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Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.

Methods

This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively.

The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.

Results

The mean follow-up was 61.9 months ± 31.4 (13–124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = − 0.15, p = 0.04) and function IKS (R = − 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.

Conclusion

Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.

Level of evidence

IV, case series.

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References

  1. Ahlbäck S (1968) Osteoarthrosis of the knee A radiographic investigation. Acta Radiol Diagn (Stockh) 277:7–72

    Google Scholar 

  2. Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S (2022) Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 30(2):688–697

    Article  PubMed  Google Scholar 

  3. Babis GC, An K-N, Chao EYS, Rand JA, Sim FH (2002) Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results. J Bone Joint Surg Am 84(8):1380–1388

    Article  PubMed  Google Scholar 

  4. Backstein D, Morag G, Hanna S, Safir O, Gross A (2007) Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty 22(4):2–6

    Article  PubMed  Google Scholar 

  5. Bardot L-P, Micicoi G, Favreau H, Zeman P, Khakha R, Ehlinger M, Ollivier M (2021) Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06446-6

    Article  PubMed  Google Scholar 

  6. de Carvalho LH, Temponi EF, Soares LFM, Gonçalves MBJ, Costa LP (2014) Physical activity after distal femur osteotomy for the treatment of lateral compartment knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 22(7):1607–1611

    Article  PubMed  Google Scholar 

  7. Cerciello S, Lustig S, Servien E, Batailler C, Neyret P (2017) Correction of tibial valgus deformity. J Knee Surg 30(05):421–425

    Article  PubMed  Google Scholar 

  8. Chambat P, Selmi TAS, Dejour D, Denoyers J (2000) Varus tibial osteotomy. Operat Tech Sports Med 8(1):44–47

    Article  Google Scholar 

  9. Coakley A, McNicholas M, Biant L, Tawy G (2023) A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee 40:97–110

    Article  PubMed  Google Scholar 

  10. Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB (2013) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21(1):152–160

    Article  PubMed  Google Scholar 

  11. Coventry MB (1987) Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. J Bone Joint Surg Am 69(1):32–38

    Article  CAS  PubMed  Google Scholar 

  12. Coventry MB (1973) Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am 55(1):23–48

    Article  CAS  PubMed  Google Scholar 

  13. Debette C, Parratte S, Maucort-Boulch D, Blanc G, Pauly V, Lustig S, Servien E, Neyret P, Argenson JN (2014) French adaptation of the new knee society scoring system for total knee arthroplasty. Orthop Traumatol Surg Res 100(5):531–534

    Article  CAS  PubMed  Google Scholar 

  14. Duerr RA, Harangody S, Magnussen RA, Kaeding CC, Flanigan DC (2020) Technique for medial closing-wedge proximal tibia osteotomy in the valgus knee. Arthrosc Tech 9(7):e925–e933

    Article  PubMed  PubMed Central  Google Scholar 

  15. Eberbach H, Mehl J, Feucht MJ, Bode G, Südkamp NP, Niemeyer P (2017) Geometry of the valgus knee: contradicting the dogma of a femoral-based deformity. Am J Sports Med 45(4):909–914

    Article  PubMed  Google Scholar 

  16. van Egmond N, Stolwijk N, van Heerwaarden R, van Kampen A, Keijsers NLW (2017) Gait analysis before and after corrective osteotomy in patients with knee osteoarthritis and a valgus deformity. Knee Surg Sports Traumatol Arthrosc 25(9):2904–2913

    Article  PubMed  Google Scholar 

  17. Jacquet C, Pioger C, Khakha R, Steltzlen C, Kley K, Pujol N, Ollivier M (2021) Evaluation of the “minimal clinically important difference” (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 29(3):820–826

    Article  PubMed  Google Scholar 

  18. Jain M, Weber A, Maly K, Manjaly G, Deek J, Tsvyetkova O, Stulić M, Toca-Herrera JL, Jantsch MF (2022) A-to-I RNA editing of filamin a regulates cellular adhesion, migration and mechanical properties. FEBS J 289(15):4580–4601

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jan N, Fayard J-M, Thaunat M, Sonnery-Cottet B, Chambat P (2015) Ostéotomies tibiales de varisation par fermeture dans l’arthrose fémoro-tibiale latérale – technique chirurgicale et résultats à long terme. Revue de Chirurgie Orthopédique et Traumatologique 101(7):S229

    Article  Google Scholar 

  20. Jokio PJ, Lindholm TS, Vankka E (1985) Medial and lateral gonarthrosis treated with high tibial osteotomy: a prospective study. Arch Orth Traum Surg 104(3):135–144

    Article  CAS  Google Scholar 

  21. Lee KM, Chang CB, Park MS, Kang S-B, Kim TK, Chung CY (2015) Changes of knee joint and ankle joint orientations after high tibial osteotomy. Osteoarthrit Cart 23(2):232–238

    Article  CAS  Google Scholar 

  22. Lee WC, Kwan YH, Chong HC, Yeo SJ (2017) The minimal clinically important difference for knee society clinical rating system after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25(11):3354–3359

    Article  PubMed  Google Scholar 

  23. van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, van Heerwaarden RJ (2020) 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(9):2798–2807

