Abstract
BackgroundThe purpose of this study was to investigate the correction error associated with soft tissue balance in high tibial osteotomy (HTO) and the difference between opening wedge HTO (OWHTO) and closed wedge HTO (CWHTO).MethodsA total of 170 knees of 130 patients (85 knees of 68 patients in OWHTO and 85 knees of 62 patients in CWHTO) were evaluated. Anteroposterior radiographs of the knee and full-length leg were taken preoperatively, immediately under general anesthesia postoperatively, 2 days, and 1 and 12 months postoperatively. The femorotibial angle (FTA), joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA) were measured.ResultsThe postoperative FTA was decreased from 170.5 ± 2.1° at 0 day to 168.6 ± 2.2° at 2 days in OWHTO (P < 0.05), whereas it was not changed from 168.7 ± 2.4° at 0 day to 168.1 ± 2.8° at 2 days in CWHTO. The JLCA was 4.8 ± 1.8° preoperatively, 4.2 ± 1.9° at 0 day, 2.2 ± 1.8° at 2 days (P < 0.05 vs 0 day), 2.6 ± 1.7° at 1 month, and 2.7 ± 1.6° at 12 months in OWHTO, and 7.1 ± 3.2° preoperatively, 4.1 ± 2.4° at 0 day (P < 0.05 vs preoperative), 3.4 ± 2.5° at 2 days, 3.9 ± 2.3° at 1 month, and 4.2 ± 2.6° at 12 months in CWHTO. Multiple regression analysis showed that preoperative factors affecting change of the JLCA from preoperative to postoperative 1 month were the correction angle in OWHTO (P = 0.001) and the preoperative standing JLCA in OWHTO (P < 0.001) and CWHTO (P < 0.001).ConclusionsA significant decrease of the JLCA occurred immediately after osteotomy under anesthesia in CWHTO, whereas in OWHTO there was no decrease under anesthesia, but it decreased several days postoperatively.
Highlights
High tibial osteotomy (HTO) is an established realignment procedure to alter the mechanical load for medial compartmental osteoarthritis (OA) of the knee
The postoperative femorotibial angle (FTA) was significantly decreased from 0 day to 2 days in opening wedge high tibial osteotomy (HTO) (OWHTO) (P < 0.05), whereas it was not significantly altered during the postoperative period in closed wedge HTO (CWHTO)
The postoperative joint line convergence angle (JLCA) was significantly decreased from 0 day to 2 day in OWHTO (P < 0.05), whereas it was not significantly altered during the postoperative period in CWHTO
Summary
High tibial osteotomy (HTO) is an established realignment procedure to alter the mechanical load for medial compartmental osteoarthritis (OA) of the knee. Accurate correction is mandatory for success of the surgical procedure in HTO, since the long-term clinical outcomes depend on postoperative lower limb alignment [1, 2]. Correction error associated with changes of the JLCA is thought to occur due to a discrepancy between intraoperative and postoperative conditions in the assessment of limb alignment. It is difficult to predict the effect of soft tissue balance on postoperative limb alignment under different conditions. Filling the gap between preoperative or intraoperative prediction and the postoperative real measurements is a key to success in the achievement of more accurate correction. The purpose of this study was to investigate the correction error associated with soft tissue balance in high tibial osteotomy (HTO) and the difference between opening wedge HTO (OWHTO) and closed wedge HTO (CWHTO)
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