Paper 23: Taking the Load Off: Effect of Varus Producing Distal Femoral Osteotomy and High Tibial Osteotomy on Compartment Pressures and Contact Area in Varying Stages of Knee Flexion

Abstract

Objectives: Study Objective: Evaluate mean contact area, mean contact pressure, and peak contact pressure in the medial and lateral compartment of the knee following varus producing high tibial osteotomy and distal femoral osteotomy in varying states of knee flexion (0*, 30*, 60*, 90*). Background: Genu valgum causes mechanical pressure to be transferred to the lateral compartment. In patients with valgus alignment and a diseased lateral compartment, both lateral opening wedge distal femoral osteotomy (DFO) and high tibial closing wedge osteotomy (HTO) can be used to unload a diseased lateral compartment of the knee. To the best of our knowledge, there are no biomechanical studies investigating how a DFO and HTO affect lateral compartment contact pressure and area in varying states of flexion. Prior anatomic studies have shown that, in valgus knees, the tibial wear is posterior. Additional, biomechanical studies have indicated that DFO exerts the greatest effect in full extension but it’s effect is decreased as flexion angle rises. Hypothesis: Medial closing wedge high tibial osteotomy will significantly decrease contact area, mean contact pressure and peak contact pressure in the lateral knee compartment through knee flexion to a greater extent compared to lateral opening wedge distal femoral osteotomy. Methods: Lateral opening wedge DFO and medial closing wedge HTO was performed, correcting a mean of 8°, in 10 cadaveric knees using plate fixation. Tibio- femoral contact pressure of the medial and lateral compartment was measured in 0°, 30°, 60°, and 90° of knee flexion before and after osteotomy using thin electronic sensors (K-scan Model 4000, 1500 psi; Tekscan Inc, South Boston, MA) and load applied through an Instron device (Instron, Norwood, MA). Peak contact pressure (PCP), average contact pressure (ACP), and contact area (CA) were measured for each condition. Mixed-effects regression analyses were used to compare the change in variables before and after osteotomy and between flexion angles. Results: The lateral ACP was significantly decreased in the HTO state when compared to native in 30° (p=0.015), 60° (p=0.0199), and 90° (p<0.0001) of flexion. The lateral ACP was also significantly decreased in the HTO state when compared to the DFO state in 60° (p=0.0093) and 90° of flexion (p<0.0001). Following DFO, the lateral ACP returned to that of the native state in 60° (p=1.000) and 90° (p=1.000) of flexion. The medial ACP was significantly increased when compared to both the native and HTO state in 60° (p<0.001; p=0.015) and 90° (p<0.0001; p=0.0435) of flexion. Conclusions: With varus corrections of <10°, medial closing HTO is more effective at unloading the lateral compartment than lateral opening DFO. This effect is amplified as the knee flexion angle increases.