Analysis of the determinant factor of the medial joint space width after medial opening wedge high tibial osteotomy

IntroductionThe decrease in the medial joint space width (MJSW) in patients with osteoarthritis (OA) is proportional to the degree of arthritis. The purpose of this study was to evaluate the affecting factors of the MJSW by serial radiologic assessment after medial open wedge high tibial osteotomy (MOW-HTO).Materials and methodsBetween March 2014 and March 2019, 162 MOW-HTO knees that underwent serial radiologic assessment and follow-up MRI were enrolled. Changes in the MJSW were analyzed by dividing into three groups: group I, low quartile (< 25%); II, middle quartile (25-75%); and III, high quartile (> 75%), according to the magnitude of the MJSW. The correlation between the MJSW and weight-bearing line ratio (WBLR), hip knee ankle angle (HKA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (m-LDFA), joint line orientation angle (JLOA), and MRI cartilage status was analyzed. Multiple linear regression analysis was used to analyze factors affecting the amount of change in the MJSW. The clinical outcome was also correlated with the MJSW.ResultsThe amount of change in the JLCA, which has the largest beta value (weight-bearing standing anteroposterior (AP) view and 45 degrees flexion posteroanterior view (Rosenberg view) beta = - 0.699 and beta = -5.221, both p < 0.001, respectively), had the greatest contribution to the change in the MJSW. The WBLR was also related (standing AP and Rosenberg beta = 0.177 and beta = 0.264, p = 0.015 and p = 0.004, respectively). There was no statistical difference between the amount of change in the MJSW and the change in cartilage. The clinical outcomes did not differ between the groups.ConclusionThe JLCA was the most important contributing factor for the MJSW, followed by WBLR. This contribution was more pronounced in Rosenberg view than standing AP view. Changes in cartilage status were not related to the MJSW and JLCA. The clinical outcome was not related to the MJSW, either.

Automated summary

This study evaluated the factors affecting the medial joint space width (MJSW) after medial open wedge high tibial osteotomy (MOW-HTO). The change in MJSW was analyzed and correlated with parameters such as weight-bearing line ratio (WBLR), hip knee ankle angle (HKA), joint line convergence angle (JLCA), etc. The JLCA and WBLR were found to be major contributing factors to the change in MJSW, and cartilage status and clinical outcome were not related to MJSW.