Offloading effect in the unoperated contralateral knee after unilateral medial open wedge high tibial osteotomy: A SPECT/CT analysis

IF 1.6 4区医学 Q3 ORTHOPEDICS Knee Pub Date : 2024-09-05 DOI:10.1016/j.knee.2024.08.009

Jae Ang Sim, Jigang Jeun, Byung Hoon Lee

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Abstract

Background

An open wedge high tibial osteotomy (OWHTO) may lead to gait alteration, which change the contact loading in the contralateral knee, while clear evidence about the impact on contralateral knee still lacks. The purpose of the current study was to evaluate the change in scintigraphic uptake using SPECT-CT in the medial compartment of the contralateral knee following OWHTO.

Methods

Contralateral radiographic measurements were performed for patients with medial osteoarthritis and varus malalignment of >5° treated with OWHTO in this retrospective analysis. The medial compartmental changes according to SPECT/CT analysis before and 1-year after OWHTO were evaluated on the contralateral side.

Results

The study comprised 72 patients. The mean preoperative mechanical femorotibial angle was a mean varus of 7.6° (range, 5.1° – 13.0°), corrected to a mean valgus of 2.5° (range, 1.9° – −8.5°) postoperatively. The average grading of the scintigraphic uptakes in the medial compartment of the contralateral knee was significantly decreased 1 year postoperatively than after the surgery (from 2.8 ± 0.4 to 2.1 ± 0.6, p < 0.001). Measurable differences in varus alignment on radiographs of the contralateral limb were identified. The preoperative mechanical axis value decreased from 8.0° ± 2.4° to 6.7° ± 2.6° at the 3-month postoperative visit (p = 0.011). The overall decrease in varus alignment remained at the 2-year final postoperative follow-up.

Conclusion

Alignment correction by OWHTO results in reducing scintigraphy uptakes in medial compartment and improvement in mechanical alignment of the contralateral knee.

Level of evidence

Therapeutic Level IV.

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单侧内侧开放式楔形高胫骨截骨术后未手术对侧膝关节的卸载效应：SPECT/CT分析

背景开放性楔形胫骨高位截骨术（OWHTO）可能会导致步态改变，从而改变对侧膝关节的接触负荷，但目前仍缺乏有关其对对侧膝关节影响的明确证据。本研究旨在通过 SPECT-CT 评估 OWHTO 术后对侧膝关节内侧间室闪烁摄取的变化。根据 SPECT/CT 分析，评估了 OWHTO 术前和术后 1 年对侧内侧间室的变化。术前机械股胫夹角平均为7.6°（范围为5.1° - 13.0°），术后矫正为平均2.5°（范围为1.9° - 8.5°）。术后一年，对侧膝关节内侧间室的闪烁摄取平均分级比术后明显降低（从 2.8 ± 0.4 降至 2.1 ± 0.6，p <0.001）。在对侧肢体的 X 光片上发现了可测量的屈曲对位差异。术前的机械轴值从 8.0° ± 2.4° 降至术后 3 个月时的 6.7° ± 2.6°（p = 0.011）。结论通过 OWHTO 矫正对位可减少内侧间室的闪烁照相摄取，并改善对侧膝关节的机械对位。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.