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. 2021 Dec;13(1_suppl):132S-146S.
doi: 10.1177/19476035211007903. Epub 2021 Apr 22.

The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

Gwenllian Tawy  1 , Hamza Shahbaz  2 , Michael McNicholas  1   3 , Leela Biant  1   4   5
Affiliations

The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

Gwenllian Tawy et al. Cartilage. 2021 Dec.

Abstract

Objective: This systematic review aimed to determine whether coronal angular corrections correlate with patient reported outcomes following valgus-producing high tibial osteotomy (HTO).

Design: Ovid MEDLINE, Embase, and Web of Science were systematically searched. Studies that reported hip-knee-ankle angles (HKA) or femorotibial angles (FTA), and the Oxford Knee Score (OKS), visual analogue scale (VAS) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), or EQ-5D before and after valgus-producing HTO were eligible. Correlation analyses were performed where appropriate to investigate the relationships between variables. PROSPERO ID: CRD42019135467.

Results: This study included 39 articles including 50 cohorts. VAS was reported in 22 studies, OKS in 9, KOOS in 12 and EQ-5D in 2. The HKA angle was corrected from 7.1° ± 1.7° varus to 2.3° ± 1.7° valgus at final follow-up. The FTA changed from 3.0° ± 2.0° varus to 7.7° ± 1.3° valgus. Outcome scores improved with clinical and statistical significance postoperatively. Spearman correlations for nonparametric data revealed greater changes in knee alignment were moderately associated with larger improvements in VAS scores (r = 0.50). Furthermore, those who experienced greater changes in alignment showed larger improvements in the KOOS Activity and Quality of Life domains (r = 0.72 and r = 0.51, respectively).

Conclusion: On average, patients did not achieve the "ideal correction" of 3° to 6° valgus postoperatively. Nevertheless, statistical and clinical improvements in patient-reported outcome measure scores were consistently reported. This suggests that the "ideal correction" may be more flexible than 3° to 6°.

Keywords: high tibial osteotomy; knee; osteoarthritis; patient reported outcomes; review.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of systematic search.
See this image and copyright information in PMC

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