Change in limb length after high tibial osteotomy using computer-assisted surgery: a comparative study of closed- and open-wedge osteotomies

Abstract

III.

Medial opening-wedge high tibial osteotomy affects leg length whereas a lateral closing-wedge osteotomy does not: a systematic review

“…In Bae et al ’s study,33 there were no differences in average knee score, functional score, range of motion (ROM) or complication rate between CW and OWHTO. In Kim et al ’s study,35 the average ROM, Knee Society (KS) knee score, KS function score, Hospital for Special Surgery (HSS) score and a visual analogue scale (VAS) for pain showed no difference between CWHTO and OWHTO.…”

“…In this study, the mean tibial length increased by 4.3±3.4 mm and the mean leg length increased by 5.5±4.4 mm after OWHTO; in contrast, the mean tibial length decreased by 4.1±2.9 mm and the mean leg length decreased by 2.7±4.0 mm after CWHTO. Bae et al 33 also evaluated the mean changes in leg length using a navigation system. OWHTO resulted in 6.2±2.6 mm lengthening, whereas CWHTO showed 1.3±1.9 mm shortening.…”

“…However, no correlation was found between the amount of closing and changes in leg length after CWHTO. Bae et al 33 performed Pearson’s correlation analyses and found that correction angle and posterior tibial slope changes were positively and negatively correlated with changes in leg length, respectively, after OWHTO. However, changes in neither the correction angle nor the posterior tibial slope were correlated with leg length after CWHTO.…”

“…Two studies33 35 have reported an increased proportion of patients with a change in leg length >5 mm after HTO. Bae et al 33 revealed that 57% (17/30) of patients showed changes in leg length >6 mm after OWHTO, whereas none did after CWHTO. In addition, Kim et al 35 reported that 90% (27/30) of patients showed changes in leg length >5 mm, compared with only 3% (1/30) of patients after CWHTO.…”

Modular device used in the surgery of the human tibia

“…HIGH TIBIAL OSTEOTOMIES (HTO) performed in the lower limb area can be classified according to several criteria such as: depending on the type of osteotomy wedge, there can be opening wedge or closing wedge osteotomies, when the incision (incisions) is initiated from the medial area the osteotomy is medial, and when it starts from the lateral area, the osteotomy is lateral and depending on the number of the cutting planes, there are uniplanar or biplanar osteotomies. Figure 3 shows the osteotomy in the proximal tibia and both the opening wedge osteotomy and the closing wedge osteotomy are presented [7,8]. It can be seen that in the case of closing wedge osteotomy (Figure 3a) two cuts are performed, the resulting wedge is eliminated, the cuts are placed one over the other with the axial correction of the tibia.…”