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Relationship between increased knee joint line obliquity after medial open-wedge high tibial osteotomy and patient-reported outcome measures

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study evaluated the correlation between postoperative knee joint line obliquity after medial open-wedge high tibial osteotomy and patient-reported outcome measures excluding excessively overcorrected knees. This study further identified preoperative radiological factors related to the increased postoperative knee joint line obliquity.

Materials and methods

We retrospectively evaluated patients who underwent medial open-wedge high tibial osteotomy between March 2013 and March 2021. Postoperative excessively overcorrected knees with hip-knee-ankle angle > 7° were excluded. We investigated radiological parameters and patient-reported outcome measures preoperatively and at the last follow-up. The following radiologic parameters were measured: hip-knee-ankle angle, weight-bearing line ratio, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, lateral distal tibial angle, joint line convergent angle, knee joint line obliquity, ankle joint line obliquity, hip abduction angle, tibial posterior slope, Carton-Deschamps index, and patella tilting angle. Clinical outcomes were evaluated using Japanese knee outcome measures. This assessment criterion is based on the Western Ontario McMaster Universities Arthritis Index and MOS Short Form 36. Multiple regression analysis was performed to evaluate the association between postoperative knee joint line obliquity and patient-reported outcome measures or preoperative radiological factors (P < .05).

Results

A total of 52 knees were included. The mean age at the time of the surgery was 61.6 ± 9.0 years and the mean follow-up period was 30.6 ± 10.1 months. Increased postoperative knee joint line obliquity was associated with lower Japanese knee outcome measures. The preoperative hip-knee-ankle angle was significantly associated with postoperative knee joint line obliquity.

Conclusions

Increased knee joint line obliquity after medial open-wedge high tibial osteotomy is associated with inferior clinical outcomes. Care should be given to the center of the rotational angulation in around-knee osteotomy to avoid postoperative increased knee joint line obliquity.

Level of evidence

Retrospective comparative study, Level III.

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Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Abbreviations

AJLO:

Ankle joint line obliquity

CDI:

Carton-Deschamps index

CORA:

Center of the rotational angulation

DFO:

Distal femoral osteotomy

HAA:

Hip abduction angle

HKA:

Hip-knee-ankle

JLCA:

Joint line convergent angle

LDTA:

Lateral distal tibial angle

MOWHTO:

Medial open-wedge high tibial osteotomy

mLDFA:

Mechanical lateral distal femoral angle

mMPTA:

Mechanical medial proximal tibial angle

OA:

Osteoarthritis

PROMs:

Patient-reported outcome measures

PT:

Patella tilting angle

TPS:

Tibial posterior slope

WBLR:

Weight-bearing line ratio

WOMAC:

Western Ontario McMaster Universities Arthritis Index

References

  1. Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D, Frank S, Schulz-Jahrsdörfer M, Richter J (2018) Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and Varus malalignment. Am J Sports Med 46:1362–1370. https://doi.org/10.1177/0363546518758016

    Article  PubMed  Google Scholar 

  2. Babis GC, An KN, Chao EY, Rand JA (2002) Double level osteotomy of the knee: a method to retain joint-line obliquity. J Bone Joint Surg Am 84:1380–1388. https://doi.org/10.2106/00004623-200208000-00014’

    Article  PubMed  Google Scholar 

  3. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM (2021) Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided. Knee Surg Sports Traumatol Arthrosc 29:3299–3309. https://doi.org/10.1007/s00167-020-06166-3

    Article  PubMed  Google Scholar 

  4. Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205. https://doi.org/10.1007/s00167-012-2122-3

    Article  PubMed  Google Scholar 

  5. Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K, Kambara S, Yoshiya S, Higa M (2018) Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc 26:1873–1878. https://doi.org/10.1007/s00167-017-4680-x

    Article  PubMed  Google Scholar 

  6. Wang D, Willinger L, Athwal KK, Williams A, Amis AA (2021) Knee joint line obliquity causes tibiofemoral subluxation that alters contact areas and meniscal loading. Am J Sports Med 49:2351–2360. https://doi.org/10.1177/03635465211020478

    Article  PubMed  PubMed Central  Google Scholar 

  7. Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Fujita K, Yamamuro Y (2019) Comparison of clinical and radiologic outcomes between normal and overcorrected medial proximal tibial angle groups after open-wedge high tibial osteotomy. Arthroscopy 35:2898-2908.e1. https://doi.org/10.1016/j.arthro.2019.04.030

    Article  PubMed  Google Scholar 

  8. Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S (2022) Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 30:688–697. https://doi.org/10.1007/s00167-020-06430-6

