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Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A varus-producing medial closing wedge high tibial osteotomy (MCWHTO) is an uncommon procedure. The aim of this retrospective study was to assess the survivorship and prevalence of post-operative subjective knee laxity and satisfaction in a large cohort of patients with a MCWHTO performed without a MCL-reefing procedure.

Methods

All patients (n = 176) who underwent a MCWHTO in our clinic between 2008 and 2016 were approached to participate. After review of patient charts, questionnaires were sent to willingly patients. Primary outcome was the survivorship of the MCWHTO; secondary outcome was patient-reported instability and satisfaction.

Results

One-hundred and thirteen patients participated in the study. The 5-year survival rate of the MCWHTO was almost 80%. A total of 77% of the patients was satisfied with the treatment. With regard to post-operative subjective knee laxity, 26% of the patients experienced instability of the knee post-operation. Instability was significantly correlated with the KOOS domains, the Lysholm score, the IKDC knee function score and the Physical and Mental Health Domains of the SF-36.

Conclusion

Medial closing wedge high tibial osteotomy provides good results regarding survivorship and patient satisfaction for patients with a valgus deformity which is located in the proximal tibia. Clinically relevant is that in the surgical technique without MCL-reefplasty instability is significantly correlated with worse patient-reported outcome measures. The addition of a MCL reefing procedure will improve outcome in selected patients.

Level of evidence

III.

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Abbreviations

BMI:

Body mass index

HKA:

Hip–knee–ankle

HTO:

High tibial osteotomy

IKDC:

International Knee Documentation Committee

KOOS:

Knee Injury and Osteoarthritis Outcome Score

MCL:

Medial collateral ligament

MCWHTO:

Medial closing wedge high tibial osteotomy

NRS:

Numeric rating scale

PROMS:

Patient-reported outcome measurement scores

SF-36:

Short Form 36

TKA:

Total knee arthroplasty

QoL:

Quality of life

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Authors and Affiliations

  1. Maartenskliniek Woerden, Woerden, The Netherlands

    W. A. M. van Lieshout, B. J. T. van Ginneken & R. J. van Heerwaarden

  2. Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands

    W. A. M. van Lieshout & G. M. M. J. Kerkhoffs

  3. Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands

    R. J. van Heerwaarden

Authors
  1. W. A. M. van Lieshout
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  2. B. J. T. van Ginneken
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  3. G. M. M. J. Kerkhoffs
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  4. R. J. van Heerwaarden
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Contributions

WvL was responsible for data collection and interpretation, assisted in the study design and drafted the manuscript; BvG conducted the telephone calls, was responsible for data acquisition and performed the statistical analysis and wrote the method and results section; GK revised the manuscript and assisted with study design and result interpretations; RvH was the project supervisor and responsible for the study design, performed most of the surgeries, assisted in writing and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to R. J. van Heerwaarden.

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Conflict of interest

The first author has received a contribution from the Marti Keuning-Eckhardt Stichting (Stichting MKE) to conduct this research. None of the other authors have anything to declare.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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van Lieshout, W.A.M., van Ginneken, B.J.T., Kerkhoffs, G.M.M.J. et al. Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc 28, 2798–2807 (2020). https://doi.org/10.1007/s00167-019-05480-9

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