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Hanada M, Hotta K, Matsuyama Y. Femoral trochlear groove cartilage damage after open-wedge high tibial osteotomy is associated with the change in patellar height relative to the femoral condyle. Orthop Traumatol Surg Res 2024:103898. [PMID: 38663741 DOI: 10.1016/j.otsr.2024.103898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/28/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Medial open-wedge high tibial osteotomy (OWHTO) is performed for isolated medial compartment osteoarthritis or osteonecrosis of the knee and correction of varus deformity of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO. HYPOTHESIS The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes. PATIENTS AND METHODS Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices. RESULTS Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with>1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53×10-14-0.812, p=0.047). PF cartilage damage tended to progress in ΔMBI<-0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (p=0.037 and 0.038, respectively). DISCUSSION The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Higashi-ku, 431-3192, Japan.
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Higashi-ku, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Higashi-ku, 431-3192, Japan
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Said E, Ahmed AM, Addosooki A, Attya HA, Awad AK, Ahmed EH, Tammam H. Comparison of the clinical and radiological outcomes of Puddu and TomoFix plates for medial opening-wedge high tibial osteotomy: A two-year follow-up of a randomized controlled trial. Orthop Traumatol Surg Res 2024:103845. [PMID: 38403264 DOI: 10.1016/j.otsr.2024.103845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Opening-wedge high tibial osteotomy (OWHTO) requires fixation devices for stabilization of the osteotomy gap. The two most commonly used fixation devices are the Puddu and the TomoFix plates. Based on its design, each implant generates a characteristic stability profile. The aim of this randomized controlled trial (RCT) was to investigate the short-term clinical and radiological outcomes of OWHTO using the Puddu and TomoFix plating systems. We hypothesized that the TomoFix plate would achieve superior clinical and radiographic results compared to the Puddu plate. METHODS A total of 60 patients were randomly allocated to undergo OWHTO either using the Puddu plate or the TomoFix plate if conservative treatment failed with symptomatic medial compartment knee osteoarthritis (OA) stage I or II according to Ahlbäck classification, and varus malalignment. All patients underwent clinical and radiological assessment preoperatively, and at 3, 6, 12, and 24months postoperatively. Radiological measurement of the hip-knee-ankle (HKA) angle, and posterior tibial slope (PTS) was performed. Functional assessment was carried out using the Hospital for Special Surgery Knee-Rating Scale (HSS) and the Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index. Patients were also evaluated for intraoperative and postoperative complications throughout the follow-up period. RESULTS The mean angular correction was 9.6±4°, and 10.5±4.8° in the Puddu and TomoFix groups, respectively (p=0.488). The mean PTS change was significantly higher in the Puddu group (3.4±1.1°) compared to the TomoFix group (0.8±0.7°) (p<0.001). There was a statistically significant improvement in the mean HSS and WOMAC in both groups until one year postoperatively. Neither HSS nor WOMAC showed a statistically significant difference between the Puddu and TomoFix groups at any time during the first two postoperative years. The overall complication rate was not significantly different between the Puddu and TomoFix groups. However, the TomoFix group demonstrated higher incidence of symptomatic hardware (23% vs. 3.3%) and removal of metalwork (17% vs. 0%) than the Puddu group (p=0.023 and 0.020, respectively). CONCLUSION This RCT suggests that the implant choice for OWHTO has no significant impact on functional outcomes during the first 2years postoperatively. While the Puddu plate was associated with an unintentional increase in the PTS during the surgery, both implants allowed coronal and sagittal plane corrections to be preserved postoperatively. The overall complication rates were similar, but the TomoFix required more material to be removed because it is more cumbersome. However, these results need to be confirmed on a larger scale. LEVEL OF EVIDENCE II; randomized controlled trial.
