Use of a lateral offset short-leg walking cast before high tibial osteotomy

The clinical results after high tibial osteotomy for the treatment of symptomatic varus gonarthrosis are unpredictable. Although preoperative gait analysis has been shown to be useful in predicting successful outcome after high tibial osteotomy, there are no readily available preoperative clinical tests for predicting success. The authors did a study to determine the effects of an offset short-leg walking cast as a potential predictor of clinical success after high tibial osteotomy. Specifically, the authors evaluated the effect of an offset short-leg walking cast on pain relief and changes in the peak external adduction moments in patients with symptomatic varus gonarthrosis indicated for high tibial osteotomy. Nineteen consecutive patients indicated for high tibial osteotomy were enrolled and completed the study. All patients had precast gait analysis to determine baseline parameters. Immediately after gait analysis, a short-leg lateral offset walking cast was applied and worn for 3 days to allow time for adaptation. Gait analysis then was repeated. Western Ontario and McMaster Universities Osteoarthritis Index pain scores were obtained before and after the cast was applied. The cast resulted in a mean reduction in pain of 53%, and a mean reduction in the peak external adduction moment of 36% in the 17 of 19 patients who tolerated the cast. The reduction in pain was correlated with the reduction in the peak adduction moment (r = 0.63). The authors conclude that an offset short-leg walking cast results in pain reduction that correlates with changes in external adduction moments about the knee. Therefore, an offset short-leg walking cast may prove to be an effective tool for predicting patients who ultimately will benefit from valgus high tibial osteotomy.