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Hybrid closed wedge high tibial osteotomy improves patellofemoral joint congruity compared with open wedge high tibial osteotomy

  • Tetsuro IshimatsuEmail author
  • Ryohei Takeuchi
  • Hiroyuki Ishikawa
  • Yuichiro Yamaguchi
  • Akira Maeyama
  • Katsunari Osawa
  • Woon-Hwa Jung
KNEE
  • 82 Downloads

Abstract

Purpose

To evaluate clinical outcomes and radiographic changes in patellofemoral (PF) joint congruity between open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge HTO (HCWHTO).

Methods

From 2011 to 2013, 36 knees in 31 patients who underwent OWHTO and 21 knees in 17 patients who underwent HCWHTO were evaluated in this retrospective study with a minimum 5-year follow-up. Radiological outcomes including hip–knee–ankle angle (HKA), femoral patellar height index (FPHI), preoperative PF osteoarthritis (OA) grade, medial and lateral joint spaces of the PF joint, and congruence angle were measured. Clinical parameters including the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee Score (OKS) were also evaluated. Preoperative and final follow-up values for each procedure were compared in outcome analyses.

Results

Mean preoperative HKA and the degree of PF-OA were significantly more severe for patients treated with HCWHTO compared with those treated with OWHTO (p = 0.001, p = 0.0001). Mean postoperative FPHI was significantly decreased with proximalization of the patella in HCWHTO (p = 0.01) but showed no significant change in OWHTO (n.s.). Regarding PF joint congruity after HCWHTO, lateral joint space and congruence angle were significantly improved (p = 0.0001, p = 0.005), while medial joint space was not significantly changed (n.s.). After OWHTO, congruence angle showed no significant difference (n.s.), but medial and lateral joint spaces were significantly decreased (p = 0.0001, p = 0.018). There were no significant differences in KOOS and OKS between the groups (n.s., n.s.).

Conclusions

Although degrees of varus knee and PF-OA were more severe in HCWHTO than those in OWHTO, HCWHTO led to improved PF joint congruity, and its mid-term clinical outcomes were equivalent to those of OWHTO. Therefore, in patients with varus knee combined with PF-OA preoperatively, HCWHTO is a more effective treatment than OWHTO.

Level of evidence

Therapeutic level III.

Keywords

Open wedge high tibial osteotomy Hybrid closed wedge high tibial osteotomy Patellofemoral joint congruity Osteoarthritis Knee 

Notes

Acknowledgements

The authors thank Shuhei Otsuki and Daisuke Setoguchi for their advice and expert technical assistance with the statistical analysis. The authors also thank Springer Nature for editing a draft of this manuscript. Furthermore, the authors thank Takuaki Yamamoto for giving an opportunity of this study.

Author contributions

Designed the study: TI, RT, HI, YY, and KO. Analysed the data: TI and KO. Wrote the manuscript: TI and RT. Supervised the study: RT, AM, and WHJ. All authors read and approved the final manuscript.

Funding

This study did not receive any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Aderinto J, Cobb AG (2002) Lateral release for patellofemoral arthritis. Arthroscopy 18(4):399–403CrossRefGoogle Scholar
  2. 2.
    Amendola A, Rorabeck CH, Bourne RB, Apyan PM (1989) Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty 4 (Suppl):S11–S17CrossRefGoogle Scholar
  3. 3.
    Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):197–205CrossRefGoogle Scholar
  4. 4.
    Bellemans J, Vandenneucker H, Vanlauwe J, Victor J (2010) The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees. Knee Surg Sports Traumatol Arthrosc 18(2):152–156CrossRefGoogle Scholar
  5. 5.
    Bito H, Takeuchi R, Kumagai K, Aratake M, Saito I, Hayashi R, Sasaki Y, Saito T (2010) Opening wedge high tibial osteotomy affects both the lateral patellar tilt and patellar height. Knee Surg Sports Traumatol Arthrosc 18(7):955–960CrossRefGoogle Scholar
  6. 6.
    Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Jt Surg Br 59(2):241–242CrossRefGoogle Scholar
  7. 7.
    Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325Google Scholar
  8. 8.
    Christodoulou NA, Tsaknis RN, Sdrenias CV, Galanis KG, Mavrogenis AF (2005) Improvement of proximal tibial osteotomy results by lateral retinacular release. Clin Orthop Relat Res 441:340–345CrossRefGoogle Scholar
  9. 9.
    Duivenvoorden T, van Diggele P, Reijman M, Bos PK, van Egmond J, Bierma-Zeinstra SMA, Verhaar JAN (2017) Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc 25(3):895–901CrossRefGoogle Scholar
  10. 10.
    El Amrani MH, Levy B, Scharycki S, Asselineau A (2010) Patellar height relevance on opening-wedge high tibial osteotomy. Orthop Traumatol Surg Res 96:37–43CrossRefGoogle Scholar
  11. 11.
    Feucht MJ, Minzlaff P, Saier T, Cotic M, Südkamp NP, Niemeyer P, Imhoff AB, Hinterwimmer S (2014) Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 38(11):2273–2280CrossRefGoogle Scholar
  12. 12.
    Fosco M, Dagher E (2016) Proposal of a therapeutic protocol for selected patients with patellofemoral knee osteoarthritis: arthroscopic lateral retinacular release followed by viscosupplementation. Musculoskelet Surg 100(3):171–178CrossRefGoogle Scholar
  13. 13.
    Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15(8):978–984CrossRefGoogle Scholar
  14. 14.
    Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WC, Wymenga AB (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11(6):457–461CrossRefGoogle Scholar
  15. 15.
    Goldhahn S, Takeuchi R, Nakamura N, Nakamura R, Sawaguchi T (2017) Responsiveness of the knee injury and osteoarthritis outcome score (KOOS) and the oxford knee score (OKS) in Japanese patients with high tibial osteotomy. J Orthop Sci 22(5):862–867CrossRefGoogle Scholar
  16. 16.
    Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Nakanishi A, Ueoka K (2017) Patellofemoral osteoarthritis progression and alignment changes after open-wedge high tibial osteotomy do not affect clinical outcomes at mid-term follow-up. Arthroscopy 33(10):1832–1839CrossRefGoogle Scholar
  17. 17.
    Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39(1):64–70CrossRefGoogle Scholar
  18. 18.
    Ihle C, Ahrend M, Grünwald L, Ateschrang A, Stöckle U, Schröter S (2017) No change in patellar height following open wedge high tibial osteotomy using a novel femur-referenced measurement method. Knee 24(5):1118–1128CrossRefGoogle Scholar
  19. 19.
    Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104CrossRefGoogle Scholar
  20. 20.
    Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis. With special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197Google Scholar
  21. 21.
    Jamieson S (2004) Likert scales: how to (ab)use them. Med Educ 38:1217–1218CrossRefGoogle Scholar
  22. 22.
    Javidan P, Adamson GJ, Miller JR, Durand P Jr, Dawson PA, Pink MM, Lee TQ (2013) The effect of medial opening wedge proximal tibial osteotomy on patellofemoral contact. Am J Sports Med 41(1):80–86CrossRefGoogle Scholar
  23. 23.
    Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y (2005) Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13(7):539–544CrossRefGoogle Scholar
  24. 24.
    Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Südkamp N, Niemeyer P, Bode G (2018) High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-5194-x Google Scholar
  25. 25.
    Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R (2018) Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc 26(6):1859–1866CrossRefGoogle Scholar
  26. 26.
    Kujala UM, Osterman K, Kormano M, Komu M, Schlenzka D (1989) Patellar motion analyzed by magnetic resonance imaging. Acta Orthop Scand 60(1):13–16CrossRefGoogle Scholar
  27. 27.
    Lee OS, Ahn S, Lee YS (2018) Changes of sagittal and axial alignments of patella after open- and closed-wedge high-tibial osteotomy: a systematic review and meta-analysis. J Knee Surg 31(7):625–634CrossRefGoogle Scholar
  28. 28.
    Lee YS, Lee BK, Lee SH, Park HG, Jun DS, Moon DH (2013) Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 21(11):2542–2547CrossRefGoogle Scholar
  29. 29.
    Lee YS, Lee SB, Oh WS, Kwon YE, Lee BK (2016) Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24(1):129–133CrossRefGoogle Scholar
  30. 30.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138CrossRefGoogle Scholar
  31. 31.
    McNamara I, Birmingham TB, Fowler PJ, Giffin JR (2013) High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surg Sports Traumatol Arthrosc 21(1):23–31CrossRefGoogle Scholar
  32. 32.
    Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Jt Surg Am 56(7):1391–1396CrossRefGoogle Scholar
  33. 33.
    Murayama K, Nakayama H, Murakami T, Yoshiya S, Otsuki S, Tachibana T (2018) The effect of concomitant arthroscopic lateral retinacular release on postoperative patellar position and orientation in open wedge high tibial osteotomy. Knee Surg Relat Res 30(3):241–246CrossRefGoogle Scholar
  34. 34.
    Nakamura N, Takeuchi R, Sawaguchi T, Ishikawa H, Saito T, Goldhahn S (2011) Cross-cultural adaptation and validation of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sci 16(5):516–523CrossRefGoogle Scholar
  35. 35.
    Otsuki S, Murakami T, Okamoto Y, Nakagawa K, Okuno N, Wakama H, Neo M (2018) Hybrid high tibial osteotomy is superior to medial opening high tibial osteotomy for the treatment of varus knee with patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-018-5015-2 Google Scholar
  36. 36.
    Otsuki S, Nakajima M, Okamoto Y, Oda S, Hoshiyama Y, Iida G, Neo M (2016) Correlation between varus knee malalignment and patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24(1):176–181CrossRefGoogle Scholar
  37. 37.
    Song EK, Seon JK, Park SJ, Jeong MS (2010) The complications of high tibial osteotomy: closing—versus opening-wedge methods. J Bone Jt Surg Br 92(9):1245–1252CrossRefGoogle Scholar
  38. 38.
    Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 34(Suppl 2):B55–B62CrossRefGoogle Scholar
  39. 39.
    Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15(9):1094–1100CrossRefGoogle Scholar
  40. 40.
    Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53CrossRefGoogle Scholar
  41. 41.
    Takeuchi R, Ishikawa H, Miyasaka Y, Sasaki Y, Kuniya T, Tsukahara S (2014) A novel closed-wedge high tibial osteotomy procedure to treat osteoarthritis of the knee: hybrid technique and rehabilitation measures. Arthrosc Tech 3(4):e431–e437CrossRefGoogle Scholar
  42. 42.
    van den Bekerom MP, Patt TW, Kleinhout MY, van der Vis HM, Albers GH (2018) Early complications after high tibial osteotomy: a comparison of two techniques. J Knee Surg 21(1):68–74CrossRefGoogle Scholar
  43. 43.
    van Egmond N, van Grinsven S, van Loon CJ, Gaasbeek RD, van Kampen A (2016) Better clinical results after closed—compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthrosc 24(1):34–41CrossRefGoogle Scholar
  44. 44.
    Wright JM, Heavrin B, Begg M, Sakyrd G, Sterett W (2001) Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 14(3):163–173Google Scholar
  45. 45.
    Wu CC (2011) Combined lateral retinacular release with drilling chondroplasty for treatment of patellofemoral osteoarthritis associated with patellar malalignment in elderly patients. Knee 18(1):24–29CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Joint Surgery CenterYokosuka Municipal HospitalYokosuka CityJapan
  2. 2.Department of Orthopaedic SurgeryFukuoka University Faculty of MedicineFukuokaJapan
  3. 3.Department of Orthopaedic SurgeryMurup HospitalGyeongnamSouth Korea

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