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Opening Wedge High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis: Planning for Improving Outcomes without lateral compartment overloading

Opening Wedge High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis: Planning for Improving Outcomes without lateral compartment overloading

S. Ali Ghasemi, MD, UNITED STATES Joshua Rory Buksbaum, BS, UNITED STATES Jonggu Shin, MD, UNITED STATES Austin T. Fragomen, MD, UNITED STATES S Rozbruch, UNITED STATES Adam Daniel Geffner, BA, UNITED STATES

Hospital for special Surgery, New York, New York, UNITED STATES

2021 Congress   ePoster Presentation     rating (1)


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Summary: The biomechanical studies showed the best mechanical axis angle is between 0 and 3 degrees valgus after HTO surgery in varus knee Osteoarthritis with optimal medial compartment loading and lateral unloading. We evaluated the midterm outcome of our technique in achieving this amount of correction and reliability of our technique to prevent the overcorrection and under correction.

High tibial osteotomy is the known surgery in treatment for varus deformity and Uni-compartmental osteoarthritis (OA) of the knee. A biomechanical study showed the post-operative mechanical axis angle between 0 and 3 degrees valgus not only unloaded the medial compartment but also caused no significant increase in the lateral compartment contact pressure and loading and probable subsequent lateral compartment OA. The purpose of this study is to evaluate the clinical and radiological results of OWHTO and our planning method based on MAD measurement in the patients with varus deformity and uni-compartmental knee OA to achieve a reliable correction without lateral compartment overloading.


A retrospective case-series of patients with Kellgren- Lawrence classification (KL) grade 3 or above (14 patients and 14 limbs) was performed. Radiographic parameters were mechanical axis deviation (MAD), mechanical axis angle (MAA), medial proximal tibial angle (MPTA), Caton-Deschamps Index (CDI), posterior proximal tibial angle (PPTA), and joint line obliquity angle (JLOA). MAD measurements were used for planning. The pre-operative goal was correction of the mechanical axis to pass laterally to the lateral tibial spine. Accuracy of MAD correction was calculated with the preplanned goal. SF-36 score was obtained for clinical performance.


The mean change in MAD was 26.6mm medial from midline to 12.1 lateral from midline (p < 0.001). The MAA changed from 7.35 to -3.5 (p < 0.001). The MPTA improved from 83.7 degrees to 93.1 degrees (p < 0.001), and the PPTA changed from 80.4 degrees to 77.3 degrees (p < 0.0001). The CDI changed from 1.03 to 0.8 (p < 0.0001), and patients did not experience patellofemoral pain. The JLOA improved from 2.7 to 1.3 degrees. The mean SF-36 scores showed significant improvement from 65.2 pre-Op to 82.2 post-Op (p < 0.05). The accuracy of MAD correction was 98.3%


OWHTO considerably improved the clinical outcome for uni-compartmental knee OA. The planning technique based on the measurement of MAD used in study provides accurate and reliable results besides prevention of lateral compartment overloading.