Journal of Clinical Medicine
Association Between Postoperative Mechanical Alignment and Clinical Outcomes After Medial Opening-Wedge High Tibial Osteotomy: A Retrospective Cohort Study
By Muhammed Kazez, Ömer Cihan Batur, Gokhan Once and 3 others.
Abstract
Background
The optimal coronal mechanical alignment after medial opening-wedge high tibial osteotomy (MOWHTO) remains controversial. This study aimed to evaluate the association between postoperative hip–knee–ankle angle (HKA) and early- to mid-term clinical outcomes and to explore whether this relationship showed evidence of nonlinearity within the observed valgus range.
Methods
This single-center retrospective cohort study included 188 patients who underwent MOWHTO with a 10- or 12.5-mm osteotomy opening. The primary exposure was HKA measured at 6 weeks postoperatively, and the final follow-up International Knee Documentation Committee (IKDC) score was designated as the primary clinical outcome. Lysholm and visual analog scale (VAS) scores were evaluated as secondary outcomes. Associations between postoperative HKA and clinical outcomes were assessed using multivariable linear regression with HC3 heteroskedasticity-robust standard errors, while potential nonlinear relationships were explored by incorporating a quadratic HKA term.