High Tibial Osteotomy Is Associated with Improvements in Both Knee and Ankle Alignment in Medial Compartment...

Introduction: Medial compartment knee osteoarthritis (OA) is characterized by varus deformity. A medial open-wedge high tibial osteotomy (MOWHTO), frequently invoked in the treatment of this deformity, affects the knee as well as the ankle joints. This study aims to evaluate the radiological and clinical effects of a MOWHTO on the ankle joint. Materials and Methods: A retrospective analysis was conducted with data from 110 patients (mean age: 52 years; 74.5% female) who underwent a MOWHTO between 2020 and 2023. Radiographic assessments were conducted both preoperatively and one year after surgery using full-length weight-bearing radiographs. The measurements included several alignment parameters such as the hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral distal tibial angle (LDTA), and talar tilt. Clinical outcomes were assessed using the Lysholm knee score and the American Orthopedic Foot and Ankle Society (AOFAS) ankle score. Results: While changes in the LDTA demonstrated a small effect size (d = 0.225), moderate-to-large effect sizes were observed in key alignment parameters (MPTA (d = 0.838), the JLCA (d = 0.798), and talar tilt (d = 0.752)), all of which showed statistically significant differences indicative of a correction in the joint alignment of potential clinical significance. Median Lysholm and AOFAS scores at one year were 90 and 100, respectively, indicating favorable clinical outcomes. No significant difference in outcomes was observed based on the amount of correction. Conclusions: An MOWHTO not only restores knee alignment but also significantly improves ankle alignment in the coronal plane. These findings suggest that an MOWHTO is associated with the restoration of knee alignment and with improvements in ankle alignment in the coronal plane.