Publication
Title
No clinical outcome difference between varus phenotypes after medial opening-wedge high tibial osteotomy at 2 years follow-up
Author
Abstract
PurposeClinical studies regarding medial open-wedge high tibial osteotomy (MOWHTO) often analyse a large group of mechanical varus knees rather than differentiating for its primary varus-inducing component. This study aims to compare the radiological and clinical outcomes of the most prevalent varus malalignment phenotypes using the coronal plane alignment of the knee (CPAK) classification.MethodsMOWHTO cases with minimal 2-year clinical follow-up were retrospectively selected from a knee osteotomy database (2016-2020). Based on the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), subjects were allocated to the correct CPAK phenotype pre- and postoperatively. Clinical outcomes were the numeric rating scale (NRS), the knee injury and osteoarthritis outcome score (KOOS) and the therapeutic response rate (TRR) at 2-year follow-up. Inter-observer correlation coefficient (ICC) and unpaired student t test were performed for cross-phenotype comparison.ResultsOne hundred thirty-five (135) subjects were found eligible (53.0 years old +/- 9.6 [19-77], 72% male, 53% left-sided). The most prevalent preoperative phenotype was CPAK 1 (n = 70 (52%)) and the postoperative phenotype was CPAK 6 (n = 66 (49%)). All CPAK phenotypes improved significantly relative to baseline but cross-phenotype comparison yielded no significant differences in clinical outcome. The TRR at 2 years was 67% for CPAK 1, 69% for CPAK 2 and 87% for CPAK 4. The TRR for CPAK 6 was 64% compared with 80% for CPAK 9, which was not significantly different.ConclusionAt 2-year follow-up, no clinically significant differences are observed between different CPAK phenotypes. Accurate MOWHTO corrections provide significant clinical improvement even in the femoral-driven varus knee and the constitutional varus knee dominated by intra-articular wear. The clinical indication for MOWHTO performance should not be reduced to the medial arthritic varus knee with underlying tibial varus alone.Level of EvidenceLevel IV, retrospective comparative study.
Language
English
Source (journal)
Knee surgery, sports traumatology, arthroscopy. - Heidelberg, 1993, currens
Publication
New york : Springer , 2024
ISSN
0942-2056 [print]
1433-7347 [online]
DOI
10.1002/KSA.12099
Volume/pages
32 :4 (2024) , p. 1016-1025
ISI
001173317500001
Pubmed ID
38409956
Full text (Publisher's DOI)
Full text (publisher's version - intranet only)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
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Creation 29.03.2024
Last edited 10.04.2024
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