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Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aimed to determine correction error predictors of lower extremitiy alignment after hybrid closed-wedge high tibial osteotomy (HCWHTO).

Materials and methods

From 2011 to 2015, 102 knees in 75 patients with medial compartment knee osteoarthritis of the knee and varus knee deformities who underwent HCWHTO were evaluated in this retrospective study with a minimum 2-year follow-up. Preoperative radiological parameters including weight-bearing line ratio (WBL ratio), mechanical leg axis angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and JLCA under varus or valgus stress were measured. The knees were divided into the following three groups based on the WBL ratio on average 54 months after procedure: acceptable (WBL crossing the tibial plateau between 50 and 70%), under-correction (< 50%), and overcorrection (> 70%). A multiple regression analysis was performed to evaluate predictors that could influence postoperative WBL ratio and cut-off values of predictive preoperative factors was analysed.

Results

Significant differences in pre- and postoperative WBL ratios and mechanical leg axis angles were found. Preoperative mLDFA in the under-correction group (89.4° ± 2.1°) was significantly higher than that in the overcorrection group (87.4° ± 2.2°) (p = 0.015), while other preoperative parameters revealed no significant differences. The postoperative MPTA in the under-correction group (92.1° ± 3.7°) was significantly lower than that in the other two groups (p = 0.005 and p = 0.0001, respectively), while there was no significant change between the acceptable (94.6° ± 3.4°) and the overcorrection (96.7° ± 3.2°) groups. Multiple regression analysis revealed that mLDFA (β =  − 0.316; p = 0.010) had a significant impact on postoperative WBLR. The cut-off value for under-correction of mLDFA was 89.5°and sensitivity and specificity were 53.6 and 71.6%, respectively (p = 0.014).

Conclusions

Preoperative mLDFA is significantly associated with postoperative alignment in HCWHTO. While postoperative MPTA is important, disregarding the preoperative mLDFA may bears a high risk of malcorrection. Varus alignment of the knee with larger mLDFA may be an indication for not only HCWHTO, but also for distal femoral osteotomy.

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Acknowledgements

The authors thank Naoki Deguchi and Kotaro Miyazaki for their expert technical assistance with the statistical analysis. The authors also thank Editage (www.editage.com) for editing a draft of this manuscript.

Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Department of Joint Surgery Center, Yokosuka City Hospital, 1-3-2 Nagasaka, Yokosuka city, Kanagawa, 240-0195, Japan

    Tetsuro Ishimatsu, Ryohei Takeuchi, Hiroyuki Ishikawa & Katsunari Osawa

  2. Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan

    Tetsuro Ishimatsu, Akira Maeyama & Takuaki Yamamoto

  3. Department of Joint Surgery Center, Saiwaitsurumi Hospital, 21-1 Toyooka, Tsurumi-ku, Yokosuka city, Kanagawa, 240-0195, Japan

    Ryohei Takeuchi & Katsunari Osawa

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  1. Tetsuro Ishimatsu
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Correspondence to Ryohei Takeuchi.

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Ethical approval

The study was conducted in accordance with the Declaration of Helsinki. It was approved by the institutional review board (Yokosuka Municipal Hospital, ID-number: 30-11).

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The study involved human participants.

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Informed consent was obtained from all patients included in this study.

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Ishimatsu, T., Takeuchi, R., Ishikawa, H. et al. Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy. Arch Orthop Trauma Surg 142, 3675–3685 (2022). https://doi.org/10.1007/s00402-021-03974-1

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  • DOI: https://doi.org/10.1007/s00402-021-03974-1

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