Ortho One Orthopaedic Specialty Centre, Coimbatore, India.
Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, India.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):499-505. doi: 10.1007/s00590-023-03693-w. Epub 2023 Aug 26.
High tibial osteotomy (HTO) is a popular joint-preserving option for medial compartmental osteoarthritis. However, this is associated with alterations in the patellar height (PH) and tibial slope (TS). This study aims to compare the effect of ascending (AMHTO) and descending medial opening wedge HTO (DMHTO) on patella height, posterior tibial slope and functional outcomes.
A retrospective study was conducted between February 2018 and July 2021. Patients with medial compartment osteoarthritis, varus alignment, and complete pre- and postoperative lateral and full-length anteroposterior radiographs were included. Pre- and postoperative radiological measurements include the Caton-Deschamps index (CDI), the mechanical axis deviation (MAD), and the posterior tibial slope. The functional outcomes were measured using the Oxford Knee Score (OKS), Lysholm Knee Score (LKS), and Tegner Activity Scale (TAS). The osteotomy union was checked with serial X-rays every 6 weeks till a satisfactory union was achieved.
Fifty-eight patients were included in the study. Thirty-four (58%) patients received AMHTO, and 24 (42%) received DMHTO. There was no baseline difference in the demographic variables or functional scores between the two groups. The preoperative mean MAD of - 9.65° ± 3.67° was corrected significantly to + 0.08 ± 2.80° (varus -, valgus + , P = 0.034). A significant difference in preoperative and postoperative CDI of 0.93 ± 0.45 and 0.83 ± 0.27, respectively, was noted (P = 0.023). In the AMHTO group, a statistically significant decrease in PH from preoperative 1.03 ± 0.77 to 0.84 ± 0.12 was noted (P = 0.003). There was a significant improvement in functional outcomes between baseline and 9-month follow-up in both groups. There was no significant difference between the functional outcomes of the two groups at 9-month follow-up.
The study confirmed our hypothesis that descending HTO caused less alteration in the patella height compared to ascending HTO. There is no significant difference in the functional outcomes between the groups. However, in patients with PFOA, and when attempting higher degree of correction through AMHTO, the possibility of worsening of symptoms due to change in PH must be considered.
胫骨高位截骨术（HTO）是治疗内侧间室骨关节炎的一种常用保关节方法。然而，这种方法会改变髌骨高度（PH）和胫骨后倾角（TS）。本研究旨在比较上升（AMHTO）和下降内侧开口楔形 HT0（DMHTO）对髌骨高度、胫骨后倾角和功能结果的影响。
这是一项回顾性研究，于 2018 年 2 月至 2021 年 7 月进行。纳入了内侧间室骨关节炎、内翻畸形、术前和术后完整的侧位和全长前后位 X 线片的患者。术前和术后的影像学测量包括 Caton-Deschamps 指数（CDI）、机械轴偏差（MAD）和胫骨后倾角。功能结果采用牛津膝关节评分（OKS）、Lysholm 膝关节评分（LKS）和 Tegner 活动量表（TAS）进行测量。每隔 6 周进行连续 X 线检查，直到获得满意的愈合。
本研究共纳入 58 例患者。34 例（58%）患者接受 AMHTO，24 例（42%）患者接受 DMHTO。两组在人口统计学变量或功能评分方面无基线差异。术前平均 MAD 为-9.65°±3.67°，显著纠正为+0.08°±2.80°（内翻-，外翻+，P=0.034）。术前和术后 CDI 分别为 0.93±0.45 和 0.83±0.27，差异有统计学意义（P=0.023）。在 AMHTO 组，PH 从术前的 1.03±0.77 显著下降至 0.84±0.12（P=0.003）。两组在基线和 9 个月随访时的功能结果均有显著改善。两组在 9 个月随访时的功能结果无显著差异。
该研究证实了我们的假设，即与上升 HTO 相比，下降 HTO 对髌骨高度的改变较小。两组之间的功能结果无显著差异。然而，对于 PFOA 患者，并且当试图通过 AMHTO 进行更高程度的矫正时，由于 PH 变化引起症状恶化的可能性必须加以考虑。
