Comparison of the Leg-Length Change between Opening- and Closing-Wedge High Tibial Osteotomy: A Systematic Review and Meta-Analysis

O-Sung Lee; Soyeon Ahn; Yong Seuk Lee

doi:10.1055/s-0038-1641176

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2019; 32(04): 372-379
DOI: 10.1055/s-0038-1641176

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of the Leg-Length Change between Opening- and Closing-Wedge High Tibial Osteotomy: A Systematic Review and Meta-Analysis

O-Sung Lee

¹Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon-si, Gyonggi-do, South Korea

,

Soyeon Ahn

²Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul, Korea

,

Yong Seuk Lee

³Division of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea

› Author Affiliations

Abstract

The aim of this meta-analysis was to compare the effects of closing-wedge (CW) and opening-wedge (OW) high tibial osteotomies (HTOs) on the change in leg length. Our hypotheses were that leg length will increase after OW HTO and decrease after CW HTO, and the magnitude of the change in leg length would be negligible in both techniques. Multiple databases including MEDLINE, Embase, and Cochrane were searched for studies comparing the change in leg length after HTO with that before HTO. After testing for publication bias and heterogeneity, we aggregated variables by using the random-effects model. The weighted mean differences of leg length were estimated before and after OW and CW HTOs with 95% confidence intervals (CIs). Four studies that analyzed 127 OW HTOs and 175 CW HTOs were included in this meta-analysis. Leg length increased by 6.96 mm after OW HTO (95% CI: –3.43 to 17.36) and decreased by 1.95 mm after CW HTO (95% CI: –10.89 to 7). Additionally, the change in leg length after OW HTO had a positive correlation with the degree of correction. The leg length increased after OW HTO, and the increase was sufficiently large to cause clinical concerns. The change in leg length after CW HTO was negligible despite the decrease in length. Therefore, CW HTO seems to be a better treatment option than OW HTO if a large correction is required.

Keywords

knee - high tibial osteotomy - closing wedge - opening wedge - leg length - meta-analysis

Full Text

References

References
1 Magnussen RA, Lustig S, Demey G, Neyret P, Servien E. The effect of medial opening and lateral closing high tibial osteotomy on leg length. Am J Sports Med 2011; 39 (09) 1900-1905
2 Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 2006; 88 (11) 1454-1459
3 Duivenvoorden T, Brouwer RW, Baan A. , et al. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 2014; 96 (17) 1425-1432
4 Gaasbeek RD, Nicolaas L, Rijnberg WJ, van Loon CJ, van Kampen A. Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study. Int Orthop 2010; 34 (02) 201-207
5 van Egmond N, van Grinsven S, van Loon CJ, Gaasbeek RD, van Kampen A. Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 34-41
6 Bae DK, Song SJ, Kim HJ, Seo JW. Change in limb length after high tibial osteotomy using computer-assisted surgery: a comparative study of closed- and open-wedge osteotomies. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 120-126
7 Harper MC, Canale ST. Angulation osteotomy. A trigonometric analysis. Clin Orthop Relat Res 1982; 166: 173-181
8 Mihalko WM, Krackow KA. Preoperative planning for lower extremity osteotomies: an analysis using 4 different methods and 3 different osteotomy techniques. J Arthroplasty 2001; 16 (03) 322-329
9 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 (10) 1006-1012
10 McCaw ST, Bates BT. Biomechanical implications of mild leg length inequality. Br J Sports Med 1991; 25 (01) 10-13
11 Rannisto S, Okuloff A, Uitti J, Paananen M, Rannisto PH, Malmivaara A, Karppinen J. Leg-length discrepancy is associated with low back pain among those who must stand while working. BMC Musculoskelet Disord 2015; 16: 110-116
12 Walsh M, Connolly P, Jenkinson A, O'Brien T. Leg length discrepancy--an experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture 2000; 12 (02) 156-161
13 Kim JI, Kim BH, Lee KW. , et al. Lower limb length discrepancy after high tibial osteotomy: prospective randomized controlled trial of lateral closing versus medial opening wedge osteotomy. Am J Sports Med 2016; 44 (12) 3095-3102
14 Nerhus TK, Ekeland A, Solberg G, Sivertsen EA, Madsen JE, Heir S. Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 910-917
15 Kessler AC, Pugh LI, Stasikelis PJ. Length changes in tibial osteotomy with angular correction. J Pediatr Orthop B 2005; 14 (05) 337-339
16 Hernigou P, Jaafar A, Hamdadou A. Leg length changes after upper tibial osteotomy: analysis of different preoperative planning methods [in French]. Rev Chir Orthop Repar Appar Mot 2002; 88 (01) 68-73