Hybrid High Tibial Osteotomy is Superior to Medial Opening High Tibial Osteotomy for the Treatment of Varus Knee with Patellofemoral Osteoarthritis

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2018 Jun 28

PMID 29947840

Citations 14

Authors

Shuhei Otsuki

Tomohiko Murakami

Yoshinori Okamoto

Kosuke Nakagawa

Nobuhiro Okuno

Hitoshi Wakama

Masashi Neo

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate patellofemoral congruity after opening wedge high tibial osteotomy (OWHTO) and hybrid HTO.

Methods: Twenty-four knees with hybrid HTO and 24 with OWHTO were evaluated in this study. The Caton-Deschamps and modified Miura-Kawamura indices were used to evaluate pre- and post-operative patellar heights for both types of surgery. Tibial tuberosity-trochlear groove (TT-TG) distance, patellar tilt, and medial and lateral joint space at the patellofemoral joint were compared. Anterior knee pain was assessed using the Kujala anterior knee pain scale.

Results: There was no significant difference between the correction angles of the hybrid HTO and OWHTO. Pre- and post-operative values for the Caton-Deschamps and modified Miura-Kawamura indices in patients who underwent hybrid HTO changed from 0.90 to 0.94 and from 0.95 to 1.03, respectively, with no significant differences noted. Following OWHTO, these values decreased significantly from 0.91 to 0.73 and from 1.06 to 0.84, respectively (p < 0.01). The post-operative patellar height after OWHTO was significantly lower than that after hybrid HTO (p < 0.01). After hybrid HTO, the TT-TG distance decreased significantly from 11.4 to 7.4 (p < 0.01), but it did not change significantly after OWHTO. Although pre- and post-operative patellar tilt were not altered significantly in either group, the medial joint space of the patellofemoral joint was significantly increased post-operatively following hybrid HTO (p = 0.035). The pre-operative Kujala scores were significantly lower in the hybrid HTO group, but post-operative scores improved in both groups.

Conclusions: Hybrid HTO provides a better post-operative patellofemoral joint than does OWHTO with regard to patellar position and reduction of the TT-TG distance, as well as improved clinical outcomes. Hybrid HTO, rather than OWHTO, is the preferred technique for the treatment of varus knees combined with patellofemoral osteoarthritis.

Level Of Evidence: Retrospective comparative study, Level III.

Citing Articles

Return to sports after unilateral medial opening wedge high tibial osteotomy in highly active patients: Analysis of factors affecting functional recovery.

Nakayama H, Kanto R, Onishi S, Iseki T, Nakao Y, Tachibana T J Exp Orthop. 2025; 12(1):e70083.

PMID: 39759094 PMC: 11696251. DOI: 10.1002/jeo2.70083.

Difference in the anterior displacement of the tibial tuberosity relative to the proximal tibial fragment between opening wedge and closed wedge high tibial osteotomies.

Kikuchi K, Kumagai K, Yamada S, Nejima S, Choe H, Ike H SICOT J. 2024; 10:21.

PMID: 38819291 PMC: 11141518. DOI: 10.1051/sicotj/2024020.

Derotational Hybrid Closed-Wedge High Tibial Osteotomy for Knee Osteoarthritis With Patellar Subluxation Caused by Tibial Torsional Deformity.

Nakamura R, Kawashima F, Amemiya M, Shimakawa T, Okano A Arthrosc Tech. 2023; 12(10):e1687-e1694.

PMID: 37942092 PMC: 10627868. DOI: 10.1016/j.eats.2023.05.017.

Potential anatomic risk factors resulting oversized postoperative medial proximal tibial angle after double level osteotomy.

Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H BMC Musculoskelet Disord. 2022; 23(1):1121.

PMID: 36550449 PMC: 9784003. DOI: 10.1186/s12891-022-06101-2.

Surgical planning of osteotomies around the knee differs between preoperative standing and supine radiographs in nearly half of cases.

Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H BMC Musculoskelet Disord. 2022; 23(1):497.

PMID: 35619060 PMC: 9134639. DOI: 10.1186/s12891-022-05461-z.

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