Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results

Ko Chiba,Goji Chiba,Takashi Miyamoto,Makoto Osaki,Akihiko Yonekura

doi:10.1007/s00402-016-2609-3

Ko Chiba, Goji Chiba + Show 3 more

Open Access

https://doi.org/10.1007/s00402-016-2609-3

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Abstract

PurposeTibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure.Methods11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated.ResultsThe VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure.ConclusionImprovements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

Highlights

ResultsThe visual analog scale (VAS) improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively
High tibial osteotomy (HTO) is an effective treatment for unicompartmental varus knee osteoarthritis (OA), especially for young and elder patients as well as physically active individuals, despite the widespread use of joint replacements [1,2,3,4,5]
The visual analog scale (VAS) improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively

Summary

Results

The advantages of TCVO are: (1) the lateral joint can be reduced during the operation; (2) joint instability can be improved; (3) less risk of hinge fracture; (4) no need for long screw insertion; and (5) early weight-bearing can be started. For a severe case of tibia varus deformity, the lateral joint needs to be over-corrected so that the alignment of the lower extremity becomes valgus enough. By performing TCVO, improvements in pain and activities of daily living were observed with valgus correction of the lower extremity along with reduction and stabilization of the femorotibial joint. With making early weight-bearing possible and a minimal risk of serious postoperative complications, the effectiveness of TCVO for varus knee OA with a subluxated lateral joint was confirmed

Conclusion

Introduction

Methods

Surgical procedure

Compliance with ethical standards