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Changes in ankle and hip joints following medial opening-wedge high tibial osteotomy affect knee joint line obliquity

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to measure the change in knee joint line obliquity (KJLO) and the changes in radiologic parameters of the ankle and hip joints after medial opening-wedge high tibial osteotomy (MOWHTO), and to evaluate the correlation and causal relationship between these parameters.

Methods

This study evaluated 109 patients who underwent MOWHTO between April 2015 and December 2021. Radiologic parameters, including KJLO, medial proximal tibial angle (MPTA), ankle joint line obliquity (AJLO), and hip abduction angle (HAA), were analysed before and 1 year after MOWHTO. Multiple linear regression analysis was used to identify independent variables that significantly affected the change in KJLO after MOWHTO. Receiver operating characteristic (ROC) analysis was used to evaluate the cutoff value for a change in KJLO that exceeded 5° postoperatively, and the predicting values of radiologic parameters.

Results

Multiple linear regression analysis showed that changes in MPTA, AJLO, and HAA (β = 0.440, P < 0.001; β = − 0.310, P < 0.001; β = 0.164, P = 0.035, respectively) were predictors of the change in KJLO after MOWHTO. ROC analysis showed that the threshold value for a change in KJLO which exceeded 5° postoperatively was 4.6° (66.7% sensitivity, 63.8% specificity, P = 0.025). Moreover, ROC curves for predicting a change in KJLO of > 4.6° showed that the AUC was significantly higher for the change in MPTA than that of the other two parameters (P = 0.011 for AJLO and P < 0.001 for HAA).

Conclusion

MOWHTO increases the KJLO by valgization of the proximal tibia and causes hip adduction and ankle valgization. The postoperative ankle valgization after MOWHTO could reduce the increase in KJLO, counteracting the effects of proximal tibial valgization and hip adduction. Therefore, the effects of the hip and ankle joints should be considered to achieve an optimal KJLO and satisfactory clinical outcomes after MOWHTO.

Level of study

Cohort study, IV.

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Funding

This study received no funding.

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Author notes

  1. Sang-Gyun Kim and June-Bum Jun contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, National Medical Center, Seoul, South Korea

    Sang-Gyun Kim & Il Wook Bae

  2. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    June-Bum Jun & Dae-Hee Lee

Authors
  1. Sang-Gyun Kim
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  2. June-Bum Jun
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Corresponding author

Correspondence to Dae-Hee Lee.

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Conflict of interest

The authors declare that they have no conflict of interest related to this study.

Ethical approval

This study was approved by the institutional review board. (ID: 2023–01-097, Samsung Medical Center).

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Acquisition of informed consent was not applicable in this study.

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Kim, SG., Jun, JB., Bae, I.W. et al. Changes in ankle and hip joints following medial opening-wedge high tibial osteotomy affect knee joint line obliquity. Knee Surg Sports Traumatol Arthrosc 31, 5420–5427 (2023). https://doi.org/10.1007/s00167-023-07581-y

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  • DOI: https://doi.org/10.1007/s00167-023-07581-y

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