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Affiliation(s)
- Elsayed Said
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Mohamed Ahmed
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
| | - Ahmad Addosooki
- Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hossam Ahmed Attya
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmad Khairy Awad
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Emad Hamdy Ahmed
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Hamdy Tammam
- Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
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Zhao C, Zhang B, Liu X, Li B, Bao L, Liu C, Fan L. Intraoperative femurofibular angle combined with tibiofibular angle measurement has fewer correction errors in open-wedge high tibial osteotomy. J Orthop Surg Res 2024; 19:148. [PMID: 38374044 PMCID: PMC10877754 DOI: 10.1186/s13018-024-04619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
AIM This study aimed to verify the accuracy of intraoperative femurofibular angle combined with tibiofibular angle (FFA-TFA) measurement and compare it with traditional alignment line methods in open-wedge high tibial osteotomy (OWHTO). METHODS A total of 174 knees of 122 patients undergoing OWHTO and using an alignment line or FFA-TFA measurement as an index of optimal correction were included in this retrospective study. The intraoperative alignment line passed through the targeted weight-bearing line (WBL) of the tibial plateau in the alignment line group. The intraoperative FFA-TFA aligned to the preplanned FFA-TFA angle in the FFA-TFA group. WBL, FFA, TFA, and knee joint-line convergence angle of the femur and tibia were assessed as radiological results preoperatively and one year after surgery. The Knee Society Score and the Western Ontario and McMaster Universities were assessed as objective clinical results. RESULTS Postoperative WBL in the FFA-TFA group was closer to the target WBL than in the alignment line group (FFA-TFA vs alignment line group: 1.43 ± 1.20% vs 3.82 ± 3.29%; P < 0.001). The FFA-TFA group had fewer over-correction and under-correction rates than the alignment line group (28.7% and 12.6% vs 11.5% and 3.40%; P < 0.001). No significant differences were observed in the clinical results between the two groups one year after surgery (P > 0.05). CONCLUSIONS The intraoperative measurement of FFA-TFA had fewer complications in terms of under-correction and over-correction compared with the alignment line measurement. No significant differences between the two methods were observed in clinical results one year after surgery.
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Affiliation(s)
- Chen Zhao
- The Second Affiliated Hospital of Xi'an Medical University, Xi'an, 710038, China
| | - Bing Zhang
- The Second Affiliated Hospital of Xi'an Medical University, Xi'an, 710038, China
| | - Xuejiao Liu
- The Affiliated Hospital of Northwest University Xi'an No. 3 Hospital, Xi'an, 710016, China
| | - Bo Li
- The Second Affiliated Hospital of Xi'an Medical University, Xi'an, 710038, China
| | - Liang Bao
- The Second Affiliated Hospital of Xi'an Medical University, Xi'an, 710038, China
| | - Cong Liu
- The Second Affiliated Hospital of Xi'an Medical University, Xi'an, 710038, China
| | - Lihong Fan
- The Second Affiliated Hospital Of Xi'an Jiaotong University, Xi'an, 710004, China.
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Van Genechten W, Van Haver A, Bartholomeeusen S, Claes T, Van Beek N, Michielsen J, Claes S, Verdonk P. Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study. J Exp Orthop 2023; 10:24. [PMID: 36917322 PMCID: PMC10012299 DOI: 10.1186/s40634-023-00593-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Contemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short-term clinical outcomes when using 3D planning and a patient-specific instrumentation (PSI) kit to prepare customized bone allografts. METHODS Thirty subjects (age 48y ± 13) were included in a double-center prospective case series. A low-dose CT-scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ-5D and anchor questions. A linear-mixed model approach was implemented for data analysis. RESULTS Preoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001). CONCLUSION The study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery.
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Affiliation(s)
- Wouter Van Genechten
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium. .,More Institute, Antwerp, Belgium. .,Orthopedic Department, AZ Herentals, Herentals, Belgium.
