2.1. Case 1
A 48-year-old female patient who complained of serious pain in the right
knee and ipsilateral ankle for about three years presented to our clinic
in January 2019. She had no systemic musculoskeletal disease or other
medical history. She was 150.0 cm in height and 57.0 kg in weight, with
a body mass index of 25.3 kg/m2. Pain in both the knee
and ankle joints began three years ago due to a moderate varus deformity
and osteoarthritis of the double joints. Physical examination showed
that the right knee could actively flex to 120° and had a prominent
hyperextension of about 5°. The Hospital for Special Surgery (HSS) score
of the right knee was 65. In addition, the right ankle was swollen and
showed abnormal plantar flexion and was markedly varus. The
osteoarthritic ankle stage was Takakura’s classification stage
3.7 Hip and pelvis movements were symmetrical, full,
and pain-free. The results of the spine examination were normal with no
neurological abnormalities.
Kellgren-Lawrence (K-L) grade II~III osteoarthritic
change of the right knee was documented. The weight-bearing X-ray showed
the varus deformity, and the hip-knee-ankle (HKA) angle was 8.2°. Her
ankle was noted to have 16.4° of varus talar tilt (TT) and 6.1° of
tibial inclination (TI) (Fig. 1).
We considered that her ankle symptoms could be attributed to the varus
alignment of the left knee. Through a medial approach above the pes
anserinus, an opening wedge HTO was performed. Intraoperatively, the
medial osteotomy wedge was opened to 9° and the desired correction was
achieved. The patient recovered without any complications and was
advised to perform non-weight-bearing mobilization with a walker during
rehabilitation.
The patient was satisfied with the outcome of her surgery, reporting a
marked reduction in pain and improved stability of both knee and ankle
joints six weeks postoperatively. Three months later, there was no pain
in her left knee, and she could walk unaided. Her active range of motion
was 0 to 135°. The HSS score of the right knee was 85 three months after
surgery and she volunteered a subjective improvement in ankle pain of
95%.
The postoperative weight-bearing X-ray showed favorable limb alignment
on the coronal view. The standing HKA angle improved from a preoperative
value of 8.2° to 0° at follow-up. The TT was corrected from 16.4° to
8.2° and the TI from 6.1° to 0.7° (Fig. 2).