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. 2020 Oct 12;21(1):675.
doi: 10.1186/s12891-020-03703-6.

Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

Takahiro Ogino  1 , Ken Kumagai  2 , Shunsuke Yamada  1 , Tomotaka Akamatsu  1 , Shuntaro Nejima  1 , Masaichi Sotozawa  1 , Yutaka Inaba  1
Affiliations

Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

Takahiro Ogino et al. BMC Musculoskelet Disord. .

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) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. 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 using a dedicated software.

Results: CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P < 0.05), and a greater soft tissue correction than OWHTO (P < 0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD 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.

Keywords: Closed wedge; Correction angle; High tibial osteotomy; Mechanical axis shift; Opening wedge.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Definition of tibial axis deviation. The percentages of anatomical tibial axis deviation (%ATAD) and mechanical tibial axis deviation (%MTAD) are defined as the ratio of the distance from the medial edge of the proximal tibia to the passing points of the anatomical axis and mechanical axis on the tibial surface (A and M) and to the width of the proximal tibia (P), respectively. The percentage is calculated by multiplying this ratio by 100%
Fig. 2
Fig. 2
Preoperative planning for OWHTO or CWHTO with the same correction angle. The osteotomies are planned with a bony correction angle of 15° in a case with %MA of 0 (a), expecting %MA of 60 for CWHTO (b) and 68 for OWHTO (c)
Fig. 3
Fig. 3
A schematic comparison between CWHTO and OWHTO in the position of the mechanical tibial axis including the centre of the ankle joint after osteotomies with the same bony correction angle. Illustrations show preoperative status (a), CWHTO (b), OWHTO (c), and an overlay of the two procedures (d). The mechanical axis passes more medially after CWHTO than after OWHTO (e). The centre of the ankle is positioned more medially and proximally after CWHTO (dot) than after OWHTO (asterisk) (f)
See this image and copyright information in PMC

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