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A case series of lateral opening wedge high tibial osteotomy for valgus malalignment

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Introduction

Lateral opening wedge high tibial osteotomy is a rarely employed surgical technique used for the treatment of lateral knee pain and degeneration in the setting of genu valgum. There exists little evidence of the suitability of this procedure for patients requiring osteotomies with a small correction.

Materials and methods

A case series of 23 patients (24 knees) undergoing lateral opening wedge high tibial osteotomy with a minimum follow-up of 2 years was performed between 2002 and 2008. A surgical technique avoiding the need for fibular osteotomy is described. Adverse events, patient-reported outcomes and radiographic measures of alignment were assessed at baseline, at 6 months postoperatively, and at time of final follow-up. A subgroup of 12 patients also underwent 3D gait analysis at the same time points.

Results

The mean follow-up was 52 months (±20.4). Statistically and clinically significant improvements were identified in the lower extremity functional scale [mean change (95 %CI) = 10 (2.4, 17.6)], and in the knee injury and osteoarthritis outcome score [mean change (95 %CI) = 10.9 (0.5, 21.4)]. Mechanical axis changed from 2.4 ± 2.4° valgus to 0 ± 2.6° varus (p<0.001), anatomical axis from 6.9 ± 2.8° to 4.7 ± 2.5° valgus (p < 0.001), with weight-bearing line offset changing from 60.2 ± 11.4 % to 49.5 ± 12.4 % (p < 0.001). Change in lateral tibial slope, from 6.5 ± 2.2° to 7.5 ± 2.3°, was very small and not statistically significant (n.s.). The peak knee adduction moment during gait significantly increased [mean change (95 %CI) = 0.72 %BW*Ht (0.42, 1.02), suggesting a medial shift in dynamic knee joint load. Two patients underwent total knee arthroplasty during the study period.

Conclusions

Lateral opening wedge high tibial osteotomy is a viable surgical option for patients with lateral knee pain and valgus malalignment requiring small degrees of correction.

Level of evidence

IV.

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Acknowledgments

This study was funded thanks in part to an industry-partnered research grant from the Canadian Institutes of Health Research and Arthrex Inc.

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Authors and Affiliations

  1. Brisbane Orthopaedic and Sports Medicine Centre, 259 Wickham Tce, Brisbane, QLD, 4000, Australia

    Brett Collins

  2. Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6A 3K7, Canada

    Alan Getgood, Abdulaziz Z. Alomar, J. Robert Giffin, Kevin Willits, Peter J. Fowler, Trevor B. Birmingham & Robert B. Litchfield

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  1. Brett Collins
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  2. Alan Getgood
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  3. Abdulaziz Z. Alomar
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  4. J. Robert Giffin
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  6. Peter J. Fowler
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  7. Trevor B. Birmingham
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  8. Robert B. Litchfield
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Correspondence to Robert B. Litchfield.

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Collins, B., Getgood, A., Alomar, A.Z. et al. A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21, 152–160 (2013). https://doi.org/10.1007/s00167-012-2070-y

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  • DOI: https://doi.org/10.1007/s00167-012-2070-y

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