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Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy

  • Sang-Min Lee
    Affiliations
    Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

    Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea

    Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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  • Seong-Il Bin
    Correspondence
    Address correspondence to Seong-Il Bin, M.D., Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Republic of Korea.
    Affiliations
    Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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  • Jong-Min Kim
    Affiliations
    Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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  • Bum-Sik Lee
    Affiliations
    Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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  • Kuen Tak Suh
    Affiliations
    Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea

    Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
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  • Ju-Ho Song
    Affiliations
    Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
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      Purpose

      To evaluate the serial changes in the joint space width (JSW) of the medial and lateral compartments after medial open-wedge high tibial osteotomy (MOWHTO) and its associated factors.

      Methods

      The medial and lateral weight-bearing JSWs were measured on serial radiographs and analyzed preoperatively and postoperatively within 2 weeks, as well as at 3 months, 6 months, 1 year, and 2 years. Associations between the medial and lateral JSWs and age, body mass index, mechanical axis, correction angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA), JLCA on stress radiographs, and arthroscopic cartilage status were examined. Clinical outcome was measured according to the Knee Society objective and functional scores.

      Results

      Seventy-one patients who underwent MOWHTO with locking-plate fixation were analyzed. The respective mean medial and lateral JSWs on serial radiographs were as follows: 3.08 mm and 5.14 mm preoperatively, 3.10 mm and 4.63 mm postoperatively, 3.37 mm and 4.57 mm at 3 months, 3.40 mm and 4.59 mm at 6 months, 3.44 mm and 4.57 mm at 1 year, and 3.42 mm and 4.64 mm at 2 years. At 3 months, the medial JSW increased (P < .001), whereas the lateral JSW decreased immediately (P < .001). JSW showed no significant differences at other time points. Preoperative and postoperative JLCAs and medial femoral and tibial cartilage grades were associated with medial JSW changes (P = .021). However, no significant parameters were associated with decreases in the lateral JSW (P > .05). The postoperative Knee Society objective and functional scores improved and were maintained.

      Conclusions

      After MOWHTO, the medial JSW increased at 3 months postoperatively and the lateral JSW decreased immediately. The preoperative and postoperative JLCAs and the medial femoral and tibial cartilage grades were associated with the change in the medial JSW. However, no significant parameters were associated with the decrease in the lateral JSW.

      Level of Evidence

      Level IV, case series of therapeutic study.
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      References