| | | | | | - Toon Claes
- Orthopedic Department, AZ Herentals, Herentals, Belgium
| | | | - Jozef Michielsen
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium
| | | | - Peter Verdonk
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium.,More Institute, Antwerp, Belgium.,ORTHOCA, Antwerp, Belgium
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Erquicia JI, Gil-Gonzalez S, Ibañez M, Leal-Blanquet J, Combalia A, Monllau JC, Pelfort X. A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy: a cadaveric study. J Exp Orthop 2022; 9:124. [PMID: 36577908 PMCID: PMC9797634 DOI: 10.1186/s40634-022-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. METHODS A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. RESULTS Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. CONCLUSION Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- Juan Ignacio Erquicia
- grid.488391.f0000 0004 0426 7378Department of Orthopedic Surgery and Traumatology, Althaia Xarxa Assistencial Universitària de Manresa, Carrer Dr. Joan Soler, 1-3, 08243 Manresa, Spain ,IMOVE, Mi Tres Torres, Av. Via Augusta, 281, 08017 Barcelona, Spain
| | - Sergi Gil-Gonzalez
- grid.7080.f0000 0001 2296 0625Department of Orthopedic Surgery and Traumatology, Consorci Corporació Sanitària Parc Taulí. Universitat Autònoma de Barcelona (UAB), Parc del Taulí, 1, 08208 Sabadell, Spain
| | - Maximiliano Ibañez
- grid.7080.f0000 0001 2296 0625ICATME. Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Carrer de Sabino Arana 5, 08028 Barcelona, Spain
| | - Joan Leal-Blanquet
- grid.488391.f0000 0004 0426 7378Department of Orthopedic Surgery and Traumatology, Althaia Xarxa Assistencial Universitària de Manresa, Carrer Dr. Joan Soler, 1-3, 08243 Manresa, Spain ,IMOVE, Mi Tres Torres, Av. Via Augusta, 281, 08017 Barcelona, Spain
| | - Andrés Combalia
- grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Carrer Casanova 143, 08036 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Carrer Casanova 143, 08036 Barcelona, Spain
| | - Juan Carlos Monllau
- grid.7080.f0000 0001 2296 0625ICATME. Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Carrer de Sabino Arana 5, 08028 Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Orthopedic Surgery and Traumatology. Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Passeig Marítim, 25, 08003 Barcelona, Spain
| | - Xavier Pelfort
- grid.7080.f0000 0001 2296 0625Department of Orthopedic Surgery and Traumatology, Consorci Corporació Sanitària Parc Taulí. Universitat Autònoma de Barcelona (UAB), Parc del Taulí, 1, 08208 Sabadell, Spain
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Thürig G, Korthaus A, Frings J, Berninger MT, Frosch KH, Krause M. Influence of Medial Osteotomy Height and Hinge Position in Open Wedge High Tibial Osteotomy: A Simulation Study. Diagnostics (Basel) 2022; 12:diagnostics12102546. [PMID: 36292236 PMCID: PMC9600956 DOI: 10.3390/diagnostics12102546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: In treating medial unicompartmental gonarthrosis, medial open wedge high tibial osteotomy (mOWHTO) reduces pain and is intended to delay a possible indication for joint replacement by relieving the affected compartment. This study aimed to investigate the influence of the osteotomy height with different hinge points in HTO in genu varum on the leg axis. (2) Methods: Fifty-five patients with varus lower leg alignment obtained full-weight bearing long-leg radiographs were analyzed. Different simulations were performed: Osteotomy height was selected at 3 and 4 cm distal to the tibial articular surface, and the hinge points were selected at 0.5 cm, 1 cm, and 1.5 cm medial to the fibular head, respectively. The target of each correction was 55% of the tibial plateau measured from the medial. Then, the width of the opening wedge was measured. Intraobserver and interobserver reliability were calculated. (3) Results: Statistically significant differences in wedge width were seen at an osteotomy height of 3 cm below the tibial plateau when the distance of the hinge from the fibular head was 0.5 cm to 1.5 cm (3 cm and 0.5 cm: 8.9 +/− 3.88 vs. 3 cm and 1.5 cm: 11.6 +/− 4.39 p = 0.012). Statistically significant differences were also found concerning the wedge width between the distances 0.5 to 1.5 cm from the fibular head at the osteotomy height of 4 cm below the tibial plateau. (4 cm and 0.5 cm: 9.0 +/− 3.76 vs. 4 cm and 1.5 cm: 11.4 +/− 4.27 p = 0.026). (4) Conclusion: A change of the lateral hinge position of 1 cm results in a change in wedge width of approximately 2 mm. If hinge positions are chosen differently in preoperative planning and intraoperatively, the result can lead to over- or under-correction.
