Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

Area of Science:

• Orthopedic surgery
• Biomechanics
• Knee joint reconstruction

Background:

• Achieving a specific postoperative mechanical axis is crucial for successful high tibial osteotomy.
• Unintentional under- or overcorrection can occur despite precise surgical planning.
• Limited research exists on the clinical impact of alignment deviations after open wedge high tibial osteotomy (OWHTO).

Purpose of the Study:

• To evaluate the relationship between postoperative alignment, assessed via whole-leg standing radiographs, and clinical outcomes following OWHTO.
• To determine if under- or overcorrection impacts patient-reported outcomes (PROs).

Main Methods:

• A cohort of 89 knees (72 patients) undergoing OWHTO was analyzed.
• Patients were categorized into appropriate correction (57%-67% weightbearing line ratio), undercorrection (<57%), and overcorrection (>67%).
• Patient-reported outcomes included IKDC subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS).

Main Results:

• A higher postoperative weightbearing line ratio was significantly associated with poorer IKDC, Kujala, and KOOS scores.
• The overcorrection group (Group O) demonstrated significantly inferior PROs compared to appropriate correction (Group A) and undercorrection (Group U).
• Undercorrected knees (Group U) showed clinical results comparable to appropriately corrected knees (Group A).

Conclusions:

• Overcorrection following OWHTO is linked to diminished patient-reported outcomes and should be avoided.
• Undercorrected alignment after OWHTO appears to yield similar clinical results to appropriate correction, indicating its potential acceptability.