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Correction of Tibiofemoral Subluxation after High Tibial Osteotomy: Prospective Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy


Myung Chul Lee, MD, PhD, Prof.
KOREA, REPUBLIC OF

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Correction of Tibiofemoral Subluxation after High Tibial Osteotomy: Prospective Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy

Myung Chul Lee, MD, PhD, Prof., KOREA, REPUBLIC OF Yoonho Kwak, KOREA, REPUBLIC OF Junghwan Park, KOREA, REPUBLIC OF Hyuk-Soo Han, MD, PhD, KOREA, REPUBLIC OF

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea, Seoul, KOREA, REPUBLIC OF

2017 Congress   Paper Abstract   2017 Congress   Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Ligaments

ACL

Summary: T-F subluxation was well corrected after CW and OWHTO and degree of T-F subluxation correction was not different between two groups

Purpose

Tibiofemoral (T-F) subluxation is a common finding in the medial compartment osteoarthritis of knee with varus deformity. But the degree of T-F subluxation correction after high tibial osteotomy (HTO) and variables related to the T-F subluxation were not understood well. The purposes of this study were 1) to compare correction of T-F subluxation after lateral closing wedge (CW) and medial opening wedge (OW) HTO and 2) to find the variables related to the T-F subluxation.

Methods

In this prospective randomized comparative study, 30 unilateral CWHTO’s and 30 unilateral OWHTO’s for medial compartmental osteoarthritis with 1 year follow up were analyzed. The hip-knee-ankle (H-K-A) angle, T-F subluxation, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Hospital for Special Surgery (HSS) score, Visual Analogue Scale (VAS) were measured preoperatively and 1 year postoperatively. Pearson’s correlation analysis was conducted to find the variables related to preoperative and postoperative 1-year (residual) T-F subluxation.

Results

The mean T-F subluxation changed from 3.9±2.3mm to 1.4±1.4mm (p < 0.01) after CWHTO, while it changed from 4.3±1.8mm to 1.4±1.5mm (p<0.01) after OWHTO. The mean T-F subluxation correction was not different between two groups (2.5±2.0mm in CWHTO versus 2.9±1.9mm in OWHTO, p=0.36). Correlated variables for preoperative T-F subluxation were preoperative H-K-A angle (r=0.43, p=0.01), KSKS (r=-0.42, p<0.05), VAS (r=0.38, p<0.05) in CWHTO group while preoperative H-K-A angle (r=0.47, p<0.01), VAS (r=0.52, p<0.05) in OWHTO group. Residual T-F subluxation was significantly correlated with preoperative T-F subluxation in both groups (r=0.52, p<0.01 in CWHTO versus r=0.37, p<0.05 in OWHTO) but it was not correlated with any of postoperative clinical scores in both groups (p>0.05). KSS, HSS, VAS score improved significantly in both groups (p<0.01).

Conclusion

T-F subluxation was well corrected after CW and OWHTO and degree of T-F subluxation correction was not different between two groups. Although, preoperative T-F subluxation was one of possible reason for poor clinical scores, residual T-F subluxation was negligible and did not affect any of the postoperative clinical scores in both groups.