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Insufficient Correction and Preoperative Medial Tightness Increases the Risk of Varus Recurrence in Open-Wedge-High Tibial Osteotomy

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Abstract
-----------e-pub(22.1.12)---------
Purpose: To assess serial changes of limb alignment after open wedge high tibial osteotomy (HTO) using the weightbearing
line (WBL) ratio in the midterm, with a focus on varus recurrence. Methods: Patients undergoing open wedge
HTO from January 2010 to December 2016 were retrospectively reviewed. Those without serial postoperative weightbearing
long-leg alignment films, those who showed remained varus alignment after osteotomy, and those who had <2
years of follow-up were excluded. In terms of immediate postoperative limb alignment (3 months) measured using WBL
ratio, cases were categorized into 4 groups: <50%, undercorrection; 50% to 57%, insufficient correction; 57% to 67%,
planned correction; and >67%, overcorrection. To determine risk factors for varus recurrence (WBL ratio <50%), immediate
postoperative WBL ratio category and preoperative valgus and varus stress angles (which represent medial and
lateral tightness of the joint, respectively) were investigated using logistic regression analysis, taking other related factors
into account. Clinical outcomes according to varus recurrence were measured using Hospital for Special Surgery (HSS)
scores. Results: A total of 148 cases were included. Varus recurrence was noted in 40 cases (27.0%), with a mean followup
of 49.7 21.8 months (range 24 to 102 months). The incidence of varus recurrence was different according to WBL
ratio category: 10/10 (100.0%) in undercorrection; 16/33 (48.5%) in insufficient correction; 13/58 (22.4%) in planned
correction; and 1/47 (2.1%) in overcorrection. Based on logistic regression analysis, insufficient correction and preoperative
valgus stress angle were found to be significant risk factors (P ¼ .038, and .008, respectively). With valgus stress
angle <2, 7 of 10 insufficient correction cases showed varus recurrence (P ¼ .005). However, HSS scores did not differ
according to varus recurrence (P ¼ .363). Conclusion: Insufficient correction and preoperative medial tightness increased
the risk of varus recurrence. Especially in cases where preoperative valgus stress angle was <2, insufficient correction was
strongly associated with varus recurrence. However, no significant differences in clinical outcomes were observed
according to varus recurrence in the midterm. Level of Evidence: III, retrospective cohort study.
Author(s)
김종민빈성일송주호이범식조형권최정수
Issued Date
2021
Type
Article
DOI
10.1016/j.arthro.2021.09.028
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8711
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2579089422&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Insufficient%20Correction%20and%20Preoperative%20Medial%20Tightness%20Increases%20the%20Risk%20of%20Varus%20Recurrence%20in%20Open-Wedge-High%20Tibial%20Osteotomy&amp;offset=0&amp;pcAvailability=true
Publisher
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY
Location
미국
Language
영어
ISSN
0749-8063
Citation Volume
1
Citation Number
1
Citation Start Page
1
Citation End Page
8
Appears in Collections:
Medicine > Medicine
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