Frontiers in surgery · 2026
Excessive tibial valgus was not associated with worse 5-year clinical outcomes after medial opening-wedge high tibial osteotomy for advanced knee osteoarthritis: a retrospective cohort study.
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Wang Yisan, Cao Guorui, Wang Xiao, Wang Peizhao, Shi Xiaotao, Zhang Mingyang, Tan Honglue
Аннотация
PURPOSE: To evaluate whether excessive tibial valgus, defined as a medial proximal tibial angle (MPTA) > 95° at the final follow-up, was associated with worse 5-year clinical outcomes after medial opening-wedge high tibial osteotomy (MOWHTO) in patients with Kellgren-Lawrence (K-L) grade IV medial compartment knee osteoarthritis.
METHODS: This retrospective cohort study included 165 knees with K-L grade IV medial compartment knee osteoarthritis that underwent MOWHTO. Knees were classified according to the MPTA measured on weight-bearing full-length radiographs at the final follow-up as MPTA >95° (n = 81) or MPTA ≤95° (n = 84). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at the final follow-up. Secondary outcomes included the Lysholm score, visual analogue scale (VAS) for pain, knee range of motion (ROM), and radiographic parameters. Between-group changes were compared, and clinical outcomes were further evaluated using baseline-adjusted analysis of covariance.
RESULTS: The mean follow-up duration was 64.49 ± 3.60 months. WOMAC, Lysholm, VAS, and ROM improved significantly from baseline to the final follow-up in the overall cohort (all P < 0.001). At the final follow-up, WOMAC, Lysholm, VAS, and ROM did not differ significantly between the MPTA >95° and MPTA ≤95° groups. Although changes in MPTA and hip-knee-ankle angle were greater in the MPTA >95° group, no significant between-group differences were observed in changes in WOMAC, Lysholm, VAS, or ROM after Holm adjustment. In baseline-adjusted analyses, an MPTA >95° was not significantly associated with WOMAC (adjusted mean difference, -0.16; 95% CI, -5.42 to 5.11; P = 0.953), Lysholm (0.24; 95% CI, -3.22 to 3.69; P = 0.893), VAS (-0.07; 95% CI, -0.39 to 0.24; P = 0.645), or ROM (-1.52°; 95% CI, -4.44 to 1.39; P = 0.306).
CONCLUSION: In patients with K-L grade IV medial compartment knee osteoarthritis treated with MOWHTO, an MPTA >95° at the final follow-up was not significantly associated with worse 5-year clinical outcomes. These findings suggest that the 95° MPTA threshold should not be interpreted in isolation as a determinant of clinical outcome; however, they do not define an optimal correction target or support deliberate overcorrection beyond 95°.
METHODS: This retrospective cohort study included 165 knees with K-L grade IV medial compartment knee osteoarthritis that underwent MOWHTO. Knees were classified according to the MPTA measured on weight-bearing full-length radiographs at the final follow-up as MPTA >95° (n = 81) or MPTA ≤95° (n = 84). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at the final follow-up. Secondary outcomes included the Lysholm score, visual analogue scale (VAS) for pain, knee range of motion (ROM), and radiographic parameters. Between-group changes were compared, and clinical outcomes were further evaluated using baseline-adjusted analysis of covariance.
RESULTS: The mean follow-up duration was 64.49 ± 3.60 months. WOMAC, Lysholm, VAS, and ROM improved significantly from baseline to the final follow-up in the overall cohort (all P < 0.001). At the final follow-up, WOMAC, Lysholm, VAS, and ROM did not differ significantly between the MPTA >95° and MPTA ≤95° groups. Although changes in MPTA and hip-knee-ankle angle were greater in the MPTA >95° group, no significant between-group differences were observed in changes in WOMAC, Lysholm, VAS, or ROM after Holm adjustment. In baseline-adjusted analyses, an MPTA >95° was not significantly associated with WOMAC (adjusted mean difference, -0.16; 95% CI, -5.42 to 5.11; P = 0.953), Lysholm (0.24; 95% CI, -3.22 to 3.69; P = 0.893), VAS (-0.07; 95% CI, -0.39 to 0.24; P = 0.645), or ROM (-1.52°; 95% CI, -4.44 to 1.39; P = 0.306).
CONCLUSION: In patients with K-L grade IV medial compartment knee osteoarthritis treated with MOWHTO, an MPTA >95° at the final follow-up was not significantly associated with worse 5-year clinical outcomes. These findings suggest that the 95° MPTA threshold should not be interpreted in isolation as a determinant of clinical outcome; however, they do not define an optimal correction target or support deliberate overcorrection beyond 95°.