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Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to identify possible factors influencing the early outcome after medial open wedge high tibial osteotomy (MOWHTO).

Materials and methods

A total of 87 MOWHTO cases with a minimum of 2-year follow-up and second-look arthroscopic results available were enrolled. The cartilage degeneration state was evaluated by the International Cartilage Repair Society (ICRS) grading. Radiographic parameters including the hip–knee–ankle axis (HKA), medial proximal tibia angle (MPTA), posterior tibial slope, patellar height, mechanical lateral distal femoral angle (LDFA), joint line convergence angle (JLCA), joint line obliquity (JLO), and weight-bearing line ratio (WBLR) were measured. The pre-operative arthritic change was evaluated by Kellgren–Lawrence (KL) classification. According to the post-operative HKA, knees were divided into three (Under/Optimal/Over-correction) subgroups. Subjective International Knee Documentation Committee (IKDC) scores were evaluated and factors related to post-operative IKDC scores were analyzed.

Results

The pre-operative HKA (P = 0.002), post-operative HKA (P = 0.007), pre-operative MPTA (P = 0.011), and pre-operative WBLR (P = 0.031) were significantly related to the post-operative IKDC score. Cartilage degeneration states evaluated from first and second-look arthroscopy were not associated with post-operative IKDC score. Subgroup analysis revealed that the Under-correction group had significantly lower post-operative IKDC scores compared to the Optimal and Over-correction group (P = 0.012 and P = 0.030, respectively).

Conclusion

Our result suggests that a sub-optimal correction of coronal limb alignment negatively affects the early outcome of MOWHTO. On the other hand, the effect of the degree of cartilage degeneration was not significant.

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Abbreviations

HTO:

High tibial osteotomy

MOWHTO:

Medial open wedge high tibial osteotomy

LCWHTO:

Lateral closed wedge high tibial osteotomy

OA:

Osteoarthritis

HKA:

Hip–knee–ankle axis

MPTA:

Medial proximal tibia angle

PTS:

Posterior tibial slope

I–S ratio:

Insall–Salvati ratio

BMI:

Body mass index

KL:

Kellgren–Lawrence

ICRS:

International Cartilage Repair Society

IKDC:

International Knee Documentation Committee

VAS:

Visual analog scale

ICC:

Interclass correlation coefficient

LDFA:

Lateral distal femoral angle

JLCA:

Joint line convergence angle

JLO:

Joint line obliquity

WBLR:

Weight-bearing line ratio

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Funding

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIT) (No. 2020R1F1A1050436).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Korea

    Sang-June Lee, Jae-Hwa Kim & Wonchul Choi

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  2. Jae-Hwa Kim
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Contributions

SL was involved in acquiring the data, writing the manuscript and also researching the topic. J-HK conceived the study and performed all of the surgery. WC performed the data acquisition, analysis of results, statistical testing, and prepared and edited the manuscript. All authors read and approved the final manuscript.

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Correspondence to Wonchul Choi.

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Lee, SJ., Kim, JH. & Choi, W. Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state. Arch Orthop Trauma Surg 141, 1339–1348 (2021). https://doi.org/10.1007/s00402-021-03769-4

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