking and a decreased range of motion. These changes eventually lead to the progression of patellofemoral joint OA [3,16,17] . Kim et al [8] reported the prevalence of the progression of patellofemoral OA to be 41.2% in the femoral trochlea and 21.9% in the patella articular surface after more than 2 years in 114 patients who underwent OWHTO.…”

“…In addition, the patellofemoral joint on the sagittal plane is also in uenced by the operation [2] . Several studies have shown that OWHTO causes patella infra, increases patellofemoral joint pressure pain, increases the risk of patellofemoral OA progression, and makes it more di cult for total knee arthroplasty to be performed in the future [3][4][5][6][7][8] . Kim et al [8] reported the prevalence of the progression of patellofemoral OA to be 41.2% in the femoral trochlea and 21.9% in the patella articular surface after more than 2 years in 114 patients who underwent OWHTO.…”