Complication Rates and Clinical Outcomes of Larger Alignment Corrections Using Inverted V-shaped High Tibial Osteotomy in Severe Varus Knee Osteoarthritis: A Comparison with Smaller Corrections.

Background: Many studies have reported that larger alignment corrections in medial opening-wedge high tibial osteotomy (MOWHTO) are associated with a higher incidence of complications. However, no clinical studies have investigated whether larger alignment corrections using the inverted V-shaped high tibial osteotomy (iVHTO) procedure with locking compression plate (LCP) fixation adversely affect postoperative outcomes. Purpose: To determine whether larger alignment corrections using the iVHTO procedure with LCP fixation prolong bone union time, increase complication rates, and lead to poorer clinical outcomes compared with smaller corrections. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 109 knees (96 patients) treated with iVHTO were followed up periodically for up to 24 months postoperatively, and a final follow-up examination was conducted between 3 and 6 years after surgery. The bone union was quantitatively assessed using a radiological scoring system. At the time of analysis, the 109 knees were divided into 2 groups: the larger correction group with the correction angle of ≥13° (group L, 49 knees) and the smaller correction group with the correction angle of <13° (group S, 60 knees). The 2 groups were compared with respect to bone union time, complications, knee function scores, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: Varus knee deformity was significantly greater in group L than in group S ( Conclusion: Larger alignment corrections (≥13°) using the iVHTO procedure with LCP fixation did not prolong bone union time, increase complication rates, or lead to poorer clinical outcomes compared with smaller corrections (<13°) in patients with severe varus osteoarthritic knees.