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Clinical Effect of Isolated Lateral Closing Wedge Distal Femoral Osteotomy Compared to Medial Opening Wedge High Tibial Osteotomy for the Correction of Varus Malalignment: A Propensity Score–Matched Analysis
| Content Provider | SAGE Publishing |
|---|---|
| Author | Rupp, Marco-Christopher Lindner, Felix Winkler, Philipp W. Muench, Lukas N. Mehl, Julian Imhoff, Andreas B. Siebenlist, Sebastian Feucht, Matthias J. |
| Copyright Year | 2023 |
| Abstract | Recent evidence questions the role of medial opening wedge high tibial osteotomy (mowHTO) in the correction of femoral-based varus malalignment because of the potential creation of an oblique knee joint line. However, the clinical effectiveness of alternatively performing an isolated lateral closing wedge distal femoral osteotomy (lcwDFO), in which the mechanical unloading effect in knee flexion may be limited, is yet to be confirmed.Purpose/Hypothesis:The purpose of this article was to compare clinical outcomes between patients undergoing varus correction via isolated lcwDFO or mowHTO, performed according to the location of the deformity, in a cohort matched for confounding variables. It was hypothesized that results from undergoing isolated lcwDFO for symptomatic varus malalignment would not significantly differ from the results after mowHTO.Study Design:Cohort study; Level of evidence, 3.Methods:Consecutive patients who underwent isolated mowHTO or lcwDFO according to a tibial- or femoral-based symptomatic varus deformity between January 2010 and October 2019 were enrolled. Confounding factors, including age at surgery, sex, body mass index, preoperative femorotibial axis, and postoperative follow-up, were matched using propensity score matching. The International Knee Documentation Committee (IKDC) Subjective Knee Form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, Tegner Activity Scale, and visual analog scale (VAS) for pain were collected preoperatively and at a minimum of 24 months postoperatively.Results:Of 535 knees assessed for eligibility, 50 knees (n = 50 patients, n = 25 per group) were selected by propensity score matching. Compared with preoperatively, both the mowHTO group (IKDC, 55.1 ± 16.5 vs 71.3 ± 14.7, P = .002; WOMAC, 22.0 ± 18.0 vs 9.6 ± 10.8, P < .001; Lysholm, 55.2 ± 23.1 vs 80.7 ± 16, P < .001; VAS, 4.1 ± 2.4 vs 1.6 ± 1.8, P < .001) and the lcwDFO group (IKDC, 49.4 ± 14.6 vs 66 ± 20.1, P = .003; WOMAC, 25.2 ± 17.0 vs 12.9 ± 17.6, P = .003; Lysholm, 46.5 ± 15.6 vs 65.4 ± 28.7, P = .011; VAS, 4.5 ± 2.2 vs 2.6 ± 2.5, P = .001) had significantly improved at follow-up (80 ± 20 vs 81 ± 43 months). There were no significant differences between the groups at baseline, at final follow-up, or in the amount of clinical improvement in any of the outcome parameters (P > .05; respectively).Conclusion:Performing both mowHTO or lcwDFO yields significant improvement in clinical outcomes if performed at the location of the deformity of varus malalignment. These findings confirm the clinical effectiveness of performing an isolated lcwDFO in femoral-based varus malalignment, which is comparable with that of mowHTO in the correction of varus malalignment. |
| Related Links | https://journals.sagepub.com/doi/pdf/10.1177/03635465221142615?download=true |
| Starting Page | 437 |
| Ending Page | 445 |
| Page Count | 9 |
| ISSN | 03635465 |
| Issue Number | 2 |
| Volume Number | 51 |
| Journal | The American Journal of Sports Medicine (AJS) |
| e-ISSN | 15523365 |
| DOI | 10.1177/03635465221142615 |
| Language | English |
| Publisher | Sage Publications CA |
| Publisher Date | 2023-01-11 |
| Publisher Place | Los Angeles |
| Access Restriction | Open |
| Rights Holder | © 2023 The Author(s) |
| Subject Keyword | distal femoral osteotomy location of deformity varus malalignment high tibial osteotomy joint line obliquity |
| Content Type | Text |
| Resource Type | Article |
| Subject | Orthopedics and Sports Medicine Physical Therapy, Sports Therapy and Rehabilitation Sports Science |
