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Complication Rates and Clinical Outcomes of Larger Alignment Corrections Using Inverted V-shaped High Tibial
Kazunori Yasuda1, Koji Yabuuchi1, Eiji Kondo2
1Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan.
Background:
Many studies have reported that larger alignment corrections in medial opening-wedge high tibial osteotomy (MOWHTO) are associated with a higher incidence of complications. However, no clinical studies have investigated whether larger alignment corrections using the inverted V-shaped high tibial osteotomy (iVHTO) procedure with locking compression plate (LCP) fixation adversely affect postoperative outcomes.
Purpose:
To determine whether larger alignment corrections using the iVHTO procedure with LCP fixation prolong bone union time, increase complication rates, and lead to poorer clinical outcomes compared with smaller corrections.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A total of 109 knees (96 patients) treated with iVHTO were followed up periodically for up to 24 months postoperatively, and a final follow-up examination was conducted between 3 and 6 years after surgery. The bone union was quantitatively assessed using a radiological scoring system. At the time of analysis, the 109 knees were divided into 2 groups: the larger correction group with the correction angle of ≥13° (group L, 49 knees) and the smaller correction group with the correction angle of <13° (group S, 60 knees). The 2 groups were compared with respect to bone union time, complications, knee function scores, and the Knee injury and Osteoarthritis Outcome Score (KOOS).
Results:
Varus knee deformity was significantly greater in group L than in group S (P < .001), whereas postoperative alignment was valgus in both groups without significant differences. The correction angle of the tibia ranged from 13° to 19° (mean, 15.6) in group L and ranged from 9° to 12° (mean, 10.5) in group S. However, there were no significant differences between groups L and S in terms of the bone union time (12.7 vs 12.4 weeks), the complication rate (4.1% vs 3.3%), the Lysholm score (93 vs 96.5 points), and any of the 5 KOOS subscales (eg, symptoms: 83.6 vs 88 points). The postoperative clinical outcomes significantly improved in both groups at the final follow-up examination compared with preoperative scores.
Conclusion:
Larger alignment corrections (≥13°) using the iVHTO procedure with LCP fixation did not prolong bone union time, increase complication rates, or lead to poorer clinical outcomes compared with smaller corrections (<13°) in patients with severe varus osteoarthritic knees.