Severe varus knees result in a high rate of undercorrection of lower limb alignment after opening wedge high tibial osteotomy

Abstract

Purpose: The purpose of this study was to clarify the indication for opening wedge high tibial osteotomy (OWHTO) in terms of lower limb alignment to achieve satisfactory clinical results. Methods: Ninety-two patients (98 knees) with medial compartment knee osteoarthritis were investigated in this study. The average follow-up period was 34 months (range, 24–68 months). The average age of the patients at the time of surgery was 63 years (range, 41–77 years). Results: The patients were divided into the following two groups according to the preoperative femorotibial angle (FTA) on anteroposterior full-length radiographs of the lower limbs while weight bearing: 29 knees with a preoperative FTA of ≥185° were defined as those with severe varus (S group), and the remaining 69 knees with a preoperative FTA of <185° were defined as those with mild varus (M group). Knees with a postoperative FTA of >175° were defined as undercorrected. The Lysholm score was used to assess the clinical results. The average postoperative FTA was 175.7° ± 4.1° in the S group and 174.6° ± 3.1° in the M group (p = 0.013). Significantly, more undercorrected knees were observed in the S than M group (p = 0.00035). The postoperative Lysholm score was 85.6 ± 8.5 in the S group and 88.5 ± 5.7 in the M group at the last follow-up (p = 0.0033). Conclusion: Based on these results, we recommend that a preoperative FTA of <185° should be included as a criterion for OWHTO alone.