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Clinical Outcomes Following Medial Opening Wedge High Tibial Osteotomy in Patients With Medial Compartment Grade 4
Carlos J Pérez López1, Felix M Rivera Troia, Norman Ramírez
1From the Department of Surgery, Section of Orthopedic Surgery, Ponce Health Sciences University, Ponce Medical School Foundation , Ponce, PR (Dr. Pérez López, Dr. Rivera Troia, and Dr. Ramírez), and Mayaguez Medical Center, Mayaguez, PR (Dr. Pérez López, Dr. Rivera Troia, and Dr. Ramírez).
Purpose:
This study sought to assess clinical outcomes following medial opening wedge high tibial osteotomy (MOWHTO) in patients with symptomatic varus knee malalignment and medial compartment grade 4 chondromalacia.
Methods:
This retrospective study included patients who underwent MOWHTO between 2015 and 2023. The sample consists of 28 knees in 26 patients, all diagnosed with symptomatic varus knee malalignment and medial compartment grade 4 chondromalacia. Preoperative and postoperative knee range of motion was assessed, and patient evaluations were performed using the Lysholm Knee Score (LKS), Oxford Knee Score, and Visual Analog Scale (VAS). Lower extremity radiographs were taken to assess Kellgren-Lawrence grade (K-L) and Target Correction Angle.
Results:
The mean sample age was 50.3 years, with an average follow-up of 56.0 months. All varus deformities were successfully corrected. The mean LKS increased from 33.6 to 79.6 and Oxford Knee Score from 19.0 to 37.6. Pain, assessed using the VAS, decreased from 8.5 to 1.6. All outcome and pain scores demonstrated significant improvement (P < 0.001). In addition, 96% and 92% of patients exceeded the minimal clinically important difference threshold for the LKS and VAS, respectively. One patient required conversion to total knee arthroplasty, yielding a 98.1% procedure survival rate at 64 months. Complications included two hardware removals due to stress shielding and one wound dehiscence.
Conclusion:
MOWHTO demonstrated notable improvements in function and pain, with high survival and minimal complications. These results support its use as a viable joint-preserving treatment option for medial compartment varus overload in knees with advanced chondral damage.
