Purpose
To assess the postoperative anatomical changes in the lower extremity after inverted
V-shaped high tibial osteotomy (IVHTO) using 3-dimensional (3D) computed tomography
(CT) bone models and compare those changes after closed-wedge high tibial osteotomy
(CWHTO).
Methods
Preoperative and 3-week postoperative CT scanning of the lower extremity were obtained
from patients who underwent IVHTO and CWHTO between October 2019 and March 2021. 3D
CT bone models were reconstructed using ZedKnee software. The postoperative changes
(Δ) in (1) posterior tibial slope (PTS), (2) knee rotation angle (KRA), (3) tibial
torsional angle (TTA), (4) patella tilt (PT), (5) Insall–Salvati ratio (ISR), and
(6) tibial length (TL) were compared between IVHTO and CWHTO.
Results
Thirty-seven knees (18 IVHTO and 19 CWHTO) in 34 patients were retrospectively enrolled
in this study. ΔPTS at the medial and lateral tibial plateau in the IVHTO group (–6.5°
and –5.0°) was larger compared with that in the CWHTO group (–3.3° and –2.0°; P = .024 and P = .002, respectively). No significant differences exist between the IVHTO and CWHTO
groups in ΔKRA (0.8 ± 4.5° and –1.5 ± 6.5°; P = 0.631), ΔTTA (–3.9 ± 6.2° and –4.1 ± 7.3°; P = .951), ΔPT (–2.0 ± 4.8° and –0.6 ± 4.1°; P = .353), and ΔISR (0.0 and 0.0; P = .829). ΔTL in the IVHTO group (–1.6 ± 2.3 mm) was smaller compared with that in
the CWHTO group (–4.1 ± 1.6 mm; P < .001).
Conclusions
(1) The postoperative PTS in the IVHTO group was further decreased compared to the
CWHTO group; (2) no significant differences in ΔKRA, ΔTTA, ΔPT, and ΔISR exist between
the 2 groups; and (3) the ΔTL in the IVHTO group was significantly smaller compared
with the CWHTO group.
Level of Evidence
Level III, retrospective cohort study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: A systematic review and meta-analysis.J Knee Surg. 2017; 30: 158-165
- Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: A systematic review and meta-analysis.J Orthop Surg Res. 2019; 14: 179
- Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report.J Bone Joint Surg Am. 1965; 47: 984-990
- Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 910-917
- Complications of closing wedge high tibial osteotomy.Int Orthop. 2010; 34: 255-261
- High tibial osteotomy: A follow-up study and description of a modified technic.Clin Orthop Relat Res. 1973; 93: 274-277
- Inverted V-shaped high tibial osteotomy for medial osteoarthritic knees with severe varus deformity.Arthrosc Tech. 2018; 7: e999-e1012
- Inverted V-shaped high tibial osteotomy compared with closing-wedge high tibial osteotomy for osteoarthritis of the knee. Ten-year follow-up result.J Bone Joint Surg Br. 2006; 88: 1336-1340
- Rotational changes in the tibia after high tibial valgus osteotomy: A comparative study of lateral closing versus medial opening wedge osteotomy.Am J Sports Med. 2020; 48: 3549-3556
- Intra- and interobserver reliability and agreement in three-dimensional computed tomography measurements of component positions after total knee arthroplasty.Knee. 2019; 26: 1102-1110
- An acute oblique osteotomy and suture ligation procedure to shorten the fibula in lateral closing-wedge high tibial osteotomy.Arthrosc Tech. 2020; 9: e1299-e1308
- Variability of extraarticular tibial rotation references for total knee arthroplasty.Clin Orthop Relat Res. 2005; 436: 172-176
- Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: A comparative prospective multicenter study.Orthop Traumatol Surg Res. 2012; 98: 68-74
- Editorial Commentary: Posterior tibial slope: The "unknown size" of the knee joint.Arthroscopy. 2021; 37: 250-251
- Comparison of torsional changes in the tibia following a lateral closed or medial open wedge high tibial osteotomy.Knee. 2019; 26: 374-381
- The effect of closed- and open-wedge high tibial osteotomy on tibial slope: A retrospective radiological review of 120 cases.J Bone Joint Surg Br. 2008; 90: 1193-1197
- The effect of medial opening and lateral closing high tibial osteotomy on leg length.Am J Sports Med. 2011; 39: 1900-1905
- Change in limb length after high tibial osteotomy using computer-assisted surgery: A comparative study of closed- and open-wedge osteotomies.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 120-126
- Research Pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.Arthroscopy. 2017; 33: 1102-1112
- High tibial valgus osteotomy: Closing, opening or combined? Patellar height as a determining factor.Clin Orthop Relat Res. 2014; 472: 3432-3440
Article Info
Publication History
Published online: December 13, 2021
Accepted:
December 1,
2021
Received:
May 15,
2021
See commentary on page 1966Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
