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The effect of the joint-line obliquity on clinical outcomes in open wedge high tibial osteotomy
Author(s):
Goshima K. (Japan)
,
Goshima K. (Japan)
Affiliations:
Sawaguchi T.
,
Sawaguchi T.
Affiliations:
Shigemoto K.
,
Shigemoto K.
Affiliations:
Iwai S.
,
Iwai S.
Affiliations:
Nakanishi A.
,
Nakanishi A.
Affiliations:
Ueoka K.
Ueoka K.
Affiliations:
ESSKA Academy. Goshima K. 05/09/18; 209650; P11-1422 Topic: Open Surgery
Kenichi Goshima
Kenichi Goshima
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Abstract
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Objectives: Excessive joint-line obliquity after high tibial osteotomy potentially leads to unfavourable knee kinematics and increased shear stress at the joint surface[1][2]. However, it is still unclear whether the increased joint-line obliquity adversely affects the clinical outcomes after open wedge high tibial osteotomy (OWHTO)[3]. The purpose of this study was to evaluate the effect of the joint-line obliquity on clinical outcomes in OWHTO.

Methods: Ninety patients (the mean age: 63.3 ± 9.4 years) who underwent OWHTO with a minimum 2 years follow-up were enrolled in this study. The mean follow-up was 61.2 ± 29.8 months (range, 25 to 135 months). We divided 90 patients into 2 groups according to postoperative medial proximal tibial angle (MPTA); group A (MPTA<95°, n=55) and group B (MPTA≥95°, n=35). Radiographic assessment were performed using hip-knee-ankle angle (HKA), posterior tibial slope (PTS), joint line convergence angle (JLCA), MPTA, MPTA relative to the ground (gMPTA), the ankle joint line angle relative to the ground (gAJLA) and hip abduction angle (HAA). Furthermore, two groups were compared with respect to the clinical outcomes after HTO. The clinical evaluation included Oxford knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results: HKA significantly improved from -6.3 ± 2.8° to 4.5 ± 2.4° after OWHTO. MPTA significantly increased from 84.5 ± 2.1° to 94.2 ± 3.0°, while PTS did not change. Postoperative MPTA was 92.3 ± 1.9° in group A and 97.2 ± 1.4° in group B, while postoperative gMPTA was 90.2 ± 2.7° (89.1 ± 2.2° in group A, 92.1 ± 2.2° in group B). The mean gAJLA and HAA significantly decreased 4.5 ± 4.0° to -2.0 ± 3.6° and 3.5 ± 2.3° to -0.3 ± 2.2°, respectively. There were no significant differences in OKS and KOOS at the final follow-up between the groups; OKS (41.9 ± 6.4 in group A vs 40.5 ± 6.0 in group B), KOOS symptoms (85.9 ± 13.4 vs 81.7 ± 9.6), KOOS pain (84.9 ± 15.7 vs 85.5 ± 10.3), KOOS ADL (90.8 ± 10.1 vs 89.4 ± 8.8), KOOS sports (67.9 ± 29.3 vs 68.0 ± 20.3), and KOOS QOL (74.3 ± 21.0 vs 70.6 ± 16.9).

Conclusions: The increased joint-line obliquity slightly over 5° did not affect the clinical outcomes after OWHTO. Although the mean postoperative MPTA was 94.2°, the joint-line obliquity relative to the ground was less than 3° because of compensatory changes in the hip and ankle joint.

Keywords:
Open wedge high tibial osteotomy, joint-line obliquity, clinical outcomes
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