A systematic review of outcomes of high tibial osteotomy for the valgus knee

Coakley, Alannah; McNicholas, Michael; Biant, Leela; Tawy, Gwenllian

doi:10.1016/j.knee.2022.11.007

Cited by 7 publications

(5 citation statements)

References 35 publications

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“…38 In a retrospective study of 115 patients, Woodacre et al 40 reported an overall complication rate of 31%, including minor wound infection (9.6%), major wound infection (3.5%), and symptomatic hardware necessitating plate removal (7%). In a systematic review of 17 studies, Coakley et al 10 reported complication rates ranging from 3% to 30%; however, those authors did not synthesize complications across included studies and did not report an overall complication rate. A 2022 retrospective review of the Pearl-Diver Mariner data set reported a 90-day complication rate of 11.6% after HTO and 21.5% after DFO among a total of 2226 patients (1780 HTO, 446 DFO).…”

Section: Surgical Details and Concomitant Proceduresmentioning

confidence: 99%

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

et al. 2023

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Background: High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are well-recognized treatments to address varus and valgus malalignment, respectively, in the setting of symptomatic unicompartmental arthritis of the tibiofemoral joint. The existing literature is limited in its ability to characterize complications after HTO or DFO procedures. Purpose: The objective of this study was to determine the rate of early (≤90 days) postoperative complications and associated variables from the 15-year experience of a single academic institution. Study Design: Case series; Level of evidence, 4. Methods: Patients treated at a single academic institution between 2008 and 2022 who underwent HTO or DFO procedures were identified. All patients with minimum 90-day follow-up were considered for inclusion in the study. Exclusion criteria were inadequate follow-up, unavailable medical records, age <14 years, and revision osteotomy. Patient demographic characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. All intraoperative complications were recorded. Results: A total of 243 knees in 232 patients met eligibility and were included in the final analysis. Three intraoperative complications (1.2%) involving fracture extension of the osteotomy occurred. There were 127 early postoperative complications (121 surgical, 6 medical) in 102 knees (68 with HTO and 34 with DFO). Medical complications included pulmonary embolus in 3 patients (1.2%), urinary tract infection in 2 patients (0.8%), and postoperative ileus requiring prolonged hospitalization in 1 patient (0.4%). The most common complications were stiffness requiring a non–standard of care intervention (17.7%), superficial wound infection or wound dehiscence (13.2%), and hemarthrosis or effusion requiring aspiration (6.6%). The rate of deep infection requiring irrigation and debridement was 4.1%. Variables associated with early postoperative complications included smoking (odds ratio [OR], 3.05; 95% CI, 1.34-6.94; P = .008), concomitant chondroplasty and/or loose body removal (OR, 2.55; 95% CI, 1.50-4.33; P = .001), and concomitant ligament reconstruction (OR, 3.97; 95% CI, 1.37-11.53; P = .011). Conclusion: These 15-year data revealed a low rate of intraoperative complications (1.2%) and a relatively high rate of early (≤90 days) postoperative complications (42.0%) after an HTO or DFO procedure. Surgeons should be aware of the increased postoperative complications associated with smoking, concomitant chondroplasty, and concomitant ligament reconstruction and should use this information to counsel patients regarding appropriate expectations in the postoperative period.

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Section: Surgical Details and Concomitant Proceduresmentioning

confidence: 99%

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

et al. 2023

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“…Mirouse et al [30] obtained a slightly valgus average alignment at 181.3° and only 42% was within the correction target between 180° and 183° in their series with 21.4% of over‐corrected patients. The recent review by Coakley et al [9] showed an average varus alignment of 2.8 ± 2.9° which, according to the authors, corresponds to the targets to be obtained after tibial osteotomy for valgus malalignment. Although no study compares functional outcomes according to alignment, the preferential correction target appears to be neutral or slightly varus which is consistent with the results of this study but more evidence is needed to draw definitive conclusions.…”

