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Mid-term results of medial open-wedge high tibial osteotomy based on radiological grading of osteoarthritis

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

A Correction to this article was published on 30 July 2021

This article has been updated

Abstract

Purpose

To evaluate the mid-term results of medial open-wedge high tibial osteotomy (OWHTO) based on Kellgren–Lawrence (KL) grades.

Materials and methods

We retrospectively evaluated clinical and radiographic outcomes of 93 patients (mean age 61.4 years, mean follow-up 64.2 months, 109 consecutive knees) who underwent OWHTO for medial compartment osteoarthritis (OA). KL grade was used to evaluate knee OA (KL-1 22 cases; KL-2, 51 cases; KL-3, 36 cases). The clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) and Lysholm scores. Radiographic outcomes were assessed using pre- and post-operative mechanical axis percentage, femorotibial angle, medial proximal tibial angle, and joint line convergence angle. Hinge fracture frequency and OA progression were also evaluated based on KL grades.

Results

The JOA score improved significantly from 70.3 ± 14.9 to 96.2 ± 4.4, 64.1 ± 12.5 to 95.1 ± 5.1, and 68.6 ± 11.4 to 92.1 ± 6.1 in the KL-1, KL-2, and KL-3 groups, respectively. The JOA score in the KL-3 group was significantly lower than in the other groups. The Lysholm score improved significantly from 62.6 ± 8.8 to 97.7 ± 4.7, 62.1 ± 8.1 to 96.7 ± 4.2, and 59.2 ± 9.2 to 95.8 ± 4.6 in the KL-1, KL-2, and KL-3 groups, respectively. The post-operative Lysholm scores were not significantly different among the groups.

There were significant differences in radiographic parameters pre-operatively, but not post-operatively, among the groups. Although there were no significant differences in hinge fracture frequency and OA progression, the KL-3 grade predicted OA progression on multivariate analysis.

Conclusions

Mid-term results of OWHTO significantly improved. However, clinical score in the KL-3 group was lower than that in the KL-1 and KL-2 groups; radiological OA progression was a risk factor in KL-3.

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References

  1. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180. https://doi.org/10.1007/s00167-012-2087-2

    Article  Google Scholar 

  2. Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(Suppl 2):B55–B62. https://doi.org/10.1016/j.injury.2003.09.025

    Article  Google Scholar 

  3. Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-198306000-00035

    Article  Google Scholar 

  4. Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96. https://doi.org/10.1097/01.blo.0000229362.12244.f6

    Article  Google Scholar 

  5. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  CAS  Google Scholar 

  6. Ishimatsu T, Takeuchi R, Ishikawa H, Yamagucha Y, Maeyama A, Osawa K et al (2019) Hybrid closed wedge high tibial osteotomy improves patellofemoral joint congruity compared with open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:1299–1309. https://doi.org/10.1007/s00167-019-05350-4

    Article  Google Scholar 

  7. Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S et al (2020) Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc 28:742–750. https://doi.org/10.1007/s00167-018-5103-3

    Article  Google Scholar 

  8. Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H et al (2019) 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. https://doi.org/10.1007/s00167-018-5015-2

    Article  Google Scholar 

  9. Schroter S, Nakayama H, Yoshiya S, Stockle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 139:519–527. https://doi.org/10.1007/s00402-018-3068-9

    Article  CAS  Google Scholar 

  10. Kim HJ, Lee HJ, Shin JY, Park KH, Min SG, Kyung HS (2017) Preoperative planning using the picture archiving and communication system technique in high tibial osteotomy. J Orthop Surg (Hong Kong) 25:2309499016684701

    Article  Google Scholar 

  11. Feucht MJ, Minzlaff P, Saier T, Cotic M, Sudkamp NP, Niemeyer P et al (2014) Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 38:2273–2280. https://doi.org/10.1007/s00264-014-2442-7

    Article  Google Scholar 

  12. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K et al (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25:46–53. https://doi.org/10.1016/j.arthro.2008.08.015

    Article  Google Scholar 

  13. Nakamura R, Komatus N, Fujita K, Kuroda K, Takahashi M, Omi R et al (2017) Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. JBJS 99-B:1313–1318

