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Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

(1) To evaluate the effect of staged bilateral medial opening wedge high tibial osteotomy (HTO) on established biomechanical risk factors for disease progression and on validated measures of pain and function and (2) To compare outcomes in patients having the second surgery staged within or beyond 12 months of the first surgery.

Methods

Thirty-seven patients with bilateral varus alignment and medial compartment osteoarthritis underwent staged bilateral medial opening wedge HTO (21 within and 16 beyond 12 months). Patients underwent full-limb standing anteroposterior radiographs to determine frontal plane alignment (mechanical axis angle) and three-dimensional gait analysis to estimate the distribution of load across the tibiofemoral compartments (external knee adduction moment). Patients also completed the Knee Injury and Osteoarthritis Outcomes Scores (KOOS), the Lower Extremity Functional Scale, the Short Form Health Survey and the six-minute walk test (6MWT). Patients (both limbs) were evaluated before and approximately 6, 12 and 24 months after each surgery.

Results

There were statistically and clinically significant changes in both limbs that were of similar magnitudes and that remained relatively stable over time postoperatively. Mean (95 % CI) improvements in outcomes were as follows. Mechanical axis angle: 9.4° (8.4°, 10.4°) (i.e. average change of both limbs), peak knee adduction moment: −1.7 %BW*Ht (−2.1, −1.4 %BW*Ht) (i.e. average change of both limbs), 6MWT: 36.7 m (19.4, 54.0 m), SF-12 Physical Component Summary: 12.0 (8.5, 15.5) and KOOS Pain: 25.4 (19.6, 31.2). Other than the shorter time period to reach maximum benefit of both surgeries, there were no remarkable differences at final assessment between patients having surgeries staged within or beyond 12 months.

Conclusions

The present findings demonstrate that patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally (mechanical axis angles and external knee adduction moments), as well as clinically important improvements in patient-important outcomes, after staged medial opening wedge HTO. Current findings suggest no difference in outcomes for patients who have the second surgery staged within or beyond 12 months of the first surgery.

Level of evidence

IV.

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Acknowledgments

The authors acknowledge Mr. Ian C. Jones, MA, for his assistance.

Conflict of interest

This research was undertaken thanks to funding from the Canada Research Chairs Program (TBB), the Canadian Institutes of Health Research (CIHR) and Arthrex Inc.

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Authors and Affiliations

  1. Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, N6A 3K7, Canada

    Emily L. Sischek, Trevor B. Birmingham, Kristyn M. Leitch, Robin Martin, Kevin Willits & J. Robert Giffin

  2. Wolf Orthopaedic Biomechanics Laboratory, University of Western Ontario, London, ON, Canada

    Emily L. Sischek, Trevor B. Birmingham & J. Robert Giffin

  3. Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, ON, Canada

    Trevor B. Birmingham

  4. Biomedical Engineering Graduate Program, University of Western Ontario, London, ON, Canada

    Trevor B. Birmingham & Kristyn M. Leitch

  5. Department of Surgery, Schulich School of Medicine, University of Western Ontario, London, ON, Canada

    Kevin Willits & J. Robert Giffin

Authors
  1. Emily L. Sischek
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  2. Trevor B. Birmingham
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  3. Kristyn M. Leitch
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  4. Robin Martin
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  5. Kevin Willits
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  6. J. Robert Giffin
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Corresponding authors

Correspondence to Trevor B. Birmingham or J. Robert Giffin.

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Sischek, E.L., Birmingham, T.B., Leitch, K.M. et al. Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 22, 2672–2681 (2014). https://doi.org/10.1007/s00167-013-2559-z

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  • DOI: https://doi.org/10.1007/s00167-013-2559-z

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