Joint line obliquity after lateral closing‐wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5‐year follow‐up study

Xie, Tianshun; Huizinga, Maarten R.; Akker‐Scheek, Inge van den; Veen, Hugo C. van der; Brouwer, Reinoud W

doi:10.1007/s00167-023-07532-7

Cited by 3 publications

(1 citation statement)

References 68 publications

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“…In addition, complex biomechanics may have contributed to the statistical significance. Many recent studies on JLO associated with HTO have been reported [38][39][40][41]; however, most covered the association between postoperative JLO and clinical outcomes. The association between preJLO and ΔJLCA seems to be an area that requires further study.…”

Section: Discussionmentioning

confidence: 99%

Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy

Jung,

Chung

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to analyse the factors associated with additional postoperative alignment changes after accurate bony correction by selecting only patients with well‐performed bony correction as planned and develop a method of incorporating significant factors into preoperative planning.MethodsAmong 104 consecutive patients who underwent medial open wedge high tibial osteotomy (MOWHTO) between October 2019 and July 2022, 61 with well‐performed bony corrections were retrospectively reviewed. The major criterion for well‐performed bony correction was a difference of <1° between the simulated medial proximal tibial angle (MPTA) and the actual postoperative MPTA as measured in three dimensions. Radiographic parameters, such as the joint line convergence angle (JLCA) and joint line obliquity (JLO), were measured preoperatively and postoperatively, utilising standing and supine whole lower extremity anteroposterior, valgus and varus stress radiographs. Multiple linear regression analysis identified the factors affecting alignment changes, and a prediction model was developed. A method for applying this prediction model to preoperative planning was proposed.ResultsPreoperative JLCA on standing (preJLCAstd), preoperative JLCA on 0° valgus stress radiograph (vgJLCA0), and preoperative JLO (preJLO) were significantly correlated with JLCA change (∆JLCA) (p < 0.001, p < 0.001, p = 0.006). The prediction model was estimated as ∆JLCA = 0.493 × (vgJLCA0) − 0.727 × (preJLCAstd) + 0.189 × (preJLO) − 1.587 in. (R = 0.815, modified R2 = 0.646, p < 0.001). The proposed method resulted in a reduced overcorrection rate (p = 0.003) and an improved proportion of acceptable alignments (p = 0.013).ConclusionPreJLCAstd, vgJLCA0 and preJLO can be used to estimate ∆JLCA. PreJLO was recently identified as a significant factor associated with additional alignment changes. Utilising the proposed preoperative planning and a prediction model with these factors shows promise in calibrating postoperative alignment after MOWHTO.Level of EvidenceLevel III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy

Jung,

Chung

et al. 2024

Knee surg. sports traumatol. arthrosc.

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Around-the-knee osteotomies part 1: definitions, rationale and planning—state of the art

Kayaalp,

Apseloff,

Lott

et al. 2024

Journal of ISAKOS

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Influence of Increased Joint Line Obliquity on Survivorship After Lateral Closing-Wedge High Tibial Osteotomy

Xie,

de Vries,

van der Veen

et al. 2024

Am J Sports Med

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Background: Although high tibial osteotomy (HTO) has emerged as a powerful intervention for treating symptomatic medial osteoarthritis and varus malalignment, it can result in an increase in knee joint line obliquity (KJLO) in the frontal plane. Limited current evidence hinders understanding of the effect of increased KJLO on HTO survivorship. Purpose: To investigate the influence of KJLO and other potential risk factors on the survivorship of lateral closing-wedge HTO. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with symptomatic medial knee osteoarthritis and varus malalignment treated with lateral closing-wedge HTO at a single hospital were screened with a minimum follow-up of 5 years. HTO survival rate was assessed using Kaplan-Meier survival analysis. The influence of postoperative increased KJLO (medial proximal tibial angle ≥95°), age (≥55 years), sex (female), preoperative malalignment (hip-knee-ankle angle ≥10° of varus), postoperative untargeted alignment (hip-knee-ankle angle <2° or >6° of valgus), and preoperative osteoarthritis severity (Kellgren-Lawrence grade ≥3) on survivorship of HTO was evaluated using Cox regression analysis. A failure of HTO was defined as a conversion to total knee arthroplasty (TKA). Results: A total of 410 patients (463 knees) were included, with a mean follow-up of 13.0 years (range, 5.0-18.1 years) and a mean survival time of 11.2 years (range, 1.2-18.1 years) for patients who reached the endpoint of TKA. HTO survival rates at 5, 10, and 15 years postoperatively were 91%, 78%, and 60%, respectively. Multivariate Cox regression analysis showed no significant difference in survivorship between patients with increased KJLO and those with acceptable KJLO (178 vs 285 knees; hazard ratio [HR], 0.8; 95% CI, 0.6-1.1; P = .148), with no significant between-group difference observed in the mean follow-up length (12.9 ± 3.0 years vs 13.1 ± 3.3 years; P = .105). Female sex (HR, 2.0; P < .001) and postoperative untargeted alignment (HR, 1.6; P = .003) were risk factors for a conversion to TKA. Conclusion: Increased postoperative KJLO (medial proximal tibial angle ≥95°) had no significant influence on the survivorship of lateral closing-wedge HTO. Men demonstrated superior survival outcomes compared with women, and it was important to achieve a targeted postoperative alignment (HKA 2°-6° of valgus) to ensure favorable HTO survivorship.

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Joint line obliquity after lateral closing‐wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5‐year follow‐up study

Cited by 3 publications

References 68 publications

Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy

Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy

Around-the-knee osteotomies part 1: definitions, rationale and planning—state of the art

Influence of Increased Joint Line Obliquity on Survivorship After Lateral Closing-Wedge High Tibial Osteotomy

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