Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy
Abstract Introduction To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results. Materials and me...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2021-07-01
|
Series: | Journal of Orthopaedic Surgery and Research |
Subjects: | |
Online Access: | https://doi.org/10.1186/s13018-021-02597-x |
id |
doaj-b3df4694d763487683e59ac718054c57 |
---|---|
record_format |
Article |
spelling |
doaj-b3df4694d763487683e59ac718054c572021-07-18T11:36:32ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-07-0116111110.1186/s13018-021-02597-xSalvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomyXiaoyu Wang0Li Shi1Rui Zhang2Wenbo Wang3Lingchi Kong4Haoyu Zhao5Jia Xu6Qinglin Kang7Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalDepartment of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s HospitalAbstract Introduction To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results. Materials and methods Sixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy. Results During the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and − 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05). Conclusion Compared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.https://doi.org/10.1186/s13018-021-02597-xOsteoarthritis (OA)Open wedge high tibial osteotomy (OWHTO)Tibial condylar valgus osteotomy (TCVO) |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xiaoyu Wang Li Shi Rui Zhang Wenbo Wang Lingchi Kong Haoyu Zhao Jia Xu Qinglin Kang |
spellingShingle |
Xiaoyu Wang Li Shi Rui Zhang Wenbo Wang Lingchi Kong Haoyu Zhao Jia Xu Qinglin Kang Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy Journal of Orthopaedic Surgery and Research Osteoarthritis (OA) Open wedge high tibial osteotomy (OWHTO) Tibial condylar valgus osteotomy (TCVO) |
author_facet |
Xiaoyu Wang Li Shi Rui Zhang Wenbo Wang Lingchi Kong Haoyu Zhao Jia Xu Qinglin Kang |
author_sort |
Xiaoyu Wang |
title |
Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy |
title_short |
Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy |
title_full |
Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy |
title_fullStr |
Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy |
title_full_unstemmed |
Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy |
title_sort |
salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy |
publisher |
BMC |
series |
Journal of Orthopaedic Surgery and Research |
issn |
1749-799X |
publishDate |
2021-07-01 |
description |
Abstract Introduction To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results. Materials and methods Sixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy. Results During the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and − 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05). Conclusion Compared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°. |
topic |
Osteoarthritis (OA) Open wedge high tibial osteotomy (OWHTO) Tibial condylar valgus osteotomy (TCVO) |
url |
https://doi.org/10.1186/s13018-021-02597-x |
work_keys_str_mv |
AT xiaoyuwang salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT lishi salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT ruizhang salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT wenbowang salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT lingchikong salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT haoyuzhao salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT jiaxu salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy AT qinglinkang salvageofseverekneeosteoarthritisefficacyoftibialcondylarvalgusosteotomyversusopenwedgehightibialosteotomy |
_version_ |
1721296047396880384 |