Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176 degrees and 185 degrees were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz-joint line angle (MJL) >= 94 degrees or a mechanical medial proximal tibial angle (mMPTA) >= 95 degrees. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores (P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores (P = .0024). A good preoperative range of motion was associated with better knee score (P = .0399) and function score (P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores (P = .0317). MJL >= 94 degrees and mMPTA >= 95 degrees were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL >= 94 degrees or mMPTA >= 95 degrees) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.

Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up

Rosso, Federica;Rossi, Roberto;Cantivalli, Antonino;Pilone, Carola;Bonasia, Davide Edoardo
2022-01-01

Abstract

Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176 degrees and 185 degrees were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz-joint line angle (MJL) >= 94 degrees or a mechanical medial proximal tibial angle (mMPTA) >= 95 degrees. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores (P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores (P = .0024). A good preoperative range of motion was associated with better knee score (P = .0399) and function score (P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores (P = .0317). MJL >= 94 degrees and mMPTA >= 95 degrees were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL >= 94 degrees or mMPTA >= 95 degrees) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.
2022
50
2
461
470
HTO; arthritis; clinical outcomes; joint line obliquity; malalignment; osteotomy
Rosso, Federica; Rossi, Roberto; Cantivalli, Antonino; Pilone, Carola; Bonasia, Davide Edoardo
File in questo prodotto:
File Dimensione Formato  
120 AJSM JLO.pdf

Accesso riservato

Tipo di file: PDF EDITORIALE
Dimensione 1.04 MB
Formato Adobe PDF
1.04 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1882071
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 26
  • ???jsp.display-item.citation.isi??? 21
social impact