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Gait analysis of walking before and after medial opening wedge high tibial osteotomy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Introduction

Medial opening wedge high tibial osteotomy (HTO) is used to treat medial compartment osteoarthritis (OA) of the knee. HTO shifts the weight-bearing line from the medial compartment into the lateral compartment. The aim of this study was to investigate the functional biomechanical consequences of this alteration in alignment.

Methods

Eleven male patients with medial compartment osteoarthritis underwent three-dimensional gait analysis during level walking before 12 months and after medial opening wedge HTO. Nine male control subjects of a similar age were also tested using the same protocol. Sagittal and coronal angles and moments in both operated and non-operated knees were compared. Pre and postoperative radiographic coronal plane alignment was also measured.

Results

Walking speed increased significantly postoperatively (P = 0.0001) and was not different from controls. Preoperatively, maximum knee flexion in stance was reduced compared to control (P = 0.02). Postoperatively, maximum knee flexion increased significantly (P = 0.005) and was the same as the controls. Similar changes were observed for the maximum knee flexion moment. The mean maximum varus angle during stance was reduced from 13.5° preoperatively to 5.4° postoperatively (P = 0.0001) compared to (6.8°) in controls. The mean maximum adduction moment also reduced from 3.9 to 2.7 (% Bw/ht, P = 0.02), compared to 3.6 in control subjects. Interestingly, the adduction moments in the non-operated knee increased postoperatively from 3.3 to 4.1 (% Bw/ht, P = 0.02). The mean radiological mechanical alignment was changed from 172 degrees preoperatively to 180 degrees postoperatively (P < 0.001).

Conclusion

HTO resulted in normalisation of several dynamic knee function parameters such as walking speed, knee flexion and external knee flexion moment. As anticipated, HTO reduced the varus angle and adduction moments of the operated knee. An increased adduction moment in the non-operated knee over the first postoperative year was found.

Level of evidence

Prospective case–control clinical laboratory study, Level III.

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Authors and Affiliations

  1. Division of Sportstrauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansensgade 2, 8000, Aarhus C, Denmark

    Martin Lind

  2. Musculoskeletal Research Centre, La Trobe University, Bundoora, Melbourne, VIC, 3086, Australia

    Martin Lind, Jodie McClelland, Joanne E. Wittwer, Timothy S. Whitehead, Julian A. Feller & Kate E. Webster

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  1. Martin Lind
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  2. Jodie McClelland
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  3. Joanne E. Wittwer
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Correspondence to Martin Lind or Kate E. Webster.

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Lind, M., McClelland, J., Wittwer, J.E. et al. Gait analysis of walking before and after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21, 74–81 (2013). https://doi.org/10.1007/s00167-011-1496-y

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  • DOI: https://doi.org/10.1007/s00167-011-1496-y

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