        • Agneskirchner J.D.
        • Hurschler C.
        • Stukenborg-Colsman C.
        • Imhoff A.B.
        • Lobenhoffer P.
        Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: A biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004.
        Arch Orthop Trauma Surg. 2004; 124: 575-584
        • Agneskirchner J.D.
        • Hurschler C.
        • Wrann C.D.
        • Lobenhoffer P.
        The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: A biomechanical study.
        Arthroscopy. 2007; 23: 852-861
        • Lee B.S.
        • Jo B.K.
        • Bin S.I.
        • Kim J.M.
        • Lee C.R.
        • Kwan Y.H.
        Hinge fractures are underestimated on plain radiographs after open wedge proximal tibial osteotomy: Evaluation by computed tomography.
        Am J Sports Med. 2019; 47: 1370-1375
        • Yoo M.J.
        • Shin Y.E.
        Open wedge high tibial osteotomy and combined arthroscopic surgery in severe medial osteoarthritis and varus malalignment: Minimum 5-year results.
        Knee Surg Relat Res. 2016; 28: 270-276
        • Sawaguchi T.
        • Takeuchi R.
        • Nakamura R.
        • et al.
        Outcome after treatment of osteoarthritis with open-wedge high-tibial osteotomy with a plate: 2-Year results of a Japanese cohort study.
        J Orthop Surg (Hong Kong). 2019; 28 (2309499019887997)
        • Amis A.A.
        Biomechanics of high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 197-205
        • Kumagai K.
        • Akamatsu Y.
        • Kobayashi H.
        • Kusayama Y.
        • Koshino T.
        • Saito T.
        Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 779-784
        • Fujisawa Y.
        • Masuhara K.
        • Shiomi S.
        The effect of high tibial osteotomy on osteoarthritis of the knee: An arthroscopic study of 54 knee joints.
        Orthop Clin North Am. 1979; 10: 585-608
        • van der Woude J.A.D.
        • Wiegant K.
        • van Heerwaarden R.J.
        • et al.
        Knee joint distraction compared with high tibial osteotomy: A randomized controlled trial.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 876-886
        • Park C.H.
        • Bae D.K.
        • Kim K.I.
        • Lee J.W.
        • Song S.J.
        Serial changes in the joint space width and joint line convergence angle after closed-wedge high tibial osteotomy.
        Am J Sports Med. 2017; 45: 3254-3261
        • Song J.H.
        • Bin S.I.
        • Kim J.M.
        • Lee B.S.
        What is an acceptable limit of joint-line obliquity after medial open wedge high tibial osteotomy? Analysis based on midterm results.
        Am J Sports Med. 2020; 48: 3028-3035
        • Miniaci A.
        • Ballmer F.T.
        • Ballmer P.M.
        • Jakob R.P.
        Proximal tibial osteotomy: A new fixation device.
        Clin Orthop Relat Res. 1989; 246: 250-259
        • Lee D.H.
        • Park S.C.
        • Park H.J.
        • Han S.B.
        Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3704-3712
        • Lee S.M.
        • Bin S.I.
        • Kim J.M.
        • et al.
        Long-term outcomes of meniscal allograft transplantation with and without extrusion: Mean 12.3-year follow-up study.
        Am J Sports Med. 2019; 47: 815-821
        • Park J.G.
        • Kim J.M.
        • Lee B.S.
        • Lee S.M.
        • Kwon O.J.
        • Bin S.I.
        Increased preoperative medial and lateral laxity is a predictor of overcorrection in open wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 3164-3172
        • Lee S.M.
        • Bin S.I.
        • Kim J.M.
        • Lee B.S.
        • Park J.G.
        Absolute meniscal extrusion after lateral meniscal allograft transplantation does not progress during long-term follow-up: Average of 10.3 years’ follow-up longitudinal magnetic resonance imaging study.
        Am J Sports Med. 2020; 48: 326-333
        • Lee B.S.
        • Bin S.I.
        • Kim J.M.
        Articular cartilage degenerates after subtotal/total lateral meniscectomy but radiographic arthrosis progression is reduced after meniscal transplantation.
        Am J Sports Med. 2016; 44: 159-165
        • Lau L.C.
        • Fan J.C.
        • Chung K.Y.
        • et al.
        Satisfactory long-term survival, functional and radiological outcomes of open-wedge high tibial osteotomy for managing knee osteoarthritis: Minimum 10-year follow-up study.
        J Orthop Translat. 2020; 26: 60-66
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Jacquet C.
        • Pioger C.
        • Khakha R.
        • et al.
        Evaluation of the "Minimal Clinically Important Difference" (MCID) of the KOOS, KSS and SF-12 scores after open-wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 820-826
        • Parker D.A.
        • Beatty K.T.
        • Giuffre B.
        • Scholes C.J.
        • Coolican M.R.
        Articular cartilage changes in patients with osteoarthritis after osteotomy.
        Am J Sports Med. 2011; 39: 1039-1045
        • Schroter S.
        • Ihle C.
        • Mueller J.
        • Lobenhoffer P.
        • Stockle U.
        • van Heerwaarden R.
        Digital planning of high tibial osteotomy: Interrater reliability by using two different software.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 189-196
        • Herman B.V.
        • Giffin J.R.
        High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis.
        J Orthop Traumatol. 2016; 17: 277-285
        • Oh K.J.
        • Ko Y.B.
        • Bae J.H.
        • Yoon S.T.
        • Kim J.G.
        Analysis of knee joint line obliquity after high tibial osteotomy.
        J Knee Surg. 2016; 29: 649-657
        • Kwon S.K.
        • Moon H.K.
        • Choi C.J.
        • et al.
        Accelerated degeneration of the discoid lateral meniscus after medial opening wedge high tibial osteotomy.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 97-103
        • Prakash J.
        • Song E.K.
        • Lim H.A.
        • Shin Y.J.
        • Jin C.
        • Seon J.K.
        High tibial osteotomy accelerates lateral compartment osteoarthritis in discoid meniscus patients.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1845-1850
        • Song S.J.
        • Bae D.K.
        • Kim K.I.
        • Lee C.H.
        Conversion total knee arthroplasty after failed high tibial osteotomy.
        Knee Surg Relat Res. 2016; 28: 89-98