Relationship between the bony correction angle and mechanical axis change and their differences between closed and open
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(2020) 21:675
RESEARCH ARTICLE
Open Access
Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy Takahiro Ogino, Ken Kumagai*, Shunsuke Yamada, Tomotaka Akamatsu, Shuntaro Nejima, Masaichi Sotozawa and Yutaka Inaba
Abstract Background: The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). Methods: A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. Results: CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P < 0.05), and a greater soft tissue correction than OWHTO (P < 0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P < 0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. Conclusions: The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy. Keywords: High tibial osteotomy, Opening wedge, Closed wedge, Mechanical axis shift, Correction angle
Background High tibial osteotomy (HTO) is an established procedure to correct lower limb alignment and to reduce the mechanical force on the affected compartment. Proper overcorrection provides pain relief and subsequent * Correspondence: [email protected] Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
improvement of knee function [1, 2]. Two commonly used procedures for HTO are the lateral closed wedge HTO (CWHTO) and the medial opening wedge HTO (OWHTO). Excellent clinical outcomes have been reported with both techniques, although they each have potential advantages and disadvantages [3–5]. In CWHTO, the advantage is the possibility of large correction, and the disadvantage is the invasive surgical
© The Author(s). 2020 Open Access This article is licensed under a Creative
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