title: Differences between opening versus closing high tibial osteotomy on clinical outcomes and gait analysis.
abstract: BACKGROUND
  High tibial osteotomy (HTO) for medial knee osteoarthritis (OA) is mainly performed via two procedures: closing wedge HTO (CW) and opening wedge HTO (OW). In this study, differences between these procedures were assessed by serial clinical evaluation and gait analysis before and after surgery.
  
  
  METHODS
  Twenty-one patients underwent HTO for medial knee OA in 2011 and 2012, with 12 patients undergoing CW and nine undergoing OW. The severity of OA was classified according to the Kellgren-Lawrence classification. The Japanese Orthopedic Association score for assessment of knee OA (JOA score), the Numeric Rating Scale (NRS), and the femoral tibial angle (FTA) on X-ray were evaluated. For gait analysis, gait speed, varus moment, varus angle and lateral thrust were calculated.
  
  
  RESULTS
  The JOA score and NRS were improved significantly one year postoperatively in both groups. The FTA was maintained in both groups at one year. Varus angle and varus moment were significantly improved in both groups at each postoperative follow-up, when compared preoperatively. Lateral thrust was significantly improved at three months postoperatively in both groups. However, the significant improvement in lateral thrust had disappeared in the CW group six months postoperatively, whereas it was maintained for at least one year in the OW group.
  
  
  CONCLUSIONS
  This study found that clinical outcomes were well maintained after HTO. OW reduced knee varus moment and lateral thrust, whereas CW had little effect on reducing lateral thrust.
  
  
  METHODS
  Level IV.
authors.affiliation: Laboratory of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: snm3@hiroshima-u.ac.jp.
authors.forename: Masataka
authors.initials: M
authors.lastname: Deie
authors.affiliation: Laboratory of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hoso
authors.affiliation: Department of Rehabilitation, Hiroshima University, Hiroshima, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Shimada
authors.affiliation: Department of Rehabilitation, Hiroshima University, Hiroshima, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Iwaki
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Nakamae
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Adachi
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
keywords: Closed high tibial osteotomy; Gait analysis; Lateral thrust; Opening high tibial osteotomy; Varus moment