Skip to main content
SpringerLink
Log in

Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis

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

Abstract

Purpose

To evaluate patellofemoral congruity after opening wedge high tibial osteotomy (OWHTO) and hybrid HTO.

Methods

Twenty-four knees with hybrid HTO and 24 with OWHTO were evaluated in this study. The Caton–Deschamps and modified Miura–Kawamura indices were used to evaluate pre- and post-operative patellar heights for both types of surgery. Tibial tuberosity–trochlear groove (TT–TG) distance, patellar tilt, and medial and lateral joint space at the patellofemoral joint were compared. Anterior knee pain was assessed using the Kujala anterior knee pain scale.

Results

There was no significant difference between the correction angles of the hybrid HTO and OWHTO. Pre- and post-operative values for the Caton–Deschamps and modified Miura–Kawamura indices in patients who underwent hybrid HTO changed from 0.90 to 0.94 and from 0.95 to 1.03, respectively, with no significant differences noted. Following OWHTO, these values decreased significantly from 0.91 to 0.73 and from 1.06 to 0.84, respectively (p < 0.01). The post-operative patellar height after OWHTO was significantly lower than that after hybrid HTO (p < 0.01). After hybrid HTO, the TT–TG distance decreased significantly from 11.4 to 7.4 (p < 0.01), but it did not change significantly after OWHTO. Although pre- and post-operative patellar tilt were not altered significantly in either group, the medial joint space of the patellofemoral joint was significantly increased post-operatively following hybrid HTO (p = 0.035). The pre-operative Kujala scores were significantly lower in the hybrid HTO group, but post-operative scores improved in both groups.

Conclusions

Hybrid HTO provides a better post-operative patellofemoral joint than does OWHTO with regard to patellar position and reduction of the TT–TG distance, as well as improved clinical outcomes. Hybrid HTO, rather than OWHTO, is the preferred technique for the treatment of varus knees combined with patellofemoral osteoarthritis.

Level of evidence

Retrospective comparative study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CWHTO:

Closing wedge high tibial osteotomy

FTA:

Femorotibial angle

HTO:

High tibial osteotomy

MPTA:

Medial proximal tibial angle

OA:

Osteoarthritis

OWHTO:

Opening wedge high tibial osteotomy

PACS:

Picture archiving and communication system

%MA:

Percent of mechanical axis

TT–TG:

Tibial tuberosity–trochlear groove

References

  1. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy. J Bone Joint Surg Br 90:592–596

    Article  CAS  PubMed  Google Scholar 

  2. Amzallag J, Pujol N, Maqdes A, Beaufils P, Judet T, Catonne Y (2013) Patellar height modification after high tibial osteotomy by either medial opening-wedge or lateral closing-wedge osteotomies. Knee Surg Sports Traumatol Arthrosc 21:255–259

    Article  CAS  PubMed  Google Scholar 

  3. Bin S-I, Kim H-J, Ahn H-S, Rim DS, Lee D-H (2016) Changes in patellar height after opening wedge and closing wedge high tibial osteotomy: a meta-analysis. Arthroscopy 32:2393–2400

    Article  PubMed  Google Scholar 

  4. Bode G, Heyden von J, Pestka J, Schmal H, Salzmann G, Südkamp N, Niemeyer P (2015) Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23:1949–1955

    Article  PubMed  Google Scholar 

  5. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68:317–325

    CAS  PubMed  Google Scholar 

  6. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  PubMed  Google Scholar 

  7. Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 41:1149–1160

    Article  PubMed  Google Scholar 

  8. Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984

    Article  PubMed  Google Scholar 

  9. Gaasbeek RDA, Sonneveld H, van Heerwaarden RJ, Jacobs WCH, Wymenga AB (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11:457–461

    Article  CAS  PubMed  Google Scholar 

  10. Ittenbach RF, Huang G, Barber Foss KD, Hewett TE, Myer GD (2016) Reliability and validity of the anterior knee pain scale: applications for use as an epidemiologic screener. PLoS One 11:e0159204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kenawey M, Liodakis E, Krettek C, Ostermeier S, Horn T, Hankemeier S (2011) Effect of the lower limb rotational alignment on tibiofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc 19:1851–1859

    Article  PubMed  Google Scholar 

  12. Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y (2005) Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:539–544

    Article  PubMed  Google Scholar 

  13. Kim H-J, Lee H-J, Shin J-Y, Park K-H, Min S-G, Kyung HS (2017) Preoperative planning using the picture archiving and communication system technique in high tibial osteotomy. J Orthop Surg (Hong Kong) 25:2309499016684701

