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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
1   Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon-si, Gyonggi-do, South Korea
,
Soyeon Ahn
2   Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seoul, Korea
,
Yong Seuk Lee
3   Division of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
› Author Affiliations
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Publication History

07 August 2017

25 February 2018

Publication Date:
04 April 2018 (online)

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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
 

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