Factors associated with discrepancies between preoperatively planned and postoperative alignments in patients undergoing closed-wedge high tibial osteotomy

Abstract

Background: To evaluate the difference between preoperative plan and postoperative alignment after closed-wedge HTO and determine factors associated with difference. Methods: This retrospective cohort study included 165 cases with closed-wedge HTO. The following radiographic parameters were measured: mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibial angle (MPTA), joint line convergence angle, mediolateral joint width discrepancy, Kellgren-Lawrence (K-L) grade, and discrepancy between the correction angle in tibia and correction angle in mTFA. The linear regression analysis was used for the preoperative factors that affect the discrepancy between correction angle in tibia and correction angle in mTFA. Results: Preoperative and postoperative mTFA was varus 8.3 degrees +/- 3.7 and valgus 3.1 degrees +/- 2.6. The MPTA was varus 6.2 degrees +/- 3.1 preoperatively, valgus 3.7 degrees +/- 3.0 postoperatively. The mediolateral joint width discrepancy was 3.1 mm +/- 1.8 preoperatively and 1.8 mm +/- 1.4 postoperatively. The discrepancy between correction angle in tibia and correction angle in mTFA was 1.5 degrees +/- 2.3 valgus. By regression analysis, one degree of valgus overcorrection was found to be related with every 2.5 of joint convergence angle (r(2) = 0.396), 2.4 mm of mediolateral joint width discrepancy (r(2) = 0.310) and increased one grade of K-L classification (r(2) = 0.107) as preoperative measurement. Conclusions: The 1.5 degrees valgus overcorrection of postoperative mTFA was found compared with planned correction angle in tibia. By the equation, every 2.5 degrees of joint convergence angle and 2.4 mm of mediolateral joint width discrepancy preoperatively could predict one degree of valgus overcorrection. (C) 2017 Elsevier B.V. All rights reserved.