Abstract
BackgroundHigh tibial osteotomy is an established and helpful treatment for unicompatimental osteoarthritis associated with varus deformity. However, asupratubercle high tibial osteotomy leads to a decrease in patellar height making the technique not suitable in case of concomitant patella baja. Moreover, this kind of osteotomy can change in situ forces at patellofemoral joint and the lateral patellar tilt. With the aim to widen the indication of high tibial osteotomy was proposed a biplane opening wedge high tibial osteotomy with a distal tuberosity osteotomy (B-OWHTO). This technique provide that the tibial tuberosity remains joined to the tibial metaphysis so as not to theoretically alter the patellar height. However, some Authors claim that BOWHTO could lead to an increase in tibial slope. The purpose of the present study was to assess the tibial slope, patella-femoral changes and axial correction as well as functional outcomes following a B-OWHTO.MethodsPatients operated on with a B-OWHTO and a minimum 24 months of follow-up were included. The mechanical alignment of the lower limb, patellar height, lateral patellar tilt and posterior tibial slope were calculated preoperatively, immediately after surgery and at the 24-month follow-up. The clinical results were evaluated using the Lysholm, Kujala and Hospital for Special Surgery knee scores. The possible postoperative development of patellofemoral pain or radiologic patellofemoral alteration was also evaluated.ResultsTwenty-three patients were included with a mean follow-up of 33 months (range 27-41). The mechanical alignment of the lower limb shifted from a mean 9.3º ± 2.5 varus preoperatively to a mean 0.2º ± 2.2 valgus postoperatively. No changes in patellar height, lateral patellar tilt or in the posterior tibial slope were observed. The mean Lysholm and HSS scores improved from 68.3 ± 9.1 and 64.2 ± 5.2 preoperatively to 93.2 ± 2.1 and 94.1 ± 3.6 at final follow-up (p < 0.01). The mean Kujala score improved from 67.3 ± 9.8 to 86.4 ± 7.6 at final follow up (p < 0.01). No patients developed both radiological or clinical symptoms at patellofemoral joint.ConclusionsOpen wedge high tibial osteotomy with a dihedral L-cut distal and posterior to the tibial tubercle accurately corrected axial malalignment without any change at patella-femoral joint or any modification to the posterior tibial slope while providing improved knee function at short-term follow-up. The radiographic as well as the clinical results support the use of this technique to treat medial compartment knee osteoarthritis and varus malalignment in young and middle-aged patients with a normal-to-low patellar height.Level of evidenceCase series with no comparison group, Level IV.
Highlights
High tibial osteotomy is an established and helpful treatment for unicompatimental osteoarthritis associated with varus deformity
The use of an Open wedge high tibial osteotomy (OWHTO) is not usually recommended in cases of patella infera. (Schallberger et al 2011; Lobenhoffer et al 2009) it should be kept in mind that the origin of patella infera is likely multifactorial and so even patients with a preoperative normal-to-low patellar height could end up with this condition
A study recently has shown that an alteration of the axial alignment of the patella with a change of the lateral patellar tilt can be observed with a standard OWHTO
Summary
High tibial osteotomy is an established and helpful treatment for unicompatimental osteoarthritis associated with varus deformity. Asupratubercle high tibial osteotomy leads to a decrease in patellar height making the technique not suitable in case of concomitant patella baja This kind of osteotomy can change in situ forces at patellofemoral joint and the lateral patellar tilt. They include avoiding a fibular osteotomy and the risk of peroneal nerve complications (Gaasbeek et al 2010), smaller surgical exposure without muscle detachment, easier and more precise correction that can be change even after the osteotomy cut (Bito et al 2009; Hankemeier et al 2010) It can make an eventual future knee replacement easier due to the location of the skin approach but more because an OWHTO decreases the metaphyseal deformity caused by a closed wedge (Hui et al 2011). This fact could contribute to explaining the changes described before (Lee et al 2016)
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