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Increased joint obliquity after open-wedge high tibial osteotomy induces pain in the lateral compartment: a comparative analysis of the minimum 4-year follow-up outcomes using propensity score matching

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To analyze the effects of increased medial proximal tibial angle (MPTA) on the clinical outcomes and cartilage deterioration in the lateral compartment after a mean follow-up period of 4 years following open-wedge high tibial osteotomy (OWHTO) using propensity score matching (PSM) analysis.

Methods

Among 376 knees treated with OWHTO for medial unicompartmental osteoarthritis with varus deformity, 36 knees with MPTA increase of > 95° and 108 knees with MPTA increase of < 95° at the final follow-up were included. The baseline prognostic factors [age, sex, preoperative hip–knee–ankle (HKA) angle, body mass index, and preoperative knee range of motion] were equalized between the 2 groups using PSM; consequently, 31 pairs of patients were compared. The radiographic and clinical outcomes, including lateral compartment pain, were assessed. For 18 patients in each group, second-look arthroscopy and cartilage status assessment were performed.

Results

The preoperative demographics were similar between the groups. At the final follow-up, the HKA angle and joint line obliquity were significantly higher in the increased MPTA group. No significant differences were observed in the clinical outcomes between the groups. On second-look arthroscopy, significant cartilage deterioration of the lateral compartment was not observed in either group. Pain in the lateral compartment was experienced significantly more frequently in the increased MPTA group (p < 0.01).

Conclusion

Although excessively increased MPTA after HTO had no significant effects on the clinical outcomes and cartilage deterioration in the lateral compartment at the minimum 4-year follow-up, lateral compartment pain was experienced significantly more frequently in the increased MPTA group.

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Abbreviations

OWHTO:

Open-wedge high tibial osteotomy

OA:

Osteoarthritis

MPTA:

Medial proximal tibial angle

JLO:

Joint line obliquity

HKA:

Hip–knee–ankle

BMI:

Body-mass-index

PSM:

Propensity score matching

ROM:

Range of motion

SD:

Standard deviation

WOMAC:

Western Ontario and McMaster University

HSS:

Hospital for Special Surgery

ICRS:

International Cartilage Repair Society

TMA:

Tibia mechanical angle

VAR:

Varus

NEU:

Neutral

FMA:

Femoral mechanical angle

VAL:

Valgus

KSS:

Knee Society Score

LFC:

Lateral femoral condyle

LTC:

Lateral tibial condyle

KOOS:

Knee Injury and Osteoarthritis Outcome Score

CONSORT:

Consolidated Standards of Reporting Trials

ADL:

Activities of daily living

MFC:

Medial femoral condyle

MTC:

Medial tibial condyle

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Acknowledgements

No specific grant was received for this research from funding agencies in the public, commercial, or not-for-profit-sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-gun, Chonnam, 58128, Republic of Korea

    Gun Woo Kim, Joon Kyoo Kang, Eun Kyoo Song & Jong Keun Seon

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  1. Gun Woo Kim
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  2. Joon Kyoo Kang
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  3. Eun Kyoo Song
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GWK, JKK and EKS. Review, editing and supervision by JKS.

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Correspondence to Jong Keun Seon.

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The authors declare that they have no conflict of interest.

Funding

The authors declare that there they have non-financial competing interests.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the Ethical Standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Hwasun Chonnam National University Hospital approved this study (CNUHH-2020-195).

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Written informed consent for participation in the study was obtained from all patients, including permission to access patient’s records and publish individual clinical details.

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Kim, G.W., Kang, J.K., Song, E.K. et al. Increased joint obliquity after open-wedge high tibial osteotomy induces pain in the lateral compartment: a comparative analysis of the minimum 4-year follow-up outcomes using propensity score matching. Knee Surg Sports Traumatol Arthrosc 29, 3495–3502 (2021). https://doi.org/10.1007/s00167-020-06342-5

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