Abstract
Purpose
This study aimed to determine which preoperative factors affect the postoperative change in the joint line convergence angle (JLCA) by preoperatively quantifying soft tissue laxity.
Methods
Thirty-four patients who underwent medial open-wedge high tibial osteotomy (HTO) with a navigation were analysed. The JLCA change after HTO was calculated using standing long-bone anteroposterior radiographs taken preoperatively and 6 months postoperatively. Latent soft tissue laxity was defined as the amount of soft tissue that can be extended to valgus or varus from the weight-bearing position, and calculated by subtracting the JLCA on weight-bearing standing radiographs from that on stress radiographs. Multiple linear regression was performed to determine the preoperative factors that statistically correlated with the postoperative JLCA change.
Results
In multiple linear regression, JLCA change had a statistically significant correlation with latent medial laxity (R = 0.6) and a statistically borderline significant correlation with correction angle (R = 0.2). These imply that the postoperative JLCA change increased by 0.6° per 1° increase in latent medial laxity, and increased by 0.2° per 1° increase in correction angle. Latent medial laxity was the most crucial factor associated with postoperative JLCA changes.
Conclusion
The JLCA change could be larger in patients with large latent medial laxity or severe varus deformity requiring a large correction, which could lead to unexpected overcorrection in HTO. Postoperative JLCA change should be considered in preoperative surgical planning. Target point shifting within the hypomochlion point could be a strategy to prevent overcorrection, especially in patients with large latent medial laxity.
Level of evidence
Level IV.
Similar content being viewed by others
References
Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861
Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593
Amendola L, Fosco M, Cenni E, Tigani D (2010) Knee joint arthroplasty after tibial osteotomy. Int Orthop 34:289–295
Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205
Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 88:1454–1459
Cerciello S, Vasso M, Maffulli N, Neyret P, Corona K, Panni AS (2014) Total knee arthroplasty after high tibial osteotomy. Orthopedics 37:191–198
Chilton NW, Fleiss JL (1986) Design and analysis of plaque and gingivitis clinical trials. J Clin Periodontol 13:400–410
El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34:e622–e628
Feucht MJ, Minzlaff P, Saier T, Cotic M, Sudkamp NP, Niemeyer P, Imhoff AB, Hinterwimmer S (2014) Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 38:2273–2280
Gaasbeek RD, Nicolaas L, Rijnberg WJ, van Loon CJ, van Kampen A (2010) Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study. Int Orthop 34:201–207
Heijens E, Kornherr P, Meister C (2016) The coronal hypomochlion: a tipping point of clinical relevance when planning valgus producing high tibial osteotomies. Bone Joint J 98-B:628–633
Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354
Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72:238–244
Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hufner T (2008) Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res 26:553–561
Kuwashima U, Tashiro Y, Okazaki K, Mizu-Uchi H, Hamai S, Murakami K, Iwamoto Y (2017) Comparison of the impact of closing wedge versus opening wedge high tibial osteotomy on proximal tibial deformity and subsequent revision to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:869–875
Kyung BS, Kim JG, Jang KM, Chang M, Moon YW, Ahn JH, Wang JH (2013) Are navigation systems accurate enough to predict the correction angle during high tibial osteotomy? Comparison of navigation systems with 3-dimensional computed tomography and standing radiographs. Am J Sports Med 41:2368–2374
Lee DH, Han SB, Oh KJ, Lee JS, Kwon JH, Kim JI, Patnaik S, Shetty GM, Nha KW (2014) The weight-bearing scanogram technique provides better coronal limb alignment than the navigation technique in open high tibial osteotomy. Knee 21:451–455
Lee DH, Nha KW, Park SJ, Han SB (2012) Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy. Arthroscopy 28:1842–1850
Lee DH, Park SC, Park HJ, Han SB (2015) Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24:3704–3712
Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372
Mina C, Garrett WE Jr, Pietrobon R, Glisson R, Higgins L (2008) High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee. Am J Sports Med 36:949–955
Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259
Nakazato T, Ikehira H, Imasawa T (2017) An equation to estimate the renal cortex volume in chronic kidney disease patients. Clin Exp Nephrol 22:603–612
Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136:1337–1342
Parvizi J, Hanssen AD, Spangehl MJ (2004) Total knee arthroplasty following proximal tibial osteotomy: risk factors for failure. J Bone Joint Surg Am 86-A:474–479
Riegger-Krugh C, Gerhart TN, Powers WR, Hayes WC (1998) Tibiofemoral contact pressures in degenerative joint disease. Clin Orthop Relat Res 348:233–245
Sabharwal S, Zhao C (2008) Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am 90:43–51
Schroter S, Ihle C, Mueller J, Lobenhoffer P, Stockle U, van Heerwaarden R (2013) Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc 21:189–196
Sim JA, Kwak JH, Yang SH, Choi ES, Lee BK (2010) Effect of weight-bearing on the alignment after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 18:874–878
Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85-A:469–474
Van Thiel GS, Frank RM, Gupta A, Ghodadra N, Shewman EF, Wang VM, Bach BR, Verma NN, Cole BJ, Provencher MT (2011) Biomechanical evaluation of a high tibial osteotomy with a meniscal transplant. J Knee Surg 24:45–53
Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS (2016) Comparison of cable method and miniaci method using picture archiving and communication system in preoperative planning for open wedge high tibial osteotomy. Knee Surg Relat Res 28:283–288
Acknowledgements
We appreciate Dae-Hee Lee for his effort in providing medical advice in this study.
Funding
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2017R1A2B3007362).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest in the authorship and publication of this contribution.
Ethical approval
Ethical approval for the present study was obtained from the institutional review board of Samsung Medical Center (Study no. 2016-07-114-001)
Informed consent
For this retrospective study, formal consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Lee, D.k., Wang, J.H., Won, Y. et al. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28, 1411–1418 (2020). https://doi.org/10.1007/s00167-019-05502-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-019-05502-6