    Article  PubMed  Google Scholar 

  24. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB (2021) Coronal plane alignment of the knee (CPAK) classification: a new system for describing knee phenotypes. Bone Joint J 103(2):329–337

    Article  PubMed  Google Scholar 

  25. Maquet P (1985) The treatment of choice in osteoarthritis of the knee. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-198501000-00013

    Article  PubMed  Google Scholar 

  26. Marot V, Justo A, Alshanquiti A, Reina N, Accadbled F, Berard E, Cavaignac E (2021) Simple knee value: a simple evaluation correlated to existing knee PROMs. Knee Surg Sports Traumatol Arthrosc 29(6):1952–1959

    Article  PubMed  Google Scholar 

  27. Marot V, Murgier J, Carrozzo A, Reina N, Monaco E, Chiron P, Berard E, Cavaignac E (2019) Determination of normal KOOS and WOMAC values in a healthy population. Knee Surg Sports Traumatol Arthrosc 27(2):541–548

    Article  PubMed  Google Scholar 

  28. Micicoi G, Jacquet C, Sharma A, LiArno S, Faizan A, Kley K, Parratte S, Ollivier M (2020) Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database. Knee Surg Sports Traumatol ArthroscDOI. https://doi.org/10.1007/s00167-020-06030-4

    Article  Google Scholar 

  29. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259

    Article  Google Scholar 

  30. Mirouse G, Dubory A, Roubineau F, Poignard A, Hernigou P, Allain J, Flouzat Lachaniette CH (2017) Failure of high tibial varus osteotomy for lateral tibio-femoral osteoarthritis with < 10° of valgus: Outcomes in 19 patients. Orthop Traumatol Surg Res 103(6):953–958

    Article  CAS  PubMed  Google Scholar 

  31. Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson J-N, Parratte S (2017) Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 103(2):245–250

    Article  CAS  PubMed  Google Scholar 

  32. Paley D (2002) Principles of deformity correction. Springer, Berlin Heidelberg, Berlin, Heidelberg

    Book  Google Scholar 

  33. Pioger C, Mabrouk A, Siboni R, Jacquet C, Seil R, Ollivier M (2023) Double-level knee osteotomy accurately corrects lower limb deformity and provides satisfactory functional outcomes in bifocal (femur and tibia) valgus malaligned knees. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07325-y

    Article  Google Scholar 

  34. Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2010) Which osteotomy for a valgus knee? Int Orthopaed (SICOT) 34(2):239–247

    Article  Google Scholar 

  35. Saithna A, Kundra R, Getgood A, Spalding T (2014) Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Knee 21(1):172–175

    Article  CAS  PubMed  Google Scholar 

  36. Song J-H, Bin S-I, Kim J-M, Lee B-S (2020) What Is an acceptable limit of joint-line obliquity after medial open wedge high tibial osteotomy? Analysis based on midterm results. Am J Sports Med 48(12):3028–3035

    Article  PubMed  Google Scholar 

  37. Wang J-W, Hsu C-C (2006) Distal femoral varus osteotomy for osteoarthritis of the knee. Surgical technique. J Bone Joint Surg Am 88(Suppl 1 Pt 1):100–108

    PubMed  Google Scholar 

  38. Wolcott M, Traub S, Efird C (2010) High tibial osteotomies in the young active patient. Int Orthopaed (SICOT) 34(2):161–166

    Article  Google Scholar 

  39. Zilber S, Larrouy M, Sedel L, Nizard R (2004) Ostéotomie fémorale distale de varisation pour genu valgum invalidant. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur 90(7):659–665

    Article  CAS  PubMed  Google Scholar 

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Funding

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Author information

Authors and Affiliations

  1. University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France

    Axel Machado, Lolita Micicoi, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez & Grégoire Micicoi

  2. Unité de Recherche Clinique Côte d’Azur (UR2CA), Université Côte d’Azur, Nice, France

    Axel Machado, Lolita Micicoi, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez & Grégoire Micicoi

  3. University of Utah Health, Salt Lake City, Utah, USA

    Justin Ernat

  4. Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany

    Philipp Schippers

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  1. Axel Machado
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Contributions

AM and GM wrote the manuscript, LM and PS performed the inter-observer angle measurements, JE and J-FG and NB and RBdeD corrected the different versions. GM designed the protocol and performed statistical analysis. All authors approved the final manuscript.

Corresponding author

Correspondence to Grégoire Micicoi.

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Conflict of interest

Dr. Ernat is a paid consultant for Johnson & Johnson Depuy Mitek Sports Medicine. He is a committee member for the Arthroscopy Association of North American and the American Orthopedic Society for Sports Medicine. He is an editorial board member for Arthroscopy Journal. Pr Gonzalez is a paid consultant for Amplitude. The other authors have no conflicts of interest.

Ethical approval

The advisory ethic committee (Ethics Committee of the Côte d'Azur University) approved this study under the number IRB 2023–032.

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Machado, A., Micicoi, L., Ernat, J. et al. Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 4276–4284 (2023). https://doi.org/10.1007/s00167-023-07465-1

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