Summary

Medial opening wedge high tibial osteotomy is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands.

Abstract

Purpose

This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single-center osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient-reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions, and survivorship up to 10 years postoperatively.

Methods

A prospectively maintained single-center database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee mal-alignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean BMI of 29.6 ± 5.2 Kg/m2, were included. This comprised 71% males (n = 462) and 29% females (n =189). The mean follow-up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the knee injury and osteoarthritis outcome index scores, the Oxford knee score Oxford Knee Score – Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ5D, which is a standardized measure of health-related quality of life. All lower limb alignment measurements were recorded pre- and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5, and 10 years survivorship were recorded.

Results

A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 mm ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 mm ± 3.4 mm, and 8.9 mm ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from -5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean MPTA improved from preoperative 85.5 ± 2.3° to postoperative 91.6 ± 2.7°, and the mean Mikulicz point improved from 21.7 ± 12.6 % to 54.8 ± 11 % (all p values < 0.001). All PROMs significantly improved at 24 months follow-up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively, and 3.2% unicompartmental knee arthroplasty conversion at an average of 5.7 ± 2.5 years postoperatively. An overall 10.3 % complication rate was recorded. The 5 and 10 years survival was 97.2%, and 91.9 %, respectively.

Conclusion

Medial opening wedge high tibial osteotomy (MOWHTO) is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with evidence of overload and a varus mechanical coronal plane axis.