title: Effect of opening-wedge high tibial osteotomy on the three-dimensional kinematics of the knee.
abstract: Although it is clear that opening-wedge high tibial osteotomy (HTO) changes alignment in the coronal plane, which is its objective, it is not clear how this procedure affects knee kinematics throughout the range of joint movement and in other planes. Our research question was: how does opening-wedge HTO change three-dimensional tibiofemoral and patellofemoral kinematics in loaded flexion in patients with varus deformity?Three-dimensional kinematics were assessed over 0° to 60° of loaded flexion using an MRI method before and after opening-wedge HTO in a cohort of 13 men (14 knees). Results obtained from an iterative statistical model found that at six and 12 months after operation, opening-wedge HTO caused increased anterior translation of the tibia (mean 2.6 mm, p < 0.001), decreased proximal translation of the patella (mean -2.2 mm, p < 0.001), decreased patellar spin (mean -1.4°, p < 0.05), increased patellar tilt (mean 2.2°, p < 0.05) and changed three other parameters. The mean Western Ontario and McMaster Universities Arthritis Index improved significantly (p < 0.001) from 49.6 (standard deviation (sd) 16.4) pre-operatively to a mean of 28.2 (sd 16.6) at six months and a mean of 22.5 (sd 14.4) at 12 months. The three-dimensional kinematic changes found may be important in explaining inconsistency in clinical outcomes, and suggest that measures in addition to coronal plane alignment should be considered.
authors.affiliation: University of British Columbia, Centre for Hip Health and Mobility, 2635 Laurel Street, Vancouver BC, V5Z 1M9, Canada.
authors.forename: A G
authors.initials: AG
authors.lastname: d'Entremont
authors.affiliation: University of British Columbia, 65 Richmond St. Suite 102, New Westminster, British Columbia, Canada.
authors.forename: R G
authors.initials: RG
authors.lastname: McCormack
authors.affiliation: University of British Columbia, 500-1144 Burrard St, Vancouver, British Columbia, Canada.
authors.forename: S G D
authors.initials: SG
authors.lastname: Horlick
authors.affiliation: Fraser Orthopedic Institute, 403-233 Nelson's Crescent, New Westminster, British Columbia, Canada.
authors.forename: T B
authors.initials: TB
authors.lastname: Stone
authors.affiliation: John Hopkins Aramco Health Care Center, P O Box 11348, Dhahran 31311, Saudi Arabia.
authors.forename: M M
authors.initials: MM
authors.lastname: Manzary
authors.affiliation: University of British Columbia, Centre for Hip Health and Mobility, 2635 Laurel Street, Vancouver BC, V5Z 1M9, Canada.
authors.forename: D R
authors.initials: DR
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D060750:Bone Anteversion / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: High tibial osteotomy; Kinematics; Knee; MRI; WOMAC