Restoration of Native Leg Length After Opening-Wedge High Tibial Osteotomy: An Intraindividual Analysis

Background: Opening-wedge high tibial osteotomy (OWHTO) has been shown to significantly increase leg length, especially in patients with large varus deformity. Thus, the current literature recommends closing-wedge high tibial osteotomy to correct malalignment in these patients to prevent postoperative leg length discrepancy. However, potential preoperative leg length discrepancy has not been considered yet. Hypothesis: It was hypothesized that patients have a decreased preoperative length of the involved leg compared with the contralateral side and that OWHTO would subsequently restore native leg length. Study Design: Case series; Level of evidence, 4. Methods: Included were 67 patients who underwent OWHTO for unilateral medial compartment knee osteoarthritis and who received full leg length assessment pre- and postoperatively. Patients with varus or valgus deformity (>3°) of the contralateral side were excluded. A musculoskeletal radiologist assessed imaging for the mechanical axis, full leg length, and tibial length of the involved and contralateral lower extremity. Statistical analysis determined the pre- and postoperative leg length discrepancy and the influence of the mechanical axis. Results: Most patients (62.7%) had a decreased length of the involved leg, with a mean preoperative mechanical axis of 5.0° ± 2.9°. Length discrepancy averaged –2.2 ± 5.8 mm, indicating a shortened involved extremity ( P = .003). OWHTO significantly increased the mean lengths of the tibia and lower limb by 3.6 ± 2.9 and 4.4 ± 4.7 mm ( P < .001), leading to a postoperative tibial and full leg length discrepancy of 2.8 ± 4.3 mm and 2.2 ± 7.3 mm ( P < .001 and P = .017, respectively). Preoperative leg length discrepancy was significantly correlated with the preoperative mechanical axis of the involved limb ( r = 0.292; P = .016), and the amount of correction was significantly associated with leg lengthening after OWHTO ( r = 0.319; P = .009). Patients with a varus deformity of ≥6.5° (n = 14) had a preoperative length discrepancy of –4.5 ± 1.6 mm ( P < .001) that was reduced to 1.8 ± 3.5 mm ( P = .08). Conclusion: Patients undergoing OWHTO have a preoperative leg length discrepancy that is directly associated with the varus deformity of the involved extremity. As OWHTO significantly increases leg length, restoration of native leg length can be achieved particularly in patients with large varus deformity.

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Osteonecrosis of the Femoral Medial Condyle Due to Leg Length Discrepancy After A Traffic Accident

The Open Orthopaedics Journal ◽

10.2174/1874325002014010135 ◽

2020 ◽

Vol 14 (1) ◽

pp. 135-139

Author(s):

Wataru Kusano ◽

Takatomo Mine ◽

Koichiro Ihara ◽

Hiroyuki Kawamura ◽

Michio Shinohara ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Traffic Accident ◽

Cartilage Damage ◽

Leg Length Discrepancy ◽

Osteoarthritis Of The Knee ◽

Tibial Osteotomy ◽

Leg Length ◽

Medial Condyle ◽

Length Discrepancy ◽

Spontaneous Osteonecrosis

Untreated leg length discrepancy can cause spontaneous osteonecrosis of the knee, which is associated with subchondral insufficiency fractures of the knee and progression or onset of osteoarthritis of the knee. Spontaneous osteonecrosis of the knee can be secondary to cartilage loss or additional subchondral changes. A 40-year-old female underwent opening-wedge high tibial osteotomy and osteochondral grafting for osteonecrosis of the femoral medial condyle and osteoarthritis of the knee caused by leg length discrepancy after a traffic accident. High tibial osteotomy and cartilage restoration are often considered for the treatment of knee osteonecrosis with cartilage damage in younger patients.

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Medial opening-wedge high tibial osteotomy affects leg length whereas a lateral closing-wedge osteotomy does not: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2016-000086 ◽

2017 ◽

Vol 2 (2) ◽

pp. 75-80

Author(s):

Joong Il Kim ◽

Hyuk Soo Han ◽

Sahnghoon Lee ◽

Myung Chul Lee

Keyword(s):

Systematic Review ◽

High Tibial Osteotomy ◽

Wedge Osteotomy ◽

Tibial Osteotomy ◽

Leg Length ◽

Opening Wedge ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Wedge High Tibial Osteotomy

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Medial Opening Wedge High Tibial Osteotomy Fixation with Short Plate without any Graft, Synthetic Material or Spacer

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00162 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0016

Author(s):

Faik Türkmen ◽

Cem Sever ◽

Burkay Kutluhan Kacıra ◽

Mehmet Demirayak ◽

Mehmet Ali Acar ◽

...

Keyword(s):

Bone Graft ◽

High Tibial Osteotomy ◽

Varus Deformity ◽

Bone Grafts ◽

Osteotomy Site ◽

Osteoarthritis Of The Knee ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Synthetic Materials ◽

Wedge High Tibial Osteotomy

Objectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer.

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The ratio of mechanical axis shift to the correction angle differs in preoperative planning, but actual postoperative alignment is comparable between opening wedge and closed wedge high tibial osteotomy

10.21203/rs.3.rs-17194/v1 ◽

2020 ◽

Author(s):

Takahiro Ogino ◽

Ken Kumagai ◽

Shunsuke Yamada ◽

Tomotaka Akamatsu ◽

Shuntaro Nejima ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Preoperative Planning ◽

Mechanical Axis ◽

Tibial Osteotomy ◽

Axis Deviation ◽

Opening Wedge ◽

Correction Angle ◽

Closed Wedge ◽

Significant Difference ◽

Wedge High Tibial Osteotomy

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) were investigated. 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. The amount of change from preoperative to postoperative in each measurement is represented as Δ. Results: CWHTO resulted in a greater increase of Δ(%MTAD - %ATAD)/ΔmMPTA than OWHTO (P<0.05), and a greater decrease of ΔJLCA/ΔmMPTA than OWHTO (P<0.05). However, no significant difference was found in the Δ%MAD/ΔmMPTA between CWHTO and OWHTO. When the osteotomy was planned with the same bony correction angle, %MA 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.

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