    Article  PubMed  Google Scholar 

  9. Lee SS, So SY, Jung EY, Kim HJ, Lee BH, Wang JH (2019) Predictive factors for patellofemoral degenerative progression after opening-wedge high tibial osteotomy. Arthroscopy 35:1703–1710. https://doi.org/10.1016/j.arthro.2019.01.032

    Article  PubMed  Google Scholar 

  10. Yang JH, Lee SH, Nathawat KS, Jeon SH, Oh KJ (2013) The effect of biplane medial opening wedge high tibial osteotomy on patellofemoral joint indices. Knee 20:128–132. https://doi.org/10.1016/j.knee.2012.09.019

    Article  CAS  PubMed  Google Scholar 

  11. Hirschmann MT, Hess S, Behrend H, Amsler F, Leclercq V, Moser LB (2019) Phenotyping of hip–knee–ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability. Knee Surg Sports Traumatol Arthrosc 27:1378–1384. https://doi.org/10.1007/s00167-019-05507-1

    Article  PubMed  Google Scholar 

  12. So SY, Lee SS, Jung EY, Kim JH, Wang JH (2020) Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28:1516–1525. https://doi.org/10.1007/s00167-019-05555-7

    Article  PubMed  Google Scholar 

  13. Doi T, Akai M, Fujino K, Hoshino Y, Iwaya T, Sunami Y (2010) Effect of nonsteroidal anti-inflammatory drug plasters for knee osteoarthritis in Japanese: a randomized controlled trial. Mod Rheumatol 20:24–33. https://doi.org/10.1007/s10165-009-0227-4

    Article  PubMed  Google Scholar 

  14. Tsuji T, Yoon J, Aiba T, Kanamori A, Okura T, Tanaka K (2014) Effects of whole-body vibration exercise on muscular strength and power, functional mobility and self-reported knee function in middle-aged and older Japanese women with knee pain. Knee 21:1088–1095. https://doi.org/10.1016/j.knee.2014.07.015

    Article  PubMed  Google Scholar 

  15. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial’ osteotomy A new fixation device. Clin Orthop Relat Res 246:250–259

    Article  Google Scholar 

  16. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608. https://doi.org/10.1016/S0030-5898(20)30753-7

    Article  CAS  PubMed  Google Scholar 

  17. Staubli AE, de Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: A new LCP-concept for open wedge osteotomy of the medial proximal tibia - Early results in 92 cases. Injury 34(Supplement 2):B55–B62. https://doi.org/10.1016/j.injury.2003.09.025

    Article  PubMed  Google Scholar 

  18. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25:46–53. https://doi.org/10.1016/j.arthro.2008.08.015

    Article  PubMed  Google Scholar 

  19. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  20. Hiramatsu K, Yamada Y, Nakamura N, Mitsuoka T (2022) Factors associated with postoperative knee joint line obliquity after medial open wedge high tibial osteotomy. Am J Sports Med 50:1651–1658. https://doi.org/10.1177/03635465221079343

    Article  PubMed  Google Scholar 

  21. Rosso F, Rossi R, Cantivalli A, Pilone C, Bonasia DE (2022) Joint line obliquity does not affect the outcomes of opening wedge high tibial osteotomy at an average 10-year follow-up. Am J Sports Med 50:461–470. https://doi.org/10.1177/03635465211059811

    Article  PubMed  Google Scholar 

  22. Cohen J, Cohen P, West SG, Aiken LS (2003) Applied multiple regression/ correlation analysis for the Behavioral Sciences. Lawrence Erlbaum Associates

    Google Scholar 

  23. Akamatsu Y, Kumagai K, Kobayashi H, Tsuji M, Saito T (2018) Effect of increased coronal inclination of the tibial plateau after opening-wedge high tibial osteotomy. Arthroscopy 34:2158-2169.e2. https://doi.org/10.1016/j.arthro.2018.01.055

    Article  PubMed  Google Scholar 

  24. Kim GW, Kang JK, Song EK, Seon JK (2021) Increased joint obliquity after open-wedge high tibial osteotomy induces pain in the lateral compartment: a comparative analysis of the minimum 4-year follow-up outcomes using propensity score matching. Knee Surg Sports Traumatol Arthrosc 29:3495–3502. https://doi.org/10.1007/s00167-020-06342-5

    Article  PubMed  Google Scholar 

  25. Kim JS, Lim JK, Choi HG, Jeong HW, Park SB, Shim SJ, Lee YS (2022) Excessively increased joint-line obliquity after medial opening-wedge high tibial osteotomy is associated with inferior radiologic and clinical outcomes: what is permissible joint-line obliquity. Arthroscopy 38:1904–1915. https://doi.org/10.1016/j.arthro.2021.11.004