    Google Scholar 

  14. Kohn L, Sauerschnig M, Iskansar S, Lorenz S, Meidinger G, Imhoff AB, Hinterwimmer S (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:146–151

    Article  CAS  PubMed  Google Scholar 

  15. Koshino T (1982) The treatment of spontaneous osteonecrosis of the knee by high tibial osteotomy with and without bone-grafting or drilling of the lesion. J Bone Joint Surg Am 64:47–58

    Article  CAS  PubMed  Google Scholar 

  16. Krause M, Drenck TC, Korthaus A, Preiss A, Frosch K-H, Akoto R (2018) Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc 26:1859–1866

    Article  PubMed  Google Scholar 

  17. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  CAS  PubMed  Google Scholar 

  18. LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170

    Article  PubMed  Google Scholar 

  19. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  PubMed  Google Scholar 

  20. Monllau JC, Erquicia JI, Ibañez F, Ibañez M, Gelber PE, Masferrer-Pino A, Pelfort X (2017) Open-wedge valgus high tibial osteotomy technique with inverted L-shaped configuration. Arthroscopy Techniques 6:e2161–e2167

    Article  PubMed  PubMed Central  Google Scholar 

  21. Otsuki S, Nakajima M, Oda S, Hoshiyama Y, Fujiwara K, Jotoku T, Neo M (2013) Three-dimensional transfer of the tibial tuberosity for patellar instability with patella alta. J Orthop Sci 18:437–442

    Article  PubMed  Google Scholar 

  22. Otsuki S, Nakajima M, Okamoto Y, Oda S, Hoshiyama Y, Iida G, Neo M (2014) Correlation between varus knee malalignment and patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:176–181

    Article  PubMed  Google Scholar 

  23. Portner O (2014) High tibial valgus osteotomy: closing, opening or combined? Patellar height as a determining factor. Clin Orthop Relat Res 472:3432–3440

    Article  PubMed  PubMed Central  Google Scholar 

  24. Saier T, Minzlaff P, Feucht MJ, Lämmle L, Burghoff M, Ihle C, Imhoff AB, Hinterwimmer S (2017) Health-related quality of life after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:934–942

    Article  PubMed  Google Scholar 

  25. Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19:122–127

    Article  PubMed  Google Scholar 

  26. Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 71:245–248

    Article  CAS  PubMed  Google Scholar 

  27. Stephen JM, Kittl C, Williams A, Zaffagnini S, Marcheggiani Muccioli GM, Fink C, Amis AA (2016) Effect of medial patellofemoral ligament reconstruction method on patellofemoral contact pressures and kinematics. Am J Sports Med 44:1736–1194

    Google Scholar 

  28. Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15:1094–1100

    Article  PubMed  Google Scholar 

  29. Takeuchi R, Ishikawa H, Miyasaka Y, Sasaki Y, Kuniya T, Tsukahara S (2014) A novel closed-wedge high tibial osteotomy procedure to treat osteoarthritis of the knee: hybrid technique and rehabilitation measures. Arthroscopy Techniques 3:e431–e437

    Article  PubMed  PubMed Central  Google Scholar 

  30. Tigani D, Ferrari D, Trentani P, Barbanti-Brodano G, Trentani F (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334

    Article  CAS  PubMed  Google Scholar 

  31. Tunggal JAW, Higgins GA, Waddell JP (2010) Complications of closing wedge high tibial osteotomy. Int Orthop 34:255–261

    Article  PubMed  Google Scholar 

  32. Wright SJ, Boymans TAEJ, Grimm B, Miles AW, Kessler O (2014) Strong correlation between the morphology of the proximal femur and the geometry of the distal femoral trochlea. Knee Surg Sports Traumatol Arthrosc 22:2900–2910

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Maki Miyaki for her expert technical assistance with the statistical analysis.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan

    Shuhei Otsuki, Tomohiko Murakami, Yoshinori Okamoto, Kosuke Nakagawa, Nobuhiro Okuno, Hitoshi Wakama & Masashi Neo

Authors
  1. Shuhei Otsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohiko Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshinori Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kosuke Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuhiro Okuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hitoshi Wakama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Neo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Designed the study: SO, TM, KN, and YO. Analysed the data: SO, TM, KN, YO, NO, and HW. Wrote the manuscript: SO, TM, KN, YO, NO, HW, and MN. Supervised the study: TM, YO, and MN. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shuhei Otsuki.

Ethics declarations

Conflict of interest

The author(s) declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otsuki, S., Murakami, T., Okamoto, Y. et al. Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 27, 1332–1338 (2019). https://doi.org/10.1007/s00167-018-5015-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5015-2

Keywords

Search

Navigation