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Serial Assessment of Weight-Bearing Lower Extremity Alignment Radiographs After Open-Wedge High Tibial Osteotomy

      Purpose

      The purpose of this study was to perform a serial assessment of the radiologic parameters of the mechanical axis (MA) and the weight-bearing line (WBL) using a weight-bearing anteroposterior (AP) long-standing view of the lower extremity to determine whether the postoperative MA and WBL change with time.

      Methods

      A total of 90 consecutive lower limbs were examined retrospectively from a weight-bearing AP long-standing view of the lower extremity obtained from 120 patients who underwent open-wedge high tibial osteotomy (OWHTO). A total of 30 patients were excluded because of (1) complications (7 patients) such as bone graft collapse or broken screws, malunion, or nonunion arising after surgery and (2) no acquisition of a regular series of weight-bearing AP long-standing views of the lower extremity (23 patients). The AP long-standing view of the lower extremity was taken, and weight-bearing AP long-standing views of the lower extremity at 1 month, 6 months, 1 year, and 2 years postoperatively were used for assessment of serial change. The Picture Archiving Communication System (Marotech, Inc, St-Augustin-de-Desmaures, Quebec, Canada) was used for radiologic measurements of the WBL ratio and MA. Serial changes were compared between 1 month, 6 months, 1 year, and 2 years postoperatively.

      Results

      The WBL ratio progressively shifted medially, with significant changes at all time points until 1 year postoperatively (1 month to 6 months, P = .04; 6 months to 1 year, P = .04; 1 year to 2 years, P = .22). Even though the MA angle showed a similar decreasing trend, it showed no statistical difference (P > .05).

      Conclusions

      This study showed that after OWHTO, the WBL shifts progressively medially until 1 year postoperatively.

      Level of Evidence

      Level IV, diagnostic study.
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      References

        • Amis A.A.
        Biomechanics of high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2012; 21: 197-205
        • Sim J.A.
        • Kwak J.H.
        • Yang S.H.
        • Choi E.S.
        • Lee B.K.
        Effect of weight-bearing on the alignment after open wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 874-878
        • Pape D.
        • Duchow J.
        • Rupp S.
        • Seil R.
        • Kohn D.
        Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. A human cadaver study evaluating medial joint opening by stress radiography.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 141-148
        • Lobenhoffer P.
        • Agneskirchner J.D.
        Improvements in surgical technique of valgus high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2003; 11: 132-138
        • Bito H.
        • Takeuchi R.
        • Kumagai K.
        • et al.
        A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 382-389
        • Birmingham T.B.
        • Giffin J.R.
        • Chesworth B.M.
        • et al.
        Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient-reported outcomes.
        Arthritis Rheum. 2009; 61: 648-657
        • Gaasbeek R.D.
        • Nicolaas L.
        • Rijnberg W.J.
        • van Loon C.J.
        • van Kampen A.
        Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study.
        Int Orthop. 2009; 34: 201-207
        • Brouwer R.W.
        • Bierma-Zeinstra S.M.
        • van Raaij T.M.
        • Verhaar J.A.
        Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study.
        J Bone Joint Surg Br. 2006; 88: 1454-1459
        • Lee Y.S.
        • Lee B.K.
        • Lee S.H.
        • Park H.G.
        • Jun D.S.
        • Moon D.H.
        Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 2542-2547
        • Kraus V.B.
        • Vail T.P.
        • Worrell T.
        • McDaniel G.
        A comparative assessment of alignment angle of the knee by radiographic and physical examination methods.
        Arthritis Rheum. 2005; 52: 1730-1735
        • Sharma L.
        • Song J.
        • Felson D.T.
        • Cahue S.
        • Shamiyeh E.
        • Dunlop D.D.
        The role of knee alignment in disease progression and functional decline in knee osteoarthritis.
        JAMA. 2001; 286: 188-195
      1. Lee DH, Han SB, Oh KJ, et al. The weight-bearing scanogram technique provides better coronal limb alignment than the navigation technique in open high tibial osteotomy. Knee. October 5, 2012. [Epub ahead of print.].

        • Lee D.H.
        • Nha K.W.
        • Park S.J.
        • Han S.B.
        Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy.
        Arthroscopy. 2012; 28: 1842-1850
        • Nha K.W.
        • Lee Y.S.
        • Hwang D.H.
        • et al.
        Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus.
        Arthroscopy. 2013; 29: 226-231
        • Chae D.J.
        • Shetty G.M.
        • Lee D.B.
        • Choi H.W.
        • Han S.B.
        • Nha K.W.
        Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft.
        Knee. 2008; 15: 128-133
        • Smith T.O.
        • Sexton D.
        • Mitchell P.
        • Hing C.B.
        Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes.
        Knee. 2011; 18: 361-368
        • Brosset T.
        • Pasquier G.
        • Migaud H.
        • Gougeon F.
        Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix) and early weight-bearing: Prospective evaluation of bone union, precision and maintenance of correction in 51 cases.
        Orthop Traumatol Surg Res. 2011; 97: 705-711
        • El-Azab H.M.
        • Morgenstern M.
        • Ahrens P.
        • Schuster T.
        • Imhoff A.B.
        • Lorenz S.G.
        Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome.
        Orthopedics. 2011; 34: e622-e628
        • Madry H.
        • Ziegler R.
        • Orth P.
        • et al.
        Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: Analysis of the lateral meniscus.
        Knee Surg Sports Traumatol Arthrosc. 2012; 21: 39-48
        • Ziegler R.
        • Goebel L.
        • Cucchiarini M.
        • Pape D.
        • Madry H.
        Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part II: Standard and overcorrection do not cause articular cartilage degeneration.
        Knee Surg Sports Traumatol Arthrosc. January 23, 2013; ([Epub ahead of print.])
        • Brouwer R.W.
        • Jakma T.S.
        • Bierma-Zeinstra S.M.
        • Ginai A.Z.
        • Verhaar J.A.
        The whole leg radiograph: standing versus supine for determining axial alignment.
        Acta Orthop Scand. 2003; 74: 565-568
        • Brouwer R.W.
        • Jakma T.S.
        • Brouwer K.H.
        • Verhaar J.A.
        Pitfalls in determining knee alignment: a radiographic cadaver study.
        J Knee Surg. 2007; 20: 210-215
        • Marx R.G.
        • Grimm P.
        • Lillemoe K.A.
        • et al.
        Reliability of lower extremity alignment measurement using radiographs and PACS.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1693-1698
        • Rauh M.A.
        • Boyle J.
        • Mihalko W.M.
        • Phillips M.J.
        • Bayers-Thering M.
        • Krackow K.A.
        Reliability of measuring long-standing lower extremity radiographs.
        Orthopedics. 2007; 30: 299-303

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