    Article  PubMed  Google Scholar 

  26. Park JG, Han SB, Jang KM (2021) Association of preoperative tibial Varus deformity with joint line orientation and clinical outcome after open-wedge high tibial osteotomy for medial compartment osteoarthritis: A propensity score–matched analysis. Am J Sports Med 49:3551–3560. https://doi.org/10.1177/03635465211044146

    Article  PubMed  Google Scholar 

  27. Song JH, Bin SI, Kim JM, Lee BS (2020) What is an acceptable limit of joint-line obliquity after medial open wedge high tibial osteotomy? Analysis based on midterm results. Am J Sports Med 48:3028–3035. https://doi.org/10.1177/0363546520949552

    Article  PubMed  Google Scholar 

  28. Lee SS, Kim JH, Kim S, Jung EY, Ryu DJ, Lee DK, Wang JH (2022) Avoiding overcorrection to increase patient satisfaction after open wedge high tibial osteotomy. Am J Sports Med 50:2453–2461. https://doi.org/10.1177/03635465221102144

    Article  PubMed  Google Scholar 

  29. Oh KJ, Ko YB, Bae JH, Yoon ST, Kim JG (2016) Analysis of knee joint line obliquity after high tibial osteotomy. J Knee Surg 29:649–657. https://doi.org/10.1055/s-0036-1571430

    Article  PubMed  Google Scholar 

  30. Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136:1337–1342. https://doi.org/10.1007/s00402-016-2521-x

    Article  PubMed  Google Scholar 

  31. Kim JE, Kim DH, Lee JI, Choi HG, Jung YS, Lee SH, Lee YS (2021) Difference of preoperative varus-valgus stress radiograph is effective for the correction accuracy in the preoperative planning during open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 29:1035–1044. https://doi.org/10.1007/s00167-020-06076-4

    Article  PubMed  Google Scholar 

  32. Kim MS, Koh IJ, Sung YG, Park DC, Han SB, In Y (2021) Alignment adjustment using the valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy. BMC Musculoskelet Disord 22:585. https://doi.org/10.1186/s12891-021-04475-3

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lee OS, Lee ES, Lee YS (2019) Disparity between preoperative target correction amount and postoperative correction amount in open wedge high tibial osteotomy. Knee Surg Relat Res 31:126–131. https://doi.org/10.5792/ksrr.18.034.10.5792/ksrr.18.034

    Article  PubMed  PubMed Central  Google Scholar 

  34. Paley D (2002) Principles of deformity correction around the knee. Springer-Verlag. https://doi.org/10.1007/s001320050004

    Article  Google Scholar 

  35. Iseki T, Onishi S, Kanto M, Kanto R, Kambara S, Yoshiya S, Tachibana T, Nakayama H (2021) Double-level osteotomy for severe varus osteoarthritic knees can prevent change in leg length and restore physiological joint geometry. Knee 31:136–143. https://doi.org/10.1016/j.knee.2021.04.011

    Article  PubMed  Google Scholar 

  36. Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S, Schröter S (2020) Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc 28:742–750. https://doi.org/10.1007/s00167-018-5103-3

    Article  PubMed  Google Scholar 

  37. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 139:519–527. https://doi.org/10.1007/s00402-018-3068-9

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors have no potential conflicts of interest, including financial interests, activities, relationships, and affiliations.

Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South1 West16, Chuo-ku, Sapporo, 060-8543, Japan

    Kazushi Horita, Shinichiro Okimura, Kodai Hamaoka, Yasutoshi Ikeda, Yohei Okada, Tomoaki Kamiya & Atsushi Teramoto

  2. Sapporo Maruyama Seikeigeka Hospital, Sapporo, Japan

    Tomoyuki Suzuki

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  1. Kazushi Horita
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  2. Shinichiro Okimura
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Contributions

KH and SO study design. KH collected the data, interpreted the data, and wrote the paper. KH data collection. All authors provided critical feedback and helped to shape the manuscript.

Corresponding author

Correspondence to Shinichiro Okimura.

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The authors have no potential conflicts of interest, including financial interests, activities, relationships, and affiliations.

Ethical approval

The study protocol was approved by the Ethics Committee of Sapporo Medical University Hospital (Institutional Review board No. 3320-3064).

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All patients involved in the study have received and approved an informed consent.

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Appendix

Appendix

See below Appendix Tables 

Table 6 Intraclass correlation coefficients of the radiologic parameters
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6 and

Table 7 Correlation between postoperative KJLO and postoperative TPS, CDI, and PT
Full size table

7.

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Horita, K., Okimura, S., Hamaoka, K. et al. Relationship between increased knee joint line obliquity after medial open-wedge high tibial osteotomy and patient-reported outcome measures. Arch Orthop Trauma Surg 144, 1751–1762 (2024). https://doi.org/10.1007/s00402-024-05203-x

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