Abstract
IntroductionTo compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results.Materials and methodsSixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy.ResultsDuring the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and − 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05).ConclusionCompared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.
Highlights
To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO)
In TCVO group, Joint line convergence angle (JLCA) decreased to 1.2 ± 0.9° and medial tibial plateau depression (MTPD) increased to 5.9 ± 2.5° (p < 0.05)
In terms of limb alignment, pre-operative %MA was significantly lower in the TCVO group (5.4% ± 8.4%) than in the OWHTO group (15.9% ± 12.6%), and its value increased in both groups (p < 0.05)
Summary
To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). Lateral closed-wedge high tibial osteotomy is an established technique in correcting varus deformity of the proximal tibia, which could avoid or postpone knee arthroplasty. This technique is considered a demanding one due to significant complications such as risk of neurovascular injuries, tibiofibular joint disruption, and compartment syndrome [3, 4]. With the development of specially designed lockingcompression-fixation technique and availability of superior initial stability, medial open-wedge high tibial osteotomy (OWHTO) has gradually replaced close-wedge osteotomy procedure in treating varus deformed knees, especially for physically active patients who desire knee joint preservation [3, 5, 6]
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