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Affiliation(s)
- Grégoire Thürig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, 1700 Fribourg, Switzerland
| | - Alexander Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Markus Thomas Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Correspondence:
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Key S, Demir S, Aydın O, Say Y, Erten M. A biomechanical study: Comparison of three different implant options in high Tibial osteotomy. Clin Biomech (Bristol, Avon) 2022; 98:105722. [PMID: 35863144 DOI: 10.1016/j.clinbiomech.2022.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many implant options could be preferable for fixation after osteotomy in varus knee medial compartment arthrosis. Due to usage characteristics, it is important to compare the biomechanical properties of them. For this purpose, we aimed to examine three different implant types biomechanically in our study. METHODS Ovine tibiae undergoing medial open-wedge high tibial osteotomy were fixed in vitro with three different implants using an angular wedge plate, a metal block plate and an external fixator system. The fixed ovine tibiae were subjected to axial tensile, axial loading and three-point bending tests in a test machine. All biomechanical tests were repeated five times, the maximum and minimum values were ignored, and the average values of the remaining three test results were taken into account. The test results were interpreted after converted into force-elongation curves in Trapezium-X software. FINDINGS Biomechanical test results revealed some differences between implant types. While the metal block plate had the highest axial tensile strength value, it was the fixation group showing the lowest strength in axial load tests. The used fixator system was the highest strength in axial load tests and the lowest strength in axial tensile tests. INTERPRETATION Considering the clinically significant forces related to the biomechanical stability of the three different implants used for high tibial osteotomy, the fixator system would appear to be slightly superior, although it should be noted that torsional forces, as well as parameters that could change in living tissue, might affect the results.
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Affiliation(s)
- Sefa Key
- Department of Orthopedics and Traumatology, Bingöl State Hospital, Bingöl, Turkey
| | - Sukru Demir
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University, 23190 Elazig, Turkey
| | - Oğuz Aydın
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University, 23190 Elazig, Turkey
| | - Yakup Say
- Department of Metallurgy and Materials Engineering, College of Engineering, Munzur University, Tunceli, Turkey
| | - Mehmet Erten
- Department of Medical Biochemistry, Public Health Lab, Malatya, Turkey.
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Undercorrection: the undesired effect of compression on the osteotomy gap of the medial opening wedge high tibial osteotomy and its clinical significance. Arch Orthop Trauma Surg 2022; 142:937-946. [PMID: 33417032 DOI: 10.1007/s00402-020-03717-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Undercorrection is a common problem in opening wedge high tibial osteotomy (OWHTO). We investigated the compression effect of cortex screw on the osteotomy gap and its clinical significance. MATERIALS AND METHODS A standard OWHTO using the TomoFix plate was conducted on 20 bone models in two groups to get a 10-mm medial osteotomy gap. A cortex screw was used temporarily in a neutral (at the center) and an eccentric position (near the inclined plane) of the dynamic hole in group 1 and group 2, respectively. The mean of undercorrection observed in the two groups was compared using an independent t test. Also, the effect of compression on the gap between the plate and medial tibial cortex, and the osteotomy gap was evaluated using a Sine rule. Besides, the mean undercorrection observed was assessed for clinical significance based on the effect on the weight-bearing axis (WBA) using a Cosine Rule. RESULTS The mean undercorrection was 1.3 ± 0.6 mm and 2.6 ± 0.6 mm in group 1 and group 2, respectively. A significantly greater undercorrection was observed in group 2 (p < 0.001). The correction loss in group 2 has resulted from combinations of the sliding effect of the dynamic hole and oblique compression effect over the gap between the plate and medial tibial cortex whereas in group 1 it has only resulted from the oblique compression effect. The observed undercorrection in group 2 has resulted in clinically significant WBA shift (10%) over the width of the tibial plateau. CONCLUSIONS In OWHTO, compression is important for the stability and healing of osteotomy, but it can also cause loss of correction. In patients requiring large correction, the surgeon should control the amount of compression required and consider making extra osteotomy gap to avoid undercorrection. Furthermore, the placement of cortex screws in neutral is essential to lower the risk of undercorrection.
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Yuan L, Niu S, Zhai C, Li S, Bian J, Zhao X, Zhang Y, Wang G. Influence of lower-limb mechanical axis on the curative effect of medial high tibial osteotomy for knee osteoarthritis. BMC Surg 2022; 22:177. [PMID: 35562799 PMCID: PMC9107279 DOI: 10.1186/s12893-022-01629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the effect of the ratio of the medial tibial plateau width to the total tibial plateau width on the therapeutic efficacy of high tibial osteotomy (HTO) on the medial side for the treatment of knee osteoarthritis. METHODS In this study, we retrospectively analyzed information of 278 patients who underwent medial HTO for knee osteoarthritis with varus deformity. The Tinetti Gait and Balance Assessment Tool, the Visual Analog Scale (VAS), and the Knee Society Scoring System (KSS) were used to comprehensively evaluate the function of the knee joint after HTO. RESULