Comparison of short-term clinical outcomes between open-wedge high tibial osteotomy and tibial condylar valgus osteotomy

• Published in: BMC musculoskeletal disorders Vol. 25; no. 1; pp. 98 - 11
• Main Authors: Higuchi, Takashi, Koseki, Hironobu, Yonekura, Akihiko, Imai, Chieko, Tomonaga, Iku, Sunagawa, Shinya, Matsumura, Umi, Osaki, Makoto
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27-01-2024; BioMed Central; BMC
• Subjects: Ankle; Arthritis; Care and treatment; Clinical outcomes; Decision making; High tibial osteotomy; Humans; Instability; Joint Instability - diagnostic imaging; Joint Instability - etiology; Joint Instability - surgery; Joint surgery; Knee; Knee Joint - diagnostic imaging; Knee Joint - surgery; Knee osteoarthritis; Knee pain; Methods; Osteoarthritis; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; Osteotomy; Osteotomy - adverse effects; Osteotomy - methods; Pain; Patient outcomes; Patients; Retrospective Studies; Surgery; Surgical techniques; Tibia - diagnostic imaging; Tibia - surgery; Tibial condylar valgus osteotomy; Japan; High tibial osteotomy; Tibial condylar valgus osteotomy; Knee osteoarthritis
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-024-07205-7

This study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures.
Twenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively.
Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0).
Both osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.