Section: Discussionmentioning

confidence: 83%

“…Thus, the changes in interline obliquity after medial closing wedge high tibial osteotomy (MCWHTO), the alignment obtained, and its influence on functional results are poorly defined in the literature. A very recent review of the literature on 17 series concluded that there was a lack of studies evaluating the influence of alignment on postoperative results [9]. There are no studies assessing the influence of alignment and interline obliquity variations on functional outcomes after MWCHTO.…”

Section: Introductionmentioning

confidence: 99%

“…The objective is to unload the mechanical axis passing through the osteoarthritic compartment towards the contralateral healthy compartment in an attempt to slow osteoarthritis progression [32,37]. Lateral unicompartmental osteoarthritis is less well described than medial unicompartmental osteoarthritis, because studies often exclude patients with genu valgum [9]. In cases of lateral compartment arthrosis and overload, a varus osteotomy can be used 1 3 to altern the mechanical alignment as described above [11,34].…”

Section: Introductionmentioning

confidence: 99%

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Normo‐or slightly overcorrection show better results after medial closing wedge high tibial osteotomy

Machado

Micicoi

Ernat

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The objectives of this study were to evaluate functional results, revision-free survival, and the inluence of postoperative alignment on outcomes after MCWHTO. Methods This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre-and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its inluence on clinical outcomes were also analysed. ResultsThe mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased postoperatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = − 0.15, p = 0.04) and function IKS (R = − 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°. Conclusion Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not signiicantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw deinitive conclusions. Level of evidence IV, case series.

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“…Lower limb deformity can be effectively corrected by osteotomies around the knee (1,2,3,4,5,6,7,8,9). The post-operative outcome is associated with relief of knee pain and improvement of function in the short and long term (5,6,10,11,12,13,14). At present, osteotomy surgeries around the knee are preoperatively planned with a focus on the hip-knee-ankle (HKA) axis.…”

Section: Introductionmentioning

confidence: 99%

Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

Van Oevelen,

Burssens,

Krähenbühl

et al. 2023

EFORT Open Reviews

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Purpose Emerging reports suggest an important involvement of the ankle/hindfoot alignment in the outcome of knee osteotomy; however, a comprehensive overview is currently not available. Therefore, we systematically reviewed all studies investigating biomechanical and clinical outcomes related to the ankle/hindfoot following knee osteotomies. Methods A systematic literature search was conducted on PubMed, Web of Science, EMBASE and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on international prospective register of systematic reviews (PROSPERO) (CRD42021277189). Combining knee osteotomy and ankle/hindfoot alignment, all biomechanical and clinical studies were included. Studies investigating knee osteotomy in conjunction with total knee arthroplasty and case reports were excluded. The QUality Appraisal for Cadaveric Studies (QUACS) scale and Methodological Index for Non-Randomized Studies (MINORS) scores were used for quality assessment. Results Out of 3554 hits, 18 studies were confirmed eligible, including 770 subjects. The minority of studies (n = 3) assessed both high tibial- and distal femoral osteotomy. Following knee osteotomy, the mean tibiotalar contact pressure decreased (n = 4) except in the presence of a rigid subtalar joint (n = 1) or a talar tilt deformity (n = 1). Patient symptoms and/or radiographic alignment at the level of the ankle/hindfoot improved after knee osteotomy (n = 13). However, factors interfering with an optimal outcome were a small preoperative lateral distal tibia angle, a small hip–knee–ankle axis (HKA) angle, a large HKA correction (>14.5°) and a preexistent hindfoot deformity (>15.9°). Conclusions Osteotomies to correct knee deformity alter biomechanical and clinical outcomes at the level of the ankle/hindfoot. In general, these changes were beneficial, but several parameters were identified in association with deterioration of ankle/hindfoot symptoms following knee osteotomy.

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A systematic review of outcomes of high tibial osteotomy for the valgus knee

Cited by 7 publications

References 35 publications

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

Normo‐or slightly overcorrection show better results after medial closing wedge high tibial osteotomy

Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

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