Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent

- Medial opening wedge HTO reduced knee moments in three orthogonal planes.
- Adduction and internal rotation moment changes correlated to static alignment change.
- Flexion moment changes were more variable and not correlated to alignment change.
- Results suggest a sustained (12 months) redistribution of medial knee loads during ambulation.

Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p = 0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (p < 0.01). There were no changes in the knee moments on the non-surgical limb. Medial opening wedge high tibial osteotomy is associated with sustained (12 months) changes in knee moments in all three planes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation.