Does lateral closing wedge high tibial osteotomy increase varus instability? Lateral Closing Wedge High Tibial Osteotomy with Tibiofibular Division versus Fibular Shaft Osteotomy
Author(s):
Park J. (South Korea (ROK))
,
Park J. (South Korea (ROK))
Affiliations:
Ro D.
,
Ro D.
Affiliations:
Han H.
,
Han H.
Affiliations:
Lee M.
Lee M.
Affiliations:
ESSKA Academy. Park J. 05/09/18; 209667; P11-850 Topic: Open Surgery
Dr. Jae-Young Park
Dr. Jae-Young Park
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Abstract
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Objectives: In varus-deformed unicompartmental osteoarthritis (OA) of the knee, lateral closing wedge high tibial osteotomy (LCWHTO) is an effective procedure for correction of deformity and reduction of pain. Upon performing LCWHTO, untethering of the fibula can be done via two methods; by osteotomy of the fibular shaft or by division of the tibiofibular joint. Whether LCWHTO induces varus instability or whether there is a difference in varus instability between the two methods of fibula untethering are controversial. The purpose of this study was to compare the effect of LCWHTO, between fibular shaft osteotomy (FSO) and tibiofibular division(TFD), in increasing varus instability.

Methods: From March 2007 to October 2016, 177 cases of medial compartment OA who received LCWHTO were studied retrospectively. 30 patients who received LCWHTO with FSO (Group F) and 30 patients with TFD (Group T) were analyzed. Varus stress radiographs were taken to assess the varus instability of the knee joint at the patients' last follow-up. The lateral gapping length was measured and compared with the normal contralateral knee. Lateral plateau to fibula head distance was measured preoperatively and at the patients' last follow-up on anterior-posterior radiograph of the knee to measure the amount of fibula head migration after surgery. Mechanical alignment and medial proximal tibial angle was measured on full-limb anterior-posterior radiograph, preoperatively and at follow-up. Knee Society Score and Function Score (KSS and KSFS), Hospital for Special Surgery (HSS) score, Western Ontario MacMaster (WOMAC) score, International Knee Documentation Committee(IKDC) subjective score and Lysholm score were checked for clinical assessment. Any complication related to LCWHTO were checked.

Results: There was no significant difference in the degree of varus instability between the two groups. Lateral gapping was 9.5mm on the TFD group and 9.4mm on the FSO group. The lateral gapping difference between the affected knee and the normal contralateral knee was 0.31mm at the TFD group and 0.19mm at the FSO group.(P=0.012) Pearson's correlation coefficient showed negative correlation between follow-up period and difference in the lateral gapping between the affected knee and the normal knee.

Conclusions: In conclusion, LCWHTO with both procedures induced some amount of varus instability. However, the amount was minimal and the impact on clinical outcome was negligible. Negative correlation between follow-up period and difference in lateral gapping shows that if the alignment is changed to a valgus alignment, lateral stability may increase over time.

Keywords:
closing wedge high tibial osteotomy, tibiofibular dissociation, fibular shaft osteotomy
Objectives: In varus-deformed unicompartmental osteoarthritis (OA) of the knee, lateral closing wedge high tibial osteotomy (LCWHTO) is an effective procedure for correction of deformity and reduction of pain. Upon performing LCWHTO, untethering of the fibula can be done via two methods; by osteotomy of the fibular shaft or by division of the tibiofibular joint. Whether LCWHTO induces varus instability or whether there is a difference in varus instability between the two methods of fibula untethering are controversial. The purpose of this study was to compare the effect of LCWHTO, between fibular shaft osteotomy (FSO) and tibiofibular division(TFD), in increasing varus instability.

Methods: From March 2007 to October 2016, 177 cases of medial compartment OA who received LCWHTO were studied retrospectively. 30 patients who received LCWHTO with FSO (Group F) and 30 patients with TFD (Group T) were analyzed. Varus stress radiographs were taken to assess the varus instability of the knee joint at the patients' last follow-up. The lateral gapping length was measured and compared with the normal contralateral knee. Lateral plateau to fibula head distance was measured preoperatively and at the patients' last follow-up on anterior-posterior radiograph of the knee to measure the amount of fibula head migration after surgery. Mechanical alignment and medial proximal tibial angle was measured on full-limb anterior-posterior radiograph, preoperatively and at follow-up. Knee Society Score and Function Score (KSS and KSFS), Hospital for Special Surgery (HSS) score, Western Ontario MacMaster (WOMAC) score, International Knee Documentation Committee(IKDC) subjective score and Lysholm score were checked for clinical assessment. Any complication related to LCWHTO were checked.

Results: There was no significant difference in the degree of varus instability between the two groups. Lateral gapping was 9.5mm on the TFD group and 9.4mm on the FSO group. The lateral gapping difference between the affected knee and the normal contralateral knee was 0.31mm at the TFD group and 0.19mm at the FSO group.(P=0.012) Pearson's correlation coefficient showed negative correlation between follow-up period and difference in the lateral gapping between the affected knee and the normal knee.

Conclusions: In conclusion, LCWHTO with both procedures induced some amount of varus instability. However, the amount was minimal and the impact on clinical outcome was negligible. Negative correlation between follow-up period and difference in lateral gapping shows that if the alignment is changed to a valgus alignment, lateral stability may increase over time.

Keywords:
closing wedge high tibial osteotomy, tibiofibular dissociation, fibular shaft osteotomy
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