Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy

Kim, Man Soo; Son, Jong Min; Koh, In Jun; Bahk, Ji Hoon; In, Yong

doi:10.1007/s00402-017-2729-4

Cited by 42 publications

(44 citation statements)

References 48 publications

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“…Finally, JLCA changes can be anticipated [4,19,45] as well as accounting for the changes in soft tissue correction [27,44]. An equation has been proposed to define the acceptable intra-articular correction with the aim of achieving a more anatomic osteotomy while considering JLCA.…”

Section: Discussionmentioning

confidence: 99%

Managing intra-articular deformity in high Tibial osteotomy: a narrative review

et al. 2020

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The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.

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Section: Discussionmentioning

confidence: 99%

Managing intra-articular deformity in high Tibial osteotomy: a narrative review

et al. 2020

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“…General indications for MOWHTO were age ≤65 years, isolated symptomatic medial compartment OA of the knee and varus malalignment (hip-knee-ankle angle, varus 0°-15°), no inflammatory arthritis (rheumatoid arthritis), flexion contracture ≤15°, knee range of motion ≥120°, no joint instability, and no history of knee joint infection. 19 Patients also had to have a minimum follow-up of at least 2 years after surgery and preoperative magnetic resonance imaging (MRI) within 3 months of the operation. To avoid confounding factors that could influence postoperative PROMs, patients were excluded from the study if they had a diagnosis of traumatic OA, osteonecrosis, lateral compartment or patellofemoral OA, or under- or overcorrection.…”

Section: Methodsmentioning

confidence: 99%

Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported Outcomes After Medial Opening Wedge High Tibial Osteotomy

et al. 2020

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Background: Although the medial compartment continues to sustain some loading after medial opening wedge high tibial osteotomy (MOWHTO) in varus-deformed knees, no studies have examined the relationship between medial meniscal extrusion (MME) and patient-reported outcome measures after MOWHTO. Purpose: To examine whether compartmental baseline MME was associated with patient-reported outcome measures after MOWHTO. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study was composed of 149 MOWHTOs in 147 patients with clinical and radiological assessments. Patients were grouped according to severity of MME in the medial compartment at the time of surgery. MME was categorized into 4 groups according to MOAKS (MRI [magnetic resonance imaging] Osteoarthritis Knee Score) criteria and relative value of MME. We compared preoperative characteristics, including Kellgren-Lawrence (KL) grading scale, meniscal tear pattern, and postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores. Associations between extent of MME and WOMAC subscores at postoperative 1 and 2 years were assessed with generalized linear models. Results: Pattern of meniscal tear ( P < .05) and KL grade ( P < .05) were associated with MME. Patients with KL grades 3 and 4 at the time of surgery had significantly greater MME than those with KL grade 2 ( P < .05). When patients were divided into 4 groups according to MOAKS criteria at the time of surgery, there were significant differences in WOMAC pain scores among groups at 1 and 2 years after the operation (all P < .05). The WOMAC function score also differed among groups at postoperative 1 year ( P < .05) but not postoperative 2 years ( P > .05). When patients were divided into 4 groups according to relative MME at the time surgery, the WOMAC pain score differed significantly among groups at postoperative 1 and 2 years (all P < .05). Analysis of WOMAC pain score as the dependent variable in multivariate analyses revealed that severity of absolute and relative MME and KL grade were independent predictors of worse WOMAC pain score at postoperative 1 and 2 years (all P < .05). Conclusion: Greater preoperative MME at the time of surgery was associated with inferior patient-reported outcomes, especially pain, in patients with MOWHTO at 1 and 2 years after surgery.

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“…MOWHTO was contraindicated if a patient had inflammatory arthritis (rheumatoid arthritis), flexion contracture 15°, knee range of motion \120°, joint instability, or history of a knee joint infection. 21 Patients were excluded if they had a diagnosis of traumatic OA, osteonecrosis, incomplete preoperative data in terms of MRI analysis, or follow-up \2 years. For the current analysis reflecting preoperative BMLs, only patients who had preoperative MRI scans taken within 3 months of their operation were included.…”

Section: Methodsmentioning

confidence: 99%

“…The correction angle was measured during preoperative planning via the Dugdale method 21 with a weightbearing full-length hip-to-ankle radiograph. The target was the Fujisawa point.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…High tibial osteotomy (HTO) has become a reliable and established treatment for isolated medial compartment osteoarthritis (OA) with varus deformity of the knee joint. 21 Recently, the medial opening wedge HTO (MOWHTO) technique has been increasingly used for HTO. 32,43 Several studies have evaluated the long-term clinical results of MOWHTO and reported good and excellent outcomes for the majority of patients who underwent it for medial compartment OA.…”

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confidence: 99%

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Degree of Preoperative Subchondral Bone Marrow Lesion Is Associated With Postoperative Outcome After Medial Opening Wedge High Tibial Osteotomy

et al. 2019

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Background: In osteoarthritis of the knee, subchondral bone marrow lesion (BML) is known to be significantly associated with the severity of pain. However, little is known about the influence of preoperative BML on postoperative outcomes after medial opening wedge high tibial osteotomy (MOWHTO). Purpose: To compare patient-reported outcomes for those who underwent MOWHTO according to the severity of BML based on magnetic resonance imaging. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 136 patients who underwent MOWHTO between June 2011 and May 2016 with clinical and radiologic assessments before and after surgery were retrospectively enrolled. Patients were divided into 2 groups according to the presence or absence of BMLs. They were then subdivided into 4 or 3 groups based on the sum of BML scores of the medial femoral condyle and tibial plateau according to MRI (magnetic resonance imaging) Osteoarthritis Knee Score or Filardo classification, respectively. Associations between the severity of BML and postoperative 1- and 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores were evaluated through linear regression analysis. At postoperative 2 years, the rate of patients having a WOMAC score improvement of 15 points based on minimum clinically important difference and patient satisfaction were compared between groups. Results: BMLs were present in 96 (70.6%) of 136 cases. There were no significant differences in demographics or radiographic variables between groups according to the presence/absence or severity of BMLs (all P > .05). There was a significant association between preoperative or 1-year postoperative WOMAC pain/function score and the extent or intensity of BMLs (all P < .05). After adjusting for age, body mass index, osteoarthritis grade, and hip-knee-ankle angle, the significance persisted in the association between the extent or intensity of BMLs and WOMAC pain/function score at 1 year after surgery (all P < .05). However, a significant association was not found at postoperative 2 years (all P > .05). All groups showed similar rates of WOMAC score showing 15 points of improvement and satisfaction after MOWHTO (all P > .05). At 2 years after surgery, 82.5% of patients with BMLs were satisfied with their operation, as compared with 84.4% of those without BMLs ( P = .801). Conclusion: Although worse clinical outcomes were associated with severe BML during the recovery period, MOWHTO provided a high degree of clinical improvement on patient-reported outcomes regardless of the severity of BML at 2 years postoperatively.

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Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy

Abstract: Level III, retrospective comparative study.

Cited by 42 publications

References 48 publications

Managing intra-articular deformity in high Tibial osteotomy: a narrative review

Managing intra-articular deformity in high Tibial osteotomy: a narrative review

Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported Outcomes After Medial Opening Wedge High Tibial Osteotomy

Degree of Preoperative Subchondral Bone Marrow Lesion Is Associated With Postoperative Outcome After Medial Opening Wedge High Tibial Osteotomy

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