Abstract
BackgroundMedial open wedge high tibial osteotomy (OWHTO) may result in lower limb discrepancy (LLD), and some patients experience uncomfortable symptoms. Studies have found that the degree of LLD is one but not the only high-risk factor for inducing symptoms. The main purpose of this study is to explore the risk factors for symptomatic LLD.MethodsSixty-four patients who underwent OWHTO in our hospital between June 2018 and January 2020 were included in the study. Changes in tibia length, lower limb length, femorotibial angle (FTA), LLD, and KOOS score were evaluated before and 1 year after surgery. Questionnaire was used to investigate whether patients had uncomfortable symptoms of LLD after surgery. Binary logistic regression was applied to analyze the risk factors of symptomatic LLD.ResultsThere were 18 patients with subjective LLD uncomfortableness, 13 of them were occasional and 5 were frequent. Patients had a mean correction angle of 11.7° ± 4.6°, with a mean increase in tibial length of 6.0 ± 3.5 mm, lower limb length of 7.5 ± 2.3 mm, and LLD of 6.9 ± 4.2 mm at 1 year post-operation. Preoperative and postoperative changes in tibia length and lower limb length were statistically significant (P < 0.0001).There were statistically significant differences in pain, symptoms, ADL, sports/recreations, QOL of KOOS subclassification before and after surgery (P < 0.0001). Binary logistic regression revealed that age ≥ 55, BMI ≥ 28, and LLD ≥ 10 mm were high-risk factors for symptomatic LLD (P = 0.031, OR = 4.82; P = 0.012, OR = 6.251; P = 0.006, OR = 6.836).ConclusionPatients with age ≥ 55, BMI ≥ 28, and postoperative LLD ≥ 10 mm are more likely to develop symptomatic LLD. Older or heavier patients, who are expected to have an LLD greater than 10 mm after OWHTO should be fully informed of the possibility of postoperative LLD symptoms.
Highlights
Medial open wedge high tibial osteotomy (OWHTO) may result in lower limb discrepancy (LLD), and some patients experience uncomfortable symptoms
As a classic knee preserving surgery, high tibial osteotomy (HTO) has been developed for nearly 60 years and is one of the effective surgical interventions for treating medial compartment osteoarthritis of the knee combined with varus deformity [1]
Due to the continuous increase of pressure in the medial compartment, the medial joint space is gradually narrowed, which leads to relaxation of the lateral collateral ligament (LCL) and contraction of the medial collateral ligament (MCL), further aggravating the varus deformity and osteoarthritis, forming a vicious circle [2, 3]
Summary
Medial open wedge high tibial osteotomy (OWHTO) may result in lower limb discrepancy (LLD), and some patients experience uncomfortable symptoms. After varus deformity of lower limbs, the stress concentration in the medial compartment during loading increases the pressure on the surface of the cartilage, and when it exceeds the bearing capacity, the articular cartilage injuries can occur, leading to osteoarthritis, resulting in knee pain and limited activity, which affect the patient’s quality of life. By correcting the mechanical axis of the lower limbs, HTO shifts the weight-bearing line outward, decreases the stress concentration of the medial compartment, effectively blocks the vicious cycle and delays the progression of OA [4]. The correction of lower limb weight bearing line can be achieved by either medial open wedge high tibial osteotomy (OWHTO) or lateral closed wedge high tibial osteotomy (CWHTO) [5]. The purpose of this study was to explore the risk factors for symptomatic LLD, so as to assist clinical decision-making and improve the level of treatment
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