    CAS  Google Scholar 

  14. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y et al (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28:85–94. https://doi.org/10.1016/j.arthro.2011.06.034

    Article  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  Google Scholar 

  16. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138. https://doi.org/10.1007/s00167-002-0334-7

    Article  Google Scholar 

  17. Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartilage 14:190–195. https://doi.org/10.1016/j.joca.2005.08.013

    Article  CAS  Google Scholar 

  18. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M et al (2014) Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 42:690–698. https://doi.org/10.1177/0363546513516577

    Article  Google Scholar 

  19. Nha KW, Oh SM, Ha YW, Patel MK, Seo JH, Lee BH (2019) Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:2021–2029. https://doi.org/10.1007/s00167-018-5121-1

    Article  Google Scholar 

  20. Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthritis. Clin Orthop Relat Res 282:186

    Article  Google Scholar 

  21. Martay JL, Palmer A Jr, Bangerter NK, Clare S, Monk AP, Brown CP et al (2018) A preliminary modeling investigation into the safe correction zone for high tibial osteotomy. Knee 25:286–295. https://doi.org/10.1016/j.knee.2017.12.006

    Article  Google Scholar 

  22. Hohloch L, Kim S, Mehl J, Zwingmann J, Feucht MJ, Eberbach H et al (2018) Customized post-operative alignment improves clinical outcome following media open-wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 26:2766–2773. https://doi.org/10.1007/s00167-017-4731-3

    Article  Google Scholar 

  23. Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Nakanishi A, Ueoka K (2017) Patellofemoral osteoarthritis progression and alignment changes after open-wedge high tibial osteotomy do not affect clinical outcomes at mid-term follow-up. Arthroscopy 33:1832–1839. https://doi.org/10.1016/j.arthro.2017.04.007

    Article  Google Scholar 

  24. Kim KI, Kim DK, Song SJ, Lee SH, Bae DK (2017) Medial open-wedge high tibial osteotomy may adversely affect the patellofemoral joint. Arthroscopy 33:811–816. https://doi.org/10.1016/j.arthro.2016.09.034

    Article  Google Scholar 

  25. Tanaka T, Matsushita T, Miyaji N, Ibaraki K, Nishida K, Oka S et al (2019) Deterioration of patellofemoral cartilage status after medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:1347–1354. https://doi.org/10.1007/s00167-018-5128-7

    Article  Google Scholar 

  26. Otakara E, Nakagawa S, Arai Y, Inoue H, Kan H, Nakayama Y et al (2019) Large deformity correction in medial open-wedge high tibial osteotomy may cause degeneration of patellofemoral cartilage: a retrospective study. Medicine (Baltimore) 98:e14299. https://doi.org/10.1097/MD.0000000000014299

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Mika Shimatani for help with data collection. The authors would like to thank Editage for editing and reviewing this manuscript for English language.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, 721-0927, Japan

    Yasuhiro Takahara, Hirotaka Nakashima, Satoru Itani, Haruyoshi Katayama, Kazuaki Miyazato, Yuichi Iwasaki, Hisayoshi Kato & Yoichiro Uchida

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  1. Yasuhiro Takahara
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Contributions

YT takes the major parts in the plan, formulating the study design and interpreted the data and writing manuscript. HN performed statistical analysis in this study. SI, HK, KM, and YI contributed to collect data. HK and YU play important roles in formulating the plans. All authors have given the final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Yasuhiro Takahara.

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The authors declare that they have are no conflict of interest.

Ethical approval

This study was approved by our institutional review board (Nippon Kokan Fukuyama Hospital, Authorization number 2019-14).

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The informed consent had been obtained from the patients.

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The informed consent had been obtained from the patients.

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The original online version of this article was revised: Error in Figure 6 caption.

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Takahara, Y., Nakashima, H., Itani, S. et al. Mid-term results of medial open-wedge high tibial osteotomy based on radiological grading of osteoarthritis. Arch Orthop Trauma Surg 143, 149–158 (2023). https://doi.org/10.1007/s00402-021-04011-x

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