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

Sung-Sahn Lee; Young Keun Lee; Il Su Kim; Dong Jin Ryu; Eui Yub Jung; Do Kyung Lee; Joon Ho Wang

doi:10.1177/23259671221119152

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

Orthop J Sports Med. 2022 Aug 29;10(8):23259671221119152. doi: 10.1177/23259671221119152. eCollection 2022 Aug.

Authors

Sung-Sahn Lee¹, Young Keun Lee², Il Su Kim³, Dong Jin Ryu⁴, Eui Yub Jung⁵, Do Kyung Lee⁶, Joon Ho Wang^{3

7}

Affiliations

¹ Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Republic of Korea.
² Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangjusi, Gyeonggido, Republic of Korea.
³ Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁴ Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
⁵ Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea.
⁶ Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁷ Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.

Abstract

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.

Keywords: alignment change; high tibial osteotomy; predictive factor.