2024 · Clinical Biomechanics
Do Opening-wedge and Closing-wedge HTO Produce Similar Gait Changes?
Varus correction did not differ between groups (P = 0.543). The opening-wedge group had higher PTS and a lower Blackburne–Peel ratio (both P < 0.001).
Research structure
- 01Subject
38 patients.
- 02Methods
Retrospective comparison: 19 OW and 19 CW patients. Gait was assessed at baseline and 1 year, with clinical and radiographic follow-up at 2 years.
- 03Reported Results
Varus correction did not differ between groups (P = 0.543). The opening-wedge group had higher PTS and a lower Blackburne–Peel ratio (both P < 0.001).
An explanatory schematic separating the study population, methods, and results. It is not an original paper figure.
Abstract commentary
Participants and Methods
Main Findings
The point of reading on surgery
Limitations
Let's put it briefly.
What did this study confirm?
Varus correction did not differ between groups (P = 0.543). The opening-wedge group had higher PTS and a lower Blackburne–Peel ratio (both P < 0.001).
Can it be applied directly to individual patients' treatment decisions?
This was a small, nonrandomized cohort study. The abstract’s results and interpretation describe sagittal-plane changes inconsistently, so the group-specific values need to be checked in the original tables. A lack of short-term difference in PFJ outcomes does not establish long-term equivalence.
Keywords
- Closing wedge osteotomy
- Gait analysis
- High tibial osteotomy
- Open wedge osteotomy
- Osteoarthritis, Knee
- Retrospective Studies
- Treatment Outcome
- Knee Joint
Abstract · Original text
Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro. Comparative analysis of gait: Similar coronal but different sagittal effects between closing-wedge and opening-wedge high tibial osteotomy. Clinical biomechanics (Bristol, Avon). 2024;114:106238. doi:10.1016/j.clinbiomech.2024.106238.
BACKGROUND
High tibial osteotomy is an established surgical option for medial compartment osteoarthritis of the knee with varus alignment. It can be divided into open wedge and closing wedge by operative technique. Although they have fundamental differences, little is known about the biomechanical consequences of the two surgical methods.
METHODS
Thirty-eight patients with medial compartment osteoarthritis who underwent high tibial osteotomy (19 open-wedge and 19 closing-wedge) were retrospectively reviewed. Clinical scores and radiological measurements were assessed until postoperative two years. Gait analysis was performed preoperatively and again at postoperative one year.
FINDINGS
Varus alignment was corrected in both groups without a significant difference between them (p = 0.543). However, posterior tibial slope was higher, and the Blackburne-Peel ratio was lower in the open wedge osteotomy group after surgery (both p < 0.001). Reduction of dynamic knee varus and knee adduction moment were observed in both groups without significant differences. However, after surgery, average knee range of motion (63.3° vs 57.3°, p < 0.001) and the magnitude of knee flexion moment was significantly lower (p = 0.005) in the closing wedge group. There were no significant differences in the Kujala Anterior Knee Pain Scale and the occurrence of patellofemoral arthritis between the groups postoperatively.
INTERPRETATION
After osteotomy, a smaller average knee range of motion in the sagittal plane and a higher knee flexion moment were observed in the open wedge osteotomy group, suggesting quadriceps muscle avoidance. However, no differences in clinical scores or the short-term occurrence of patellofemoral arthritis were noted between the two surgical techniques.
The original paper.
Comparative analysis of gait: Similar coronal but different sagittal effects between closing-wedge and opening-wedge high tibial osteotomy
Do Weon Lee, Hyuk-Soo Han, Du Hyun Ro
Clinical Biomechanics · 2024