Management of combined knee medial compartmental and patellofemoral osteoarthritis with lateral closing wedge osteotomy with anterior translation of the distal tibial fragment: Does the degree of anteriorization affect the functional outcome and posterior tibial slope?

Background: The aim of this study was to assess the effect of degree of anterior translation of the distal tibial fragment after lateral closing wedge high tibial osteotomy in patients having combined knee medial compartmental and patellofemoral osteoarthritis. Methods: A retrospective study was conducted on 64 patients who were operated on for combined knee medial compartmental and patellofemoral osteoarthritis, by lateral closing wedge high tibial osteotomy with anterior translation of the distal tibial fragment. They were divided into two groups; Group I comprising 32 patients (34 knees, mean age of 51.4 +/- 7 years) whose degree of anterior translation was <1 cm and Group II comprising 32 patients (33 knees, mean age of 52.2 +/- 8.3 years) whose degree of anterior translation was >1.5 cm. The final assessment was performed via: visual analog scale, postoperative Knee Society clinical rating system function score, active range of motion, time to union, degree of correction of mechanical axis, posterior tibial slope, and Insall-Salvati ratio. Results: Group II patients exhibited statistically superior mean postoperative score and better return to their work than Group I (P = 0.013, 0.076, respectively). Both groups showed statistically significant differences between the preoperative and postoperative evaluation parameters (P < 0.001). The posterior tibial slope was decreased in both groups but with no significant difference (P = 0.527). Conclusions: Lateral closing wedge high tibial osteotomy combined with anterior translation of the distal tibial fragment more than 1.5 cm achieved significantly better postoperative functional knee score. Both groups exhibited comparatively decreased posterior tibial slope. (C) 2016 Elsevier B.V. All rights reserved.