The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Clinical and Functional Outcomes Following MOWHTO for Combined Tibial and Femoral Deformities in Varus Knees: A Retrospective Cohort Study

Document Type : RESEARCH PAPER

Authors
Mehrdad Sadighi 1
Mahmoud Jabalameli 2
Mohammadreza Dolikhani 3
Ghzaleh Shakibamaram 3
Alireza Askari 2
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 deformities involving both the tibia and femur can be addressed using proximal tibial osteotomy alone or in combination with femoral osteotomy; however, the outcomes have been inconsistent. Medial opening wedge high tibial osteotomy (MOWHTO) presents a viable alternative for correction. This study aims to evaluate the clinical and functional outcomes of MOWHTO in patients with combined tibial and femoral deformities.
Methods: We retrospectively analyzed 30 patients who underwent MOWHTO at Shafa Yahyaiyan Hospital, Iran University of Medical Sciences, between 2015 and 2021. In all cases, the procedure aimed to overcorrect the medial proximal tibial angle (MPTA) to 90 degrees, without addressing the femoral varus deformity. Preoperative and postoperative standing radiographs were used to measure the joint line obliquity angle (JLOA), joint line convergence angle (JLCA), hip-knee-ankle angle (HKA), MPTA, and mechanical lateral distal femoral angle (mLDFA). Functional outcomes were assessed using the Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual Analog Scale (VAS).
Results: The mean age of patients was 32.19 ± 11.63 years, with a mean follow-up duration of 39.38 months. MPTA increased significantly (90.53 ± 1.80 vs. 82.47 ± 3.66; p = 0.001), while the HKA and JLCA decreased significantly (p < 0.05). Functional outcomes, assessed by the KSS, KOOS, and VAS, showed significant improvement (p < 0.05). Although the JLOA increased by approximately 3 degrees postoperatively, this change was not clinically significant.
Conclusion: MOWHTO, with overcorrection of the MPTA to 90 degrees, demonstrated excellent short- to mid-term clinical and radiological outcomes. Although the follow-up duration was limited, the findings support the efficacy of MOWHTO in managing combined tibial and femoral deformities in patients with varus knee alignment     
Level of evidence: III
Keywords
Biomechanics
Gait analysis
Malalignment correction
Mechanical axis deviation
Osteoarthritis
Patient- reported outcome measures
Radiographic evaluation
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 7
July 2026
Pages 464-470

  • Receive Date 22 May 2025
  • Revise Date 28 December 2025
  • Accept Date 05 August 2025