Document Type : RESEARCH PAPER
Authors
1
Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2
Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
3
Bone, Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.22038/abjs.2025.87965.3983
Abstract
Objectives: Varus knee with combined tibial and femoral deformities can be corrected using proximal tibia osteotomy alone or with both tibial and femoral osteotomies, but results have been mixed. Medial opening wedge high tibial osteotomy offers an alternative approach. This study evaluates the clinical and functional outcomes of medial opening wedge high tibial osteotomy for correcting combined deformities.
Methods: We retrospectively analyzed 30 patients treated at Shafa Yahyaiyan Hospital, Iran University of Medical Sciences, between 2015 and 2021. All patients underwent medial opening wedge high tibial osteotomy to overcorrect the medial proximal tibial angle to 90 degrees, ignoring the femoral varus deformity. Standing radiographs were used to measure Joint Line Obliquity Angle, Joint Line Convergence Angle, Hip-Knee-Ankle Angle, medial proximal tibial angle, and Mechanical Lateral Distal Femoral Angle before and after surgery. Knee function was assessed using the Knee Society Score, Knee Injury and Osteoarthritis Outcome Score, and Visual Analog Scale.
Results: The mean patient age was 32.19 ± 11.63 years, with a follow-up period of 39.38 months. Postoperative medial proximal tibial angle increased significantly (90.53 ± 1.80 vs. 82.47 ± 3.66, p = 0.001), while Hip-Knee-Ankle Angle and Joint Line Convergence Angle decreased (p < 0.05). Functional scores from the Knee Society Score, Knee Injury and Osteoarthritis Outcome Score, and Visual Analog Scale improved significantly (p < 0.05). Although Joint Line Obliquity Angle increased by approximately 3 degrees, it was not clinically significant.
Conclusion: Medial opening wedge high tibial osteotomy, with medial proximal tibial angle overcorrection to 90 degrees, demonstrated excellent clinical and radiological outcomes in the short to medium term. Despite the limited follow-up duration, these results support the efficacy of medial opening wedge high tibial osteotomy for managing combined deformities in cases of varus knee.
Level of evidence: III
Keywords: Osteoarthritis, Mechanical axis deviation, Radiographic evaluation, Patient-reported outcome measures, Gait analysis, Biomechanics, Malalignment correction
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