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

Author:

Machado Axel12,Micicoi Lolita12,Ernat Justin3,Schippers Philipp4,Bernard de Dompsure Régis12,Bronsard Nicolas12,Gonzalez Jean‐François12,Micicoi Grégoire12ORCID

Affiliation:

1. University Institute of Locomotor and Sports (iULS), Pasteur II Hospital 30, voie Romaine 06000 Nice France

2. Unité de Recherche Clinique Côte d’Azur (UR2CA) Université Côte d’Azur Nice France

3. University of Utah Health Salt Lake City Utah USA

4. Department of Orthopedics and Traumatology University Medical Center of the Johannes Gutenberg University Mainz Langenbeckstrasse 1 55131 Mainz Germany

Abstract

AbstractPurposeThe objectives of this study were to evaluate functional results, revision‐free survival, and the influence of postoperative alignment on outcomes after MCWHTO.MethodsThis 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 influence 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 post‐operatively (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°.ConclusionFunctional results and revision‐free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly 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 definitive conclusions.Level of evidenceIV, case series.

Publisher

Wiley

Subject

Orthopedics and Sports Medicine,Surgery

Reference39 articles.

1. Osteoarthrosis of the knee A radiographic investigation;Ahlbäck S;Acta Radiol Diagn (Stockh),1968

2. Long-Term Follow-Up of Distal Femoral Varus Osteotomy of the Knee

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