The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy

Abstract

High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.] was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and 41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (in group A-66.15 months, in group B-66.61 months). We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall-Salvati ratio remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835 degrees ), than after closing wedge osteotomy (9.465 degrees ). Theoretically, the recurrence of the varus deformity, the increase of the valgus alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss; therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement.

Changes of Sagittal and Axial Alignments of Patella after Open- and Closed-Wedge High-Tibial Osteotomy: A Systematic Review and Meta-Analysis

“…Four comparative studies showed the patellar height after both OW and CW HTO. 5,10,14,20 A total of 11 studies [2][3][4]9,15,16,[21][22][23][24][25] reported postoperative changes in patellar height or patellofemoral alignment only after OW HTO and five studies [26][27][28][29][30] reported changes only after CW HTO. The measured indexes used for the evaluation of patellar indexes in each study are shown in ►Table 1.…”

Comparison of total knee arthroplasty after combined high tibial osteotomy with a matched group of primary total knee arthroplasty

“…The distance between the tibial tubercle and the joint line does not change after CO and thus the length of patellar tendon does not change significantly. [19,20] Excessive undercorrection, overcorrection and rotational deformity are not uncommon after a failed HTO [14,28] and the HTO inevitably produces some transposition of the tibial condyle with respect to its bony axis. [29] These factors can lead to difficulty in obtaining optimal soft tissue balancing, appropriate alignment and optimal positioning of the tibial component during the subsequent TKA [15,18,30] In our study, similar to Meding et al, [30] the impingement of the peg of the tibial component against the truncated lateral metaphysis did not occour, the tibial component was not medialized or downsized in any case, because the CO does not lead to significant lateral tibial bone loss and to lateral overhang.…”

“…We performed CO [19,20] (combination of lateral closing and medial opening wedge osteotomy) in all cases in 1993. We preferred CO if the planned correction was 10º or higher.…”

“…We preferred CO if the planned correction was 10º or higher. [19,20] Hardware was removed prior to TKA in all cases.…”

“…According to our former studies, [19,20] a combined high tibial osteotomy (CO) does not change considerably the position of the tibial condyle and the patella, thus we believe that CO does not compromise the subsequent TKA, hypothesizing that the clinical and radiological results and survivorship of TKA performed after failed CO are similar to primary TKA in the medium-to-long term. Therefore, in this study, we aimed to compare the results of TKAs performed after previous CO to those of a matched control group of primary TKA.…”