title: Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent.
abstract: Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p=0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (p<0.01). There were no changes in the knee moments on the non-surgical limb. Medial opening wedge high tibial osteotomy is associated with sustained (12 months) changes in knee moments in all three planes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation.
authors.affiliation: Graduate Program in Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Ontario, Canada; Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Kristyn M
authors.initials: KM
authors.lastname: Leitch
authors.affiliation: Graduate Program in Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Ontario, Canada; Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada. Electronic address: tbirming@uwo.ca.
authors.forename: Trevor B
authors.initials: TB
authors.lastname: Birmingham
authors.affiliation: Graduate Program in Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Dunning
authors.affiliation: Graduate Program in Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Ontario, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 3K7.
authors.forename: J Robert
authors.initials: JR
authors.lastname: Giffin
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology; D013977:Tibia / Q000503:physiopathology* / Q000601:surgery*; D016138:Walking / Q000502:physiology*; D016474:Weight-Bearing / Q000502:physiology*
keywords: Knee moments; Medial opening wedge high tibial osteotomy; Stair climbing; Walking