Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean
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Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients W. A. M. van Lieshout1,2 · B. J. T. van Ginneken1 · G. M. M. J. Kerkhoffs2 · R. J. van Heerwaarden1,3 Received: 5 September 2018 / Accepted: 6 March 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose A varus-producing medial closing wedge high tibial osteotomy (MCWHTO) is an uncommon procedure. The aim of this retrospective study was to assess the survivorship and prevalence of post-operative subjective knee laxity and satisfaction in a large cohort of patients with a MCWHTO performed without a MCL-reefing procedure. Methods All patients (n = 176) who underwent a MCWHTO in our clinic between 2008 and 2016 were approached to participate. After review of patient charts, questionnaires were sent to willingly patients. Primary outcome was the survivorship of the MCWHTO; secondary outcome was patient-reported instability and satisfaction. Results One-hundred and thirteen patients participated in the study. The 5-year survival rate of the MCWHTO was almost 80%. A total of 77% of the patients was satisfied with the treatment. With regard to post-operative subjective knee laxity, 26% of the patients experienced instability of the knee post-operation. Instability was significantly correlated with the KOOS domains, the Lysholm score, the IKDC knee function score and the Physical and Mental Health Domains of the SF-36. Conclusion Medial closing wedge high tibial osteotomy provides good results regarding survivorship and patient satisfaction for patients with a valgus deformity which is located in the proximal tibia. Clinically relevant is that in the surgical technique without MCL-reefplasty instability is significantly correlated with worse patient-reported outcome measures. The addition of a MCL reefing procedure will improve outcome in selected patients. Level of evidence III. Keywords Knee osteoarthritis · High tibial osteotomy · Valgus deformity · Laxity · Stability · Outcome Abbreviations BMI Body mass index HKA Hip–knee–ankle HTO High tibial osteotomy IKDC International Knee Documentation Committee KOOS Knee Injury and Osteoarthritis Outcome Score MCL Medial collateral ligament * R. J. van Heerwaarden [email protected] 1
Maartenskliniek Woerden, Woerden, The Netherlands
2
Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
3
Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA Mill, The Netherlands
MCWHTO Medial closing wedge high tibial osteotomy NRS Numeric rating scale PROMS Patient-reported outcome measurement scores SF-36 Short Form 36 TKA Total knee arthroplasty QoL Quality of life
Introduction High tibial osteotomy (HTO) is a surgical method to correct malalignment of the leg and has proven to be a good therapeutic option for delaying and potentially pre
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