Extended indications for high tibial osteotomy in mild varus deformity
Author(s):
Sim J. (South Korea (ROK))
Sim J. (South Korea (ROK))
Affiliations:
ESSKA Academy. Sim J. 05/09/18; 209715; P12-1523 Topic: Arthroscopic Surgery
Jae Ang Sim
Jae Ang Sim
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Abstract
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Objectives: High tibial osteotomy (HTO) is generally indicated for patients with medial compartment osteoarthritis with genu varum deformity. However, whether HTO indications can be extended to the patients with mild varus deformity is not established. We examined the preoperative characteristics and postoperative outcomes of HTO in patients with mild genu varum (4° or smaller) compared to patients with greater varus deformity (greater than 4°).

Methods: Seventy one patients who underwent HTO between 2013 and 2016 were included in this retrospective study. Patients were divided into either mild varus (MV) [N = 31 (44%)] and greater varus (GV) group [N = 40 (56%)] based on the mechanical femorotibial angle (mFTA). Preoperative characteristics on single photon emission computed tomography-computed tomography (SPECT-CT), magnetic resonance image and radiograph were evaluated. Radiographic parameters (mFTA, weight bearing line coordinate, medial proximal tibial angle, tibial slope) and functional outcomes (Knee Society Score) were compared pre- and postoperatively between the groups.

Results: Preoperative characteristics were similar between the MV and GV group. There was no difference in the proportion of hot uptake on SPECT-CT, medial meniscus posterior horn root tear, medial meniscus complex or radial tear, bone marrow edema, full thickness cartilage defect of medial femoral condyle and tibial plateau. Kellgren-Lawrence grade was more severe in the GV group. Coronal alignment of the MV group was corrected into more valgus than the GV group (4.5º ± 2.6º vs. 2.8º ± 11.8º in mFTA, 69% ± 12% vs. 63% ± 12% in weight bearing line coordinate). Tibial slope did not differ between the groups pre- and postoperatively. There was no difference in pre- and postoperative Knee Society knee and function scores.

Conclusions: A selected subset of patients with mild varus deformity have functional deficit similar to patients with greater varus deformity. These patients can be indicated for HTO and can benefit from HTO. Several image findings, patients' symptom and functional status should be considered for patient selection for HTO, along with the severity of varus deformity.

Keywords:
Knee; Osteoarthritis; High tibial osteotomy; Varus deformity
Objectives: High tibial osteotomy (HTO) is generally indicated for patients with medial compartment osteoarthritis with genu varum deformity. However, whether HTO indications can be extended to the patients with mild varus deformity is not established. We examined the preoperative characteristics and postoperative outcomes of HTO in patients with mild genu varum (4° or smaller) compared to patients with greater varus deformity (greater than 4°).

Methods: Seventy one patients who underwent HTO between 2013 and 2016 were included in this retrospective study. Patients were divided into either mild varus (MV) [N = 31 (44%)] and greater varus (GV) group [N = 40 (56%)] based on the mechanical femorotibial angle (mFTA). Preoperative characteristics on single photon emission computed tomography-computed tomography (SPECT-CT), magnetic resonance image and radiograph were evaluated. Radiographic parameters (mFTA, weight bearing line coordinate, medial proximal tibial angle, tibial slope) and functional outcomes (Knee Society Score) were compared pre- and postoperatively between the groups.

Results: Preoperative characteristics were similar between the MV and GV group. There was no difference in the proportion of hot uptake on SPECT-CT, medial meniscus posterior horn root tear, medial meniscus complex or radial tear, bone marrow edema, full thickness cartilage defect of medial femoral condyle and tibial plateau. Kellgren-Lawrence grade was more severe in the GV group. Coronal alignment of the MV group was corrected into more valgus than the GV group (4.5º ± 2.6º vs. 2.8º ± 11.8º in mFTA, 69% ± 12% vs. 63% ± 12% in weight bearing line coordinate). Tibial slope did not differ between the groups pre- and postoperatively. There was no difference in pre- and postoperative Knee Society knee and function scores.

Conclusions: A selected subset of patients with mild varus deformity have functional deficit similar to patients with greater varus deformity. These patients can be indicated for HTO and can benefit from HTO. Several image findings, patients' symptom and functional status should be considered for patient selection for HTO, along with the severity of varus deformity.

Keywords:
Knee; Osteoarthritis; High tibial osteotomy; Varus deformity
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