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Comparison of Hybrid and Opening Wedge High Tibial Osteotomies Based on Patellofmoral Geometry
Author(s):
Otsuki S. (Japan)
,
Otsuki S. (Japan)
Affiliations:
Murakami T.
,
Murakami T.
Affiliations:
Okamoto Y.
,
Okamoto Y.
Affiliations:
Nakagawa K.
,
Nakagawa K.
Affiliations:
Neo M.
Neo M.
Affiliations:
ESSKA Academy. Otsuki S. 05/09/18; 209666; P11-446 Topic: Knee
Dr. Shuhei Otsuki
Dr. Shuhei Otsuki
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Abstract
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Objectives: To investigate changes in patellar height and rotational alignment after opening wedge high tibial osteotomy (OWHTO) and Hybrid HTO, and consider the indications for these types of HTO based on patellofomemoral geometry.

Methods: Forty knees with varus osteoarthritis were included in this study. Twenty Hybrid HTO and 20 OWHTO, which were matched on sex and age from 80 OWHTO, were compared. Pre- and post-operative knee alignment and Caton-Deschamps and modified Miura-Kawamura index were used to evaluate patellar height and patellar tilt, tibial tuberosity - trochlear groove (TT-TG) distance and medial and lateral joint space at patellofemoral joint were measured.

Results: Body mass index and severity of osteoarthritis were not significant difference between groups. The average of correction angle in Hybrid HTO was 11.0 ± 2.9, which was no different in comparison with OWHTO (10.6 ± 2.6). Pre- and postoperative values for the Caton-Deschamps and modified Miura-Kawamura index in patients that underwent Hybrid HTO were not significant difference from 0.90 to 0.94, and 0.95 to 1.03, while these indices after OWHTO were significantly decreased from 0.91 to 0.73, and 1.06 to 0.81, respectively (p < 0.01). TT-TG distance after Hybrid HTO was significantly decreased from 11.4 to 7.4 (p < 0.01), whereas OWHTO was not different. Although pre- and postoperative patellar tilt were not altered both osteotomy, postoperative medial joint space at patellofemoral joint were significantly increased in Hybrid HTO rather than OWHTO (p = 0.035).

Conclusions: Hybrid HTO results in better postoperative patellofemoral geometry than OWHTO by preventing patella baja and improving rotational alignment. Hybrid HTO is the preferable technique for varus knees with patellofemoral osteoarthritis.

Keywords:
Hybrid HTO, OWHTO, patella height, TT-TG distance
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