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Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis

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

Abstract

Purpose

To evaluate patellofemoral congruity after opening wedge high tibial osteotomy (OWHTO) and hybrid HTO.

Methods

Twenty-four knees with hybrid HTO and 24 with OWHTO were evaluated in this study. The Caton–Deschamps and modified Miura–Kawamura indices were used to evaluate pre- and post-operative patellar heights for both types of surgery. Tibial tuberosity–trochlear groove (TT–TG) distance, patellar tilt, and medial and lateral joint space at the patellofemoral joint were compared. Anterior knee pain was assessed using the Kujala anterior knee pain scale.

Results

There was no significant difference between the correction angles of the hybrid HTO and OWHTO. Pre- and post-operative values for the Caton–Deschamps and modified Miura–Kawamura indices in patients who underwent hybrid HTO changed from 0.90 to 0.94 and from 0.95 to 1.03, respectively, with no significant differences noted. Following OWHTO, these values decreased significantly from 0.91 to 0.73 and from 1.06 to 0.84, respectively (p < 0.01). The post-operative patellar height after OWHTO was significantly lower than that after hybrid HTO (p < 0.01). After hybrid HTO, the TT–TG distance decreased significantly from 11.4 to 7.4 (p < 0.01), but it did not change significantly after OWHTO. Although pre- and post-operative patellar tilt were not altered significantly in either group, the medial joint space of the patellofemoral joint was significantly increased post-operatively following hybrid HTO (p = 0.035). The pre-operative Kujala scores were significantly lower in the hybrid HTO group, but post-operative scores improved in both groups.

Conclusions

Hybrid HTO provides a better post-operative patellofemoral joint than does OWHTO with regard to patellar position and reduction of the TT–TG distance, as well as improved clinical outcomes. Hybrid HTO, rather than OWHTO, is the preferred technique for the treatment of varus knees combined with patellofemoral osteoarthritis.

Level of evidence

Retrospective comparative study, Level III.

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Abbreviations

CWHTO:

Closing wedge high tibial osteotomy

FTA:

Femorotibial angle

HTO:

High tibial osteotomy

MPTA:

Medial proximal tibial angle

OA:

Osteoarthritis

OWHTO:

Opening wedge high tibial osteotomy

PACS:

Picture archiving and communication system

%MA:

Percent of mechanical axis

TT–TG:

Tibial tuberosity–trochlear groove

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Acknowledgements

We thank Maki Miyaki for her expert technical assistance with the statistical analysis.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan

    Shuhei Otsuki, Tomohiko Murakami, Yoshinori Okamoto, Kosuke Nakagawa, Nobuhiro Okuno, Hitoshi Wakama & Masashi Neo

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  1. Shuhei Otsuki
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  2. Tomohiko Murakami
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  3. Yoshinori Okamoto
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  4. Kosuke Nakagawa
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  5. Nobuhiro Okuno
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  6. Hitoshi Wakama
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  7. Masashi Neo
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Contributions

Designed the study: SO, TM, KN, and YO. Analysed the data: SO, TM, KN, YO, NO, and HW. Wrote the manuscript: SO, TM, KN, YO, NO, HW, and MN. Supervised the study: TM, YO, and MN. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shuhei Otsuki.

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Conflict of interest

The author(s) declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Otsuki, S., Murakami, T., Okamoto, Y. et al. Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 27, 1332–1338 (2019). https://doi.org/10.1007/s00167-018-5015-2

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  • DOI: https://doi.org/10.1007/s00167-018-5015-2

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