Excessively Increased Joint-Line Obliquity After Medial Opening-Wedge High Tibial Osteotomy Is Associated With Inferior Radiologic and Clinical Outcomes: What Is Permissible Joint-Line Obliquity

Kim, Sang Woo; Lim, Jin Kyu; Choi, Han Gyeol; Jeong, Ho Won; Park, Sung Bae; Shim, Seung Jae; Lee, Yong Seuk

doi:10.1016/j.arthro.2021.11.004

Cited by 25 publications

(43 citation statements)

References 47 publications

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“…Having said that, the findings reported by Kim et al 6 correspond with what has already been published on joint line obliquity. Other retrospective cohort studies have shown that a postoperative MPTA greater than 95 is associated with worse clinical outcomes [7][8][9] or more frequent lateral compartment pain.…”

Section: See Related Article On Page 1904supporting

confidence: 84%

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Editorial Commentary: Avoid Creating an Oblique Joint Line After an Opening Medial Wedge High Tibial Osteotomy

Servant¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: See Related Article On Page 1904supporting

confidence: 84%

“…In summary, the article by Kim et al 6 adds to the evidence that a predicted postoperative MPTA of greater than 95 should compel a surgeon to consider a double-level osteotomy. Where I work (in Suffolk, England) a phrase beloved of local tradesmen is "on the huh," meaning not level, lopsided, or askew.…”

Section: See Related Article On Page 1904mentioning

confidence: 99%

Editorial Commentary: Avoid Creating an Oblique Joint Line After an Opening Medial Wedge High Tibial Osteotomy

Servant¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Patients who had mildly increased JLO did not necessarily have a poor outcome and exhibited steady alignment at serial follow-up, in contrast, excessively increased JLO led to poor outcomes. 15 The purpose of this study was to identify the factors associated with unfavorable radiological outcomes after OWHTO for varus knees by analyzing structural parameters and determining cutoff values favoring the application of DLO. The hypothesis of this study was that there would be an optimal situation in which DLO has advantages over isolated OWHTO and an optimal cutoff value of structural parameters for which DLO should be considered in patients with severe varus knees.…”

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confidence: 99%

“… 23 In other studies, a postoperative MPTA >95º also consequently adversely affected functional and clinical outcomes. 1 , 15 …”

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Factors Associated With Unfavorable Radiological Outcomes After Opening-Wedge High Tibial Osteotomy for Varus Knees

Shim

Jeong

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Corrective osteotomy around the knee is based on deformity profiles of the femoral and tibial sides. Opening-wedge high tibial osteotomy (OWHTO) can be favored if the outcomes are not different, even if there is a certain degree of abnormal parameters after correction. Purpose/Hypothesis: The purpose of this study was to identify the factors associated with unfavorable radiological outcomes after OWHTO for varus knees. Our hypothesis was that there would be an optimal situation in which double-level osteotomy (DLO) has advantages over isolated OWHTO and an optimal cutoff value of structural parameters for which DLO should be considered in patients with severe varus knees. Study Design: Case-control study; Level of evidence, 3. Methods: The radiological and clinical outcomes of 337 patients who underwent OWHTO were retrospectively evaluated. A subgroup analysis was performed according to the weightbearing line ratio (WBLR) (group 1: <25th percentile; group 2: 25th-75th percentile; and group 3: >75th percentile) and factors associated with unfavorable radiological outcomes. For the assessment of cutoff values of the parameters favoring DLO, unfavorable radiological outcomes were categorized as follows: (1) medial proximal tibial angle (MPTA) >95°, (2) joint-line convergence angle (JLCA) >4° (insufficient medial release), (3) JLCA <0° (medial instability), (4) recurrence of a varus deformity, and (5) lateral hinge fracture. Results: The mean follow-up period was 66.2 ± 19.1 months. A low preoperative WBLR was related to a larger preoperative to postoperative change (Δ) in the WBLR, a larger reduction in coronal translation, a larger ΔMPTA, a wide preoperative lateral joint space, and a narrow preoperative medial joint space ( P < .001, P < .001, P < .001, P = .016, and P = .003, respectively). However, only an MPTA >95° was significantly related to a low WBLR in the subgroup analysis according to unfavorable radiological outcomes ( P = .038). The cutoff value of ΔWBLR causing an MPTA >95° was 46.5%, which showed a good area under the curve of 0.800, with a sensitivity of 74.4% and a specificity of 82.7%. The clinical outcomes significantly improved at the final follow-up compared with those preoperatively, with no significant differences between the WBLR groups. Conclusion: A ΔWBLR ≥46.5% led to an MPTA >95°. However, clinical outcomes were not affected. DLO should be considered if the surgeon desires a postoperative MPTA ≤95°.

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No clinical outcome difference between varus phenotypes after medial opening‐wedge high tibial osteotomy at 2 years follow‐up

Van Genechten,

Vanneste,

van Beek

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeClinical studies regarding medial open‐wedge high tibial osteotomy (MOWHTO) often analyse a large group of mechanical varus knees rather than differentiating for its primary varus‐inducing component. This study aims to compare the radiological and clinical outcomes of the most prevalent varus malalignment phenotypes using the coronal plane alignment of the knee (CPAK) classification.MethodsMOWHTO cases with minimal 2‐year clinical follow‐up were retrospectively selected from a knee osteotomy database (2016–2020). Based on the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), subjects were allocated to the correct CPAK phenotype pre‐ and postoperatively. Clinical outcomes were the numeric rating scale (NRS), the knee injury and osteoarthritis outcome score (KOOS) and the therapeutic response rate (TRR) at 2‐year follow‐up. Inter‐observer correlation coefficient (ICC) and unpaired student t test were performed for cross‐phenotype comparison.ResultsOne hundred thirty‐five (135) subjects were found eligible (53.0 years old ±9.6 [19–77], 72% male, 53% left‐sided). The most prevalent preoperative phenotype was CPAK 1 (n = 70 (52%)) and the postoperative phenotype was CPAK 6 (n = 66 (49%)). All CPAK phenotypes improved significantly relative to baseline but cross‐phenotype comparison yielded no significant differences in clinical outcome. The TRR at 2 years was 67% for CPAK 1, 69% for CPAK 2 and 87% for CPAK 4. The TRR for CPAK 6 was 64% compared with 80% for CPAK 9, which was not significantly different.ConclusionAt 2‐year follow‐up, no clinically significant differences are observed between different CPAK phenotypes. Accurate MOWHTO corrections provide significant clinical improvement even in the femoral‐driven varus knee and the constitutional varus knee dominated by intra‐articular wear. The clinical indication for MOWHTO performance should not be reduced to the medial arthritic varus knee with underlying tibial varus alone.Level of EvidenceLevel IV, retrospective comparative study.

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Excessively Increased Joint-Line Obliquity After Medial Opening-Wedge High Tibial Osteotomy Is Associated With Inferior Radiologic and Clinical Outcomes: What Is Permissible Joint-Line Obliquity

Cited by 25 publications

References 47 publications

Editorial Commentary: Avoid Creating an Oblique Joint Line After an Opening Medial Wedge High Tibial Osteotomy

Editorial Commentary: Avoid Creating an Oblique Joint Line After an Opening Medial Wedge High Tibial Osteotomy

Factors Associated With Unfavorable Radiological Outcomes After Opening-Wedge High Tibial Osteotomy for Varus Knees

No clinical outcome difference between varus phenotypes after medial opening‐wedge high tibial osteotomy at 2 years follow‐up

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