Abstract
Purpose
The purpose of this study was to detect the pre- and intra-operative influential factors for lower limb alignment correction error in open-wedge high tibial osteotomy (OWHTO).
Methods
This study involved 69 patients (71 knees) undergoing OWHTO for primary medial osteoarthritis. The weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured on radiographs preoperatively and at 1 month after surgery, and the differences between the pre- and postoperative values were calculated. The correction angle during surgery was also investigated. The radiological correction angle was defined as the difference between the pre- and postoperative MPTA. The correction error was defined as the difference between the correction angle during surgery and the radiological correction angle. The ideal correction angle was defined as when the postoperative WBL passed through Fujisawa’s point (WBL = 62.5%), and the alignment error was defined as the difference between the postoperative WBL ratio and 62.5. The correlations among the alignment error, the correction error, correction angle during surgery, pre- and postoperative WBL ratio, MPTA, and JLCA and the differences between the pre and postoperative WBL ratio, MPTA, and JLCA were investigated. In addition, the factor most influential on the alignment error was determined.
Results
The preoperative MPTA was the only predictor of the alignment error after OWHTO. The alignment error was positively correlated with the correction error and correction angle during surgery, and negatively correlated with pre- and postoperative WBL ratio, MPTA, and differences between the pre- and postoperative WBL ratio and JLCA.
Conclusion
The preoperative MPTA was the only pre- and intra-operative predictor of the alignment error after OWHTO. The larger the correction angle, the greater the alignment error. The MPTA was recommended as an indicator for improving the correction accuracy. Accurate correction based on the MPTA provides good lower limb alignment and better clinical results.
Level of evidence
III Case–control study/Retrospective comparative study.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declartion and its later amendments or comparable ethical standards.
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Kubota, M., Ohno, R., Sato, T. et al. The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27, 2410–2416 (2019). https://doi.org/10.1007/s00167-018-5216-8
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DOI: https://doi.org/10.1007/s00167-018-5216-8