Insufficient Correction and Preoperative Medial Tightness Increases the Risk of Varus Recurrence in Open-Wedge High Tibial Osteotomy

Song, Ju-Ho; Bin, Seong‐Il; Kim, Jong Min; Lee, Bum-Sik; Choe, Jung-Su; Cho, Hyung-Kwon

doi:10.1016/j.arthro.2021.09.028

Cited by 16 publications

(21 citation statements)

References 28 publications

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“…They found that the WBL ratio progressively shifted medially, with significant changes at all time points until 1 year postoperatively; the mean WBL ratios at 1 month, 1 year, and 2 years after osteotomy were 63.1%, 61.6%, and 61.6%, respectively. Song et al 30 investigated the rate and risk factors of varus recurrence, with a mean follow-up of 49.7 months. They reported that 27% of cases showed varus recurrence and that insufficient correction, defined as a WBL ratio of 50% to 57% (similar to the mean undercorrection in our study at <57%), was one of the risk factors for varus recurrence, but clinical outcomes did not differ according to varus recurrence.…”

Section: Discussionmentioning

confidence: 99%

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Lee

Kim

et al. 2022

Am J Sports Med

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Background: Achieving the postoperative mechanical axis passing through 62.5% of the tibial plateau is considered successful osteotomy surgery. Despite precise preoperative planning and surgical techniques, some procedures result in under- or overcorrection. Few studies have investigated the relationship between clinical outcomes and unintentional under- or overcorrection after open wedge high tibial osteotomy (OWHTO) using whole-leg standing radiographs. Purpose: To investigate the relationship between postoperative alignment using whole-leg standing radiographs and clinical outcomes after OWHTO. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 89 knees (72 patients) that underwent OWHTO between October 2013 and September 2018 were included. Patients with postoperative weightbearing line (WBL) ratios within 57% to 67% were classified as appropriate correction (group A; 45 cases), whereas ratios <57% and >67% were classified as undercorrection (group U; 20 cases) and overcorrection (group O; 24 cases), respectively. The following patient-reported outcomes (PROs) were investigated: International Knee Documentation Committee (IKDC) subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The correlation between postoperative WBL and PROs was analyzed. PROs were compared among the 3 groups. Results: Regarding the correlation between postoperative WBL ratio and PROs, a larger postoperative WBL ratio was significantly correlated with a poor IKDC subjective score ( P = .002), Kujala score ( P = .009), and KOOS. Group O showed inferior postoperative PRO scores when compared with group A or U, whereas group U showed a similar result to group A (mean IKDC subjective scores: group U, 62.0; group A, 61.2; group O, 47.6; P = .004). Conclusion: Overcorrection after OWHTO surgery correlated with inferior PROs; therefore, overcorrected alignment should be avoided for patient satisfaction. Knees with an undercorrected alignment showed clinical results similar to those with appropriate correction.

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Section: Discussionmentioning

confidence: 99%

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Lee

Kim

et al. 2022

Am J Sports Med

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“…In the current study, "Insufficient Correction in Cases of Preoperative Medial Tightness Increases the Risk of Varus Recurrence in Open Wedge High Tibial Osteotomy" by Song, Bin, Kim, Lee, Choe, and Cho, 11 varus recurrence was found in 27% of patients after a mean of 4 years. Varus recurrence was defined as weight-…”

Section: See Related Article On Page 1547mentioning

confidence: 67%

“…bearing line ratio (WBLR) <50% at final follow-up. 11 In total, 48.5% of patients with WBLR of 50% to 57% immediately after surgery showed varus recurrence. Interestingly, 22.4% of patients with WBLR of 57% to 67% had varus recurrence.…”

Section: See Related Article On Page 1547mentioning

confidence: 93%

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Editorial Commentary: Knee Preoperative Medial Laxity May Result in Overcorrection or Varus Recurrence After Open-Wedge High Tibial Osteotomy

Choi¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“… 5 , 12 , 20 Among these changes, the lower extremity alignment over time is also a major question, and several studies have demonstrated that serial changes in the weightbearing line (WBL) showed progression toward varus angles (varus progression) during the follow-up period. 16 , 21 , 40 However, there are only a few studies that have quantified how many patients experienced a postoperative alignment change to varus angles.…”

mentioning

confidence: 99%

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy

Lee

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and –2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°, –3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.

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Insufficient Correction and Preoperative Medial Tightness Increases the Risk of Varus Recurrence in Open-Wedge High Tibial Osteotomy

Cited by 16 publications

References 28 publications

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Editorial Commentary: Knee Preoperative Medial Laxity May Result in Overcorrection or Varus Recurrence After Open-Wedge High Tibial Osteotomy

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy

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