Radiostereometric analysis of early anatomical changes following medial opening wedge high tibial osteotomy.

Abstract

The objective of this study was to use radiostereometric analysis (RSA) to evaluate the anatomical changes that occur in the tibia immediately after surgical correction with medial opening wedge high tibial osteotomy (HTO), and the changes that occur over the course of the first twelveweeks of osseous union. Patients included nine males and one female, with a mean age of 49.0 ± 5.5 years and mean BMI of 28.4 ± 3.8 kg/m(2). The patients underwent HTO using a non-locking plate. RSA marker beads were inserted in the tibia, femur, and patella. RSA exams were first obtained intra-operatively prior to the osteotomy, and subsequently at one, two, four, six, and twelveweeks postoperatively. Patients were corrected from a mean alignment preoperatively of 8.6 ± 2.5° to 0.3 ± 1.9° postoperatively, with a mean osteotomy of 12.5 ± 3.6mm. Immediate tibia changes surrounding the osteotomy site included 9.2 ± 2.4° of valgus rotation and 6.2 ± 2.0mm of distal translation. Secondary motions included 2.5 ± 2.4° of internal rotation of the distal tibia, 1.8 ± 1.4mm of posterior movement of the femur, and 8.5 ± 3.4mm of patella baja. Micromotion between the proximal and distal tibial segments decreased over time. The results suggest that subtle changes to the anatomy occur, beyond what is intended with the procedure, but partial corrections of these phenomena occurred over the twelveweeks. Micromotion surrounding the osteotomy site decreased with osseous union.