Comparison of two osteotomies in the treatment of medial compartment osteoarthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Kangyong ¹ , TONG Ye ¹ , ZHAO Peng ¹ , ZHOU Ye ¹ ,  SHI Shaohui ²

1. Department of Orthopedics, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou Anhui, 234000, P.R.China;
2. Department of Orthopedics, Aviation General Hospital of China Medical University, Beijing, 100012, P.R.China;

Corresponding?author：

SHI Shaohui, Email: drshishaohui@126.com

Keywords：

Knee; medial compartment; osteoarthritis; open-wedge high tibial osteotomy; modified distal tibial tubercle-high tibial osteotomy

DOI：

10.7507/1002-1892.202107075

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Objective To compare the effectiveness of modified distal tibial tubercle-high tibial osteotomy (DTT-HTO) and open-wedge HTO (OWHTO) in the treatment of medial compartment osteoarthritis. Methods A clinical data of 80 patients with medial compartment osteoarthritis treated with HTO between January 2016 and January 2019 was retrospectively analyzed, including 40 patients treated with DTT-HTO (DTT-HTO group) and 40 patients treated with OWHTO (OWHTO group). There was no significant difference in gender, age, body mass index, affected side, disease duration, Kellgren-Lawrence grading of osteoarthritis, and preoperative knee society score (KSS), Hospital for Special Surgery (HSS) score, knee joint visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), posterior tibial slope (PTS), weight-bearing line ratio (WBL), Blackburne-Peel index (BPI), Caton-Deschamps index (CDI), and Insall-Salvati index (ISI) between the two groups (P>0.05). The operation time, incision length, bleeding volume, hospital stay, and complications in both groups were recorded. The KSS, HSS, and VAS scores were used to evaluated the effectiveness. A self-made questionnaire was used to evaluate the recovery of low-impact sports ability of the knee. X-ray films were used to observe the osteotomy healing and measure the HKA, PTS, WBL, and the patellar height indexes (BPI, CDI, ISI). Results All operations successfully completed in both groups. The OWHTO group operated longer than the DTT-HTO group (P<0.05). There was no significant difference in the incision length, bleeding volume, and hospital stay between the two groups (P>0.05). All incisions healed by first intention in both groups. There were 2 cases of lateral hinge fractures in the OWHTO group, and 1 case of lateral hinge fracture and 2 cases of tibial plateau fractures in the DTT-HTO group. No other complications occurred. The patients in both groups were followed up 2-4 years with an average of 2.8 years. The HSS, KSS, and VAS scores in both groups significantly improved after operation when compared with preoperative scores (P<0.05). All scores gradually improved with the time and there were significant differences between different time points (P<0.05). The HSS, KSS, and VAS scores were significantly better in the DTT-HTO group than in the OWHTO group at 3 months after operation (P<0.05). There was no significant difference between the two groups at 6 months, 1 year, and 2 years (P>0.05). At 1 year, the low-impact sports ability of the OWHTO group was rated as excellent in 8 cases, general in 25 cases, and poor in 7 cases, and as excellent in 7 cases, general in 26 cases, and poor in 7 cases of the DTT-HTO group. There was no significant difference between the two groups (Z=?0.715, P=0.475). X-ray film reexamination showed that the osteotomies healed in both groups. The healing time was (4.52±1.23) months in the OWHTO group, and (4.23±1.56) months in the DTT-HTO group, showing no significant difference (t=0.923, P=0.359). At immediate after operation, the HKA and WBL of the two groups significantly improved when compared with the preoperative values (P<0.05). However, the pre- and post-operational difference was not significant between the two groups (P>0.05). The PTS of the OWHTO group was significantly higher than preoperative value (P<0.05), while the PTS of the DTT-HTO group was lower than preoperative value (P>0.05). The pre- and post-operational difference between the two groups was significant (P<0.05). BPI and CDI in the OWHTO group were significantly lower than preoperative values (P<0.05), but there was no significant difference in ISI when compared with preoperative value (P>0.05). There was no significant difference in the BPI, CDI, and ISI of the DTT-HTO group between pre- and post-operation (P>0.05). The pre- and post-operational differences of BPI and CDI between the two groups were significant (P<0.05), and there was no significant difference in the pre- and post-operational difference of ISI (P>0.05). Conclusion The two osteotomies in the treatment of medial compartment osteoarthritis can significantly change the varus deformity and achieve satisfactory effectiveness. The early functional recovery of DTT-HTO is faster, which can avoid the increased PTS and patellar baja of traditional OWHTO. However, neither of the two surgical procedures can restore the patient’s ideal low-impact sports ability of the knee.

Citation： XU Kangyong, TONG Ye, ZHAO Peng, ZHOU Ye, SHI Shaohui. Comparison of two osteotomies in the treatment of medial compartment osteoarthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(11): 1440-1448. doi: 10.7507/1002-1892.202107075 Copy

1.	He M, Zhong X, Li Z, et al. Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review. Syst Rev, 2021, 10(1): 56. doi: 10.1186/s13643-021-01601-z.
2.	孫茂淋, 何銳, 郭林, 等. 開放楔形脛骨高位截骨術的臨床應用及研究現狀. 中國修復重建外科雜志, 2019, 33(5): 640-643.
3.	揭珂, 鄧鵬, 曾意榮. 髕骨高度測量常用 4 種方法的運用與比較. 中國組織工程研究, 2021, 25(24): 3875-3881.
4.	Ferner F, Lutter C, Dickschas J, et al. Medial open wedge vs. lateral closed wedge high tibial osteotomy-Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. Int Orthop, 2019, 43(6): 1379-1386.
5.	Kuriyama S, Watanabe M, Nakamura S, et al. Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon), 2020, 80: 105190. doi: 10.1016/j.clinbiomech.2020.105190.
6.	Debeyre J, Artigou JM. Indications and results of tibial osteotomy. Influence of laxity. Rev Chir Orthop Reparatrice Appar Mot, 1973, 59(8): 641-656.
7.	李珂, 孫鳳龍, 王宏慶, 等. 改良單平面脛骨高位截骨術治療膝關節骨關節炎的早期臨床研究. 中華骨與關節外科雜志, 2020, 13(9): 729-735.
8.	Lau LCM, Fan JCH, Chung KY, et al. Satisfactory long-term survival, functional and radiological outcomes of open-wedge high tibial osteotomy for managing knee osteoarthritis: minimum 10-year follow-up study. J Orthop Translat, 2020, 26: 60-66.
9.	Schuster P, Richter J. Editorial commentary: high tibial osteotomy is effective, even in patients with severe osteoarthritis: contradiction of another dogma from the past. Arthroscopy, 2021, 37(2): 645-646.
10.	Kuwashima U, Iwasaki K, Kurakazu I, et al. Effect of osteoarthritis severity on survival and clinical outcomes after high tibial osteotomy. Knee, 2021, 29: 441-447.
11.	Kuriyama S, Watanabe M, Nakamura S, et al. Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon), 2020, 80: 105190. doi: 10.1016/j.clinbiomech.2020.105190.
12.	Parente A, Legnani C, Bargagliotti M, et al. Medial unicompartmental knee arthroplasty after failed open-wedge high tibial osteotomy. J Arthroplasty, 2021, 36(8): 2746-2751.
13.	吳敏, 王照東, 周平輝, 等. 內側開放楔形脛骨高位截骨術中并發外側鉸鏈斷裂早期療效分析. 中國修復重建外科雜志, 2020, 34(7): 854-861.
14.	Chen YN, Chuang CH, Yang TH, et al. Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge fractures. J Orthop Surg Res, 2020, 15(1): 409. doi: 10.1186/s13018-020-01922-0.
15.	Phillips CL, Silver DA, Schranz PJ, et al. The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg (Br), 2010, 92(8): 1045-1053.
16.	Mortensen AJ, Ludwig TC, Adams BM, et al. The Blackburne-Peel Index for determining patellar height is affected by tibial slope. Arthrosc Sports Med Rehabil, 2021, 3(2): e359-e365.
17.	閔翊, 王建軍, 葉超, 等. 脛骨結節下單平面開放脛骨高位截骨術治療內側間室膝骨關節炎的近期效果觀察. 醫學綜述, 2020, 26(2): 403-407.
18.	Tanaka T, Matsushita T, Miyaji N, et al. Deterioration of patellofemoral cartilage status after medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1347-1354.
19.	Kim HJ, Shin JY, Lee HJ, et al. The patellofemoral joint does not deteriorate clinically after open-wedge high tibial osteotomy. Orthop Traumatol Surg Res, 2021, 107(4): 102907. doi: 10.1016/j.otsr.2021.102907.
20.	Moghtadaei M, Otoukesh B, Bodduhi B, et al. Evaluation of patellar position before and after medial opening wedge high tibial osteotomy: radiographic and computed tomography findings. Med Arch, 2016, 70(4): 293-295.
21.	Verhulst FV, van Sambeeck JDP, Olthuis GS, et al. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 869-875.
22.	Song GY, Zhang H, Zhang J, et al. Greater static anterior tibial subluxation of the lateral compartment after an acute anterior cruciate ligament injury is associated with an increased posterior tibial slope. Am J Sports Med, 2018, 46(7): 1617-1623.
23.	Kim GB, Kim KI, Song SJ, et al. Increased posterior tibial slope after medial open-wedge high tibial osteotomy may result in degenerative changes in anterior cruciate ligament. J Arthroplasty, 2019, 34(9): 1922-1928.
24.	Luo CA, Hwa SY, Lin SC, et al. Placement-induced effects on high tibial osteotomized construct-biomechanical tests and finite-element analyses. BMC Musculoskelet Disord, 2015, 16: 235. doi: 10.1186/s12891-015-0630-2.

1. He M, Zhong X, Li Z, et al. Progress in the treatment of knee osteoarthritis with high tibial osteotomy: a systematic review. Syst Rev, 2021, 10(1): 56. doi: 10.1186/s13643-021-01601-z.
2. 孫茂淋, 何銳, 郭林, 等. 開放楔形脛骨高位截骨術的臨床應用及研究現狀. 中國修復重建外科雜志, 2019, 33(5): 640-643.
3. 揭珂, 鄧鵬, 曾意榮. 髕骨高度測量常用 4 種方法的運用與比較. 中國組織工程研究, 2021, 25(24): 3875-3881.
4. Ferner F, Lutter C, Dickschas J, et al. Medial open wedge vs. lateral closed wedge high tibial osteotomy-Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. Int Orthop, 2019, 43(6): 1379-1386.
5. Kuriyama S, Watanabe M, Nakamura S, et al. Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon), 2020, 80: 105190. doi: 10.1016/j.clinbiomech.2020.105190.
6. Debeyre J, Artigou JM. Indications and results of tibial osteotomy. Influence of laxity. Rev Chir Orthop Reparatrice Appar Mot, 1973, 59(8): 641-656.
7. 李珂, 孫鳳龍, 王宏慶, 等. 改良單平面脛骨高位截骨術治療膝關節骨關節炎的早期臨床研究. 中華骨與關節外科雜志, 2020, 13(9): 729-735.
8. Lau LCM, Fan JCH, Chung KY, et al. Satisfactory long-term survival, functional and radiological outcomes of open-wedge high tibial osteotomy for managing knee osteoarthritis: minimum 10-year follow-up study. J Orthop Translat, 2020, 26: 60-66.
9. Schuster P, Richter J. Editorial commentary: high tibial osteotomy is effective, even in patients with severe osteoarthritis: contradiction of another dogma from the past. Arthroscopy, 2021, 37(2): 645-646.
10. Kuwashima U, Iwasaki K, Kurakazu I, et al. Effect of osteoarthritis severity on survival and clinical outcomes after high tibial osteotomy. Knee, 2021, 29: 441-447.
11. Kuriyama S, Watanabe M, Nakamura S, et al. Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon), 2020, 80: 105190. doi: 10.1016/j.clinbiomech.2020.105190.
12. Parente A, Legnani C, Bargagliotti M, et al. Medial unicompartmental knee arthroplasty after failed open-wedge high tibial osteotomy. J Arthroplasty, 2021, 36(8): 2746-2751.
13. 吳敏, 王照東, 周平輝, 等. 內側開放楔形脛骨高位截骨術中并發外側鉸鏈斷裂早期療效分析. 中國修復重建外科雜志, 2020, 34(7): 854-861.
14. Chen YN, Chuang CH, Yang TH, et al. Computational comparison of different plating strategies in medial open-wedge high tibial osteotomy with lateral hinge fractures. J Orthop Surg Res, 2020, 15(1): 409. doi: 10.1186/s13018-020-01922-0.
15. Phillips CL, Silver DA, Schranz PJ, et al. The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg (Br), 2010, 92(8): 1045-1053.
16. Mortensen AJ, Ludwig TC, Adams BM, et al. The Blackburne-Peel Index for determining patellar height is affected by tibial slope. Arthrosc Sports Med Rehabil, 2021, 3(2): e359-e365.
17. 閔翊, 王建軍, 葉超, 等. 脛骨結節下單平面開放脛骨高位截骨術治療內側間室膝骨關節炎的近期效果觀察. 醫學綜述, 2020, 26(2): 403-407.
18. Tanaka T, Matsushita T, Miyaji N, et al. Deterioration of patellofemoral cartilage status after medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1347-1354.
19. Kim HJ, Shin JY, Lee HJ, et al. The patellofemoral joint does not deteriorate clinically after open-wedge high tibial osteotomy. Orthop Traumatol Surg Res, 2021, 107(4): 102907. doi: 10.1016/j.otsr.2021.102907.
20. Moghtadaei M, Otoukesh B, Bodduhi B, et al. Evaluation of patellar position before and after medial opening wedge high tibial osteotomy: radiographic and computed tomography findings. Med Arch, 2016, 70(4): 293-295.
21. Verhulst FV, van Sambeeck JDP, Olthuis GS, et al. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 869-875.
22. Song GY, Zhang H, Zhang J, et al. Greater static anterior tibial subluxation of the lateral compartment after an acute anterior cruciate ligament injury is associated with an increased posterior tibial slope. Am J Sports Med, 2018, 46(7): 1617-1623.
23. Kim GB, Kim KI, Song SJ, et al. Increased posterior tibial slope after medial open-wedge high tibial osteotomy may result in degenerative changes in anterior cruciate ligament. J Arthroplasty, 2019, 34(9): 1922-1928.
24. Luo CA, Hwa SY, Lin SC, et al. Placement-induced effects on high tibial osteotomized construct-biomechanical tests and finite-element analyses. BMC Musculoskelet Disord, 2015, 16: 235. doi: 10.1186/s12891-015-0630-2.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of two osteotomies in the treatment of medial compartment osteoarthritis

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