Radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy

Objective: To determine the radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy (HTO). Design of study: Descriptive case series. Study duration and settings: The present study was a descriptive case series carried out at the Orthopedic Departments of District Head Quarter Hospital Faisalabad affiliated with Faisalabad Medical University, Faisalabad from Jan 2014 to March 2018. Methodology: This study involved 40 patients of both genders, aged between 40 and 65 years having advanced degenerative disease of knee limited to medial compartment of joint. These patients were treated by medial open wedge high tibial osteotomy (OWHTO) and outcome was evaluated after 5 years of surgery in terms of radiological knee mechanics, functional outcome scores, and arthroscopic evidence of cartilage regeneration in the medial compartment. A signed written consent was taken from every patient. Findings: There was a female predominance with a male-to-female ratio of 1: 4. The mean age of the patients was 53.2 +/- 6.9 years. The values of the radiographic parameters significantly changed from pre-operative condition after HTO; mechanical tibiofemoral angle [MTFA, (-8.1 +/- 1.2 degrees vs. 2.5 +/- 1.2 degrees; p-value < 0.0001)], tibial plateau inclination [TPI, (5.3 +/- 1.1 degrees vs. 3.4 +/- 1.1 degrees; p-value < 0.0001)], knee joint line orientation relative to the ground [G-KJLO, (0.3 +/- 0.1 degrees vs. 4.6 +/- 1.5 degrees; p-value < 0.0001)], and ankle joint line orientation relative to the ground [G-AJLO (8.3 +/- 3.2 degrees vs. 2.3 +/- 1.7 degrees; p-value < 0.0001)]. There was significant improvement in patient's functional status; KOOS-ADL score (45.5 +/- 7.8 vs. 73.7 +/- 8.6; p-value < 0.0001), International Knee Documentation Committee (IKDC) score (42.4 +/- 6.9 vs. 68.5 +/- 12.7; p-value < 0.0001), International Knee Society (IKS) score (149.4 +/- 11.9 vs. 179.4 +/- 10.2; p-value < 0.0001), Knee Society Score [KSS, (54.2 +/- 5.6 vs. 69.7 +/- 12.7; p-value < 0.0001)], and Hospital for Special Surgery [HSS, (50.8 +/- 3.3 vs. 64.8 +/- 10.7; p-value < 0.0001)]. 42.5% patients showed excellent regeneration of femoral and 30.0% patients showed excellent regeneration of tibial cartilage in the medial compartment. Conclusion: By significantly alternating the knee biomechanics, HTO was found to unload the medial compartment leading to regeneration of the articular cartilage and significant improvement in patient's symptoms and quality of life. It is therefore recommended in the management of patients with arthritic changes limited to medial compartment only.