Normo‐or slightly overcorrection show better results after medial closing wedge high tibial osteotomy

Abstract

Purpose The objectives of this study were to evaluate functional results, revision-free survival, and the inluence of postoperative alignment on outcomes after MCWHTO. Methods This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre-and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its inluence on clinical outcomes were also analysed. ResultsThe mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased postoperatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = − 0.15, p = 0.04) and function IKS (R = − 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°. Conclusion Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not signiicantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw deinitive conclusions. Level of evidence IV, case series.

Constitutional and postoperative joint line obliquity can predict serial alignment change after opening‐wedge high tibial osteotomy: analysis using coronal plane alignment of the knee classification

“…Medial opening‐wedge high tibial osteotomy (OWHTO) is a widely accepted procedure for the treatment of varus malaligned medial osteoarthritic knees. The favorable outcomes of OWHTO can be guaranteed when accurate correction is achieved and maintained [5, 8, 23]. However, OWHTO does not always result in intended correction, and even if an accurate correction is obtained immediately postoperatively, a change in the alignment is often observed over time, resulting in under‐ or over‐correction [26].…”

“…Several studies with various designs have addressed correction accuracy or correction loss in OWHTO [5, 16–18, 23, 25, 27, 31]; however, to the best of our knowledge, there have been limited studies analyzing alignment changes related to knee phenotypes in reconstructive surgery, especially HTO. Analyzing CPAK phenotypes in HTO could be an efficient way to intuitively understand alignment changes and introduce a novel perspective for assessing alignment in HTO.…”

Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study

“…The online tool Tyche ® (Philipp Schippers) was utilized to facilitate a multicenter study and obtain objective measurement results. 14 , 24 , 25 , 28 Fully anonymized images were temporarily uploaded to Tyche, where only dedicated observers had temporary access with encrypted connections. Observers analyzed the images blinded and in random order inside a web browser; they were provided with standard imaging tools (eg, pan, zoom, and contrast) and angle tools (eg, standard angle, Cobb angle).…”

A Lightweight Browser-Based Tool for Collaborative and Blinded Image Analysis

“…Tyche is appropriate for standard measurements like length, angle, or area. Machado et al, Micicoi et al, and Schippers et al have already used it on small series (<200 images) for orthopedic measurements [38][39][40]. In addition, with the single-choice question format, Tyche can be efficiently used to score images, like in a study by Schippers et al, which applied the Kallgren and Lawrence score to more than one hundred pelvic X-rays [41].…”