Abstract
BackgroundThe purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO.MethodsThirty-two cases involving 35 knees that had undergone HTO and the same number that had undergone TCVO for knee osteoarthritis were retrospectively evaluated. Characteristics of both groups did not differ significantly. Lower limb alignment, bone morphology, joint congruity, and joint instability were measured in standing full-length leg and knee radiographs obtained before and after surgery.ResultsRadiological features in the TCVO group included greater frequencies of advanced knee OA grade, varus lower limb malalignment, depression of the medial tibial plateau, and varus-valgus joint instability compared to the HTO group before surgery. However, tibial morphology, alignment of the lower limb, and joint instability improved to comparable levels after surgery in both groups.ConclusionsTCVO appears preferable in cases with advanced knee OA, destroyed or inclined medial tibial plateau, widened and subluxated lateral joint, and high varus-valgus joint instability.
Highlights
The purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO
OA knees with high varus-valgus joint instability, depression or inclination of the medial tibial plateau (Pagoda deformity [29]), lateral joint dilation, and lateral tibial thrust > 1 cm were included for TCVO, whereas other cases with high joint stability and without depression of the medial tibial plateau were included for HTO, in accordance with the criteria of the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS) [15]
In terms of lower limb alignment before surgery, femorotibial angle (FTA) was significantly higher in the TCVO group (183.4 ± 3.9°) than in the HTO group (180.9 ± 3.7°; P < 0.01) and HKA angle was significantly lower in the TCVO group (170.2 ± 3.2°) than in the HTO group (172.9 ± 2.9°; P < 0.01)
Summary
The purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO. Surgical approaches to the treatment of advanced medial unicompartmental knee OA have received considerable attention, and recent studies have highlighted the efficacy of osteotomy and prosthetic arthroplasty [5,6,7]. Due to advances in both materials and designs, the longevity of total knee arthroplasty (TKA) has increased, and patients from a diverse age range are undergoing this procedure [6, 7]. Knee OA with a Kellgren-Lawrence (K/L) grade [25] ≥ 2 or laxity of the knee joint represent risk factors for declining clinical outcomes after HTO [24, 26]. In terms of indications, HTO is restricted to patients with mild to moderate medial knee OA in which high joint stability is maintained [5, 15]
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