Skip to main content
SpringerLink
Log in

Gait analysis following medial opening-wedge high tibial osteotomy

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

Abstract

Purpose

High tibial osteotomy (HTO) is used to treat young and active patients with knee osteoarthritis (OA) and varus deformity. The medial compartment OA alters the patients’ gait.

Methods

A prospective study was carried out in 21 consecutive patients operated for HTO due to knee OA with varus deformity. There were 14 men and 7 women, with a median age of 51.9 years (38–64). Their gait was analyzed preoperatively and at 1 year postoperatively, and compared to a healthy control group. Clinical assessment (KOOS, WOMAC, Lysholm, and SF-36 scores) was also performed preoperatively and postoperatively.

Results

Patients with medial compartment OA had altered gait relative to the control population. Their walking speed was slower, step length was shorter, and single-leg stance time was shorter, while the double-leg stance time was longer (P < 0.001). Step width was not different between the two groups preoperatively (n.s.), but it was wider in the patient group postoperatively (P = 0.003). There were no differences in the patients’ gait parameters before and after the osteotomy (n.s.). However, there was an improved perception of walking so that it is no longer different from controls (n.s.). The KOOS, WOMAC, Lysholm and SF-36 scores improved after HTO. The preoperative median of 7° varus (1–11) was corrected to 3° valgus (0–6).

Conclusion

Medial compartment OA with varus deformity leads to gait modifications. HTO does not alter the time–distance parameters of gait; however, patients have improved perception of their walking ability. HTO leads to excellent results for knee function, and improves quality of life without modifying the gait pattern.

Level of evidence

II.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 16:21–26

    PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. Andriacchi TP (1994) Dynamics of knee malalignment. Orthop Clin North Am 25:395–403

    PubMed  CAS  Google Scholar 

  4. Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, Jenkyn TR, Fowler PJ (2009) Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient-reported outcomes. Arthritis Rheum 61:648–657

    Article  PubMed  Google Scholar 

  5. Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Giffin JR (2007) Test–retest reliability of the peak knee adduction moment during walking in patients with medial compartment knee osteoarthritis. Arthritis Rheum 57:1012–1017

    Article  PubMed  Google Scholar 

  6. Blaha JD (2004) The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty 19:22–26

    Article  PubMed  Google Scholar 

  7. Börjesson M, Weidenhielm L, Mattsson E, Olsson E (2005) Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study. Knee 12:121–127

    Article  PubMed  Google Scholar 

  8. Briem K, Ramsey DK, Newcomb W, Rudolph KS, Snyder-Mackler L (2007) Effects of the amount of valgus correction for medial compartment knee osteoarthritis on clinical outcome, knee kinetics and muscle co-contraction after opening wedge high tibial osteotomy. J Orthop Res 25:311–318

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brinkman J-M, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557

    Article  PubMed  Google Scholar 

  10. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res 11:S208–S228

    Article  Google Scholar 

  11. Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 47:984–990

    Article  PubMed  Google Scholar 

  12. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201

    Article  PubMed  Google Scholar 

  13. DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm Follow-up of Opening-Wedge High Tibial Osteotomy. Am J Sports Med 38:2077–2084

    Article  PubMed  Google Scholar 

  14. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264

    Google Scholar 

  15. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608

    PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. Lee MM, Song CH, Lee KJ, Jung SW, Shin DC, Shin SH (2014) Concurrent validity and test-retest reliability of the OPTOGait photoelectric cell system for the assessment of spatio-temporal parameters of the gait of young adults. J Phys Ther Sci 26:81–85

    Article  PubMed  PubMed Central  Google Scholar 

  18. Leitch KM, Birmingham TB, Dunning CE, Giffin JR (2015) Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent. Gait Posture 42:165–171

    Article  PubMed  Google Scholar 

  19. Lind M, McClelland J, Wittwer JE, Whitehead TS, Feller JA, Webster KE (2011) Gait analysis of walking before and after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:74–81

    Article  PubMed  Google Scholar 

  20. Lootvoet L, Massinon A, Rossillon R, Himmer O, Lambert K, Ghosez JP (1993) Upper tibial osteotomy for gonarthrosis in genu varum. Apropos of a series of 193 cases reviewed 6 to 10 years later. Rev Chir Orthop 79:375–384

    PubMed  CAS  Google Scholar 

  21. Majima T, Yasuda K, Katsuragi R, Kaneda K (2000) Progression of joint arthrosis 10 to 15 years after high tibial osteotomy. Clin Orthop Relat Res 381:177–184

    Article  Google Scholar 

  22. Mündermann A, Dyrby CO, Hurwitz DE, Sharma L, Andriacchi TP (2004) Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. Arthritis Rheum 50:1172–1178

    Article  PubMed  Google Scholar 

  23. Ornetti P, Maillefert J-F, Laroche D, Morisset C, Dougados M, Gossec L (2010) Gait analysis as a quantifiable outcome measure in hip or knee osteoarthritis: a systematic review. Joint Bone Spine 77:421–425

    Article  PubMed  Google Scholar 

  24. Prodromos CC, Andriacchi TP, Galante JO (1985) A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg Am 67:1188–1194

    Article  PubMed  CAS  Google Scholar 

  25. Ramsey DK, Snyder-Mackler L, Lewek M, Newcomb W, Rudolph KS (2007) Effect of anatomic realignment on muscle function during gait in patients with medial compartment knee osteoarthritis. Arthritis Rheum 57:389–397

    Article  PubMed  PubMed Central  Google Scholar 

  26. Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb® wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156

    Article  PubMed  Google Scholar 

  27. Saragaglia D, Chedal-Bornu B, Rouchy RC, Rubens-Duval B, Mader R, Pailhé R (2016) Role of computer-assisted surgery in osteotomies around the knee. Knee Surg Sports Traumatol Arthrosc 24:3387–3395

    Article  PubMed  CAS  Google Scholar 

  28. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28:s1269–74

    PubMed  Google Scholar 

  29. Saragaglia D, Rouchy R-C, Krayan A, Refaie R (2014) Return to sports after valgus osteotomy of the knee joint in patients with medial unicompartmental osteoarthritis. Int Orthop 38:2109–2114

    Article  PubMed  Google Scholar 

  30. Schröter S, Mueller J, van Heerwaarden R, Lobenhoffer P, Stöckle U, Albrecht D (2013) Return to work and clinical outcome after open wedge HTO. Knee Surg Sports Traumatol Arthrosc 21:213–219

    Article  PubMed  Google Scholar 

  31. Sharma L (2007) The role of varus and valgus alignment in knee osteoarthritis. Arthritis Rheum 56:1044–1047

    Article  PubMed  Google Scholar 

  32. Sischek EL, Birmingham TB, Leitch KM, Martin R, Willits K, Giffin JR (2014) Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 22:2672–2681

    Article  PubMed  Google Scholar 

  33. Turcot K, Armand S, Lübbeke A, Fritschy D, Hoffmeyer P, Suvà D (2013) Does knee alignment influence gait in patients with severe knee osteoarthritis? Clin Biomech 28:34–39

    Article  Google Scholar 

  34. Van Egmond N, Van Grinsven S, Van Loon CJ, Gaasbeek RD, Van Kampen A (2016) Better clinical results after closd- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthros 24:34–41

    Article  Google Scholar 

  35. Wada M, Imura S, Nagatani K, Baba H, Shimada S, Sasaki S (1998) Relationship between gait and clinical results after high tibial osteotomy. Clin Orthop Relat Res 354:180–188

    Article  Google Scholar 

  36. Warme BA, Aalderink K, Amendola A (2011) Is There a Role for High Tibial Osteotomies in the Athlete? Sports. Health (London) 3:59–69

    Google Scholar 

  37. Weidow J, Tranberg R, Saari T, Kärrholm J (2006) Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: gait analysis of 30 patients and 15 controls. J Orthop Res 24:1890–1899

    Article  PubMed  Google Scholar 

  38. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13:279–289

    Article  PubMed  Google Scholar 

  39. Wright RW (2009) Knee injury outcomes measures. J Am Acad Orthop Surg 17:31–39

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France

    Vincent Morin, Régis Pailhé, Brice Rubens Duval, Roch Mader, Jérémy Cognault, René-Christopher Rouchy & Dominique Saragaglia

Authors
  1. Vincent Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Régis Pailhé
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brice Rubens Duval
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roch Mader
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jérémy Cognault
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. René-Christopher Rouchy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dominique Saragaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vincent Morin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morin, V., Pailhé, R., Duval, B.R. et al. Gait analysis following medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 26, 1838–1844 (2018). https://doi.org/10.1007/s00167-017-4421-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4421-1

Keywords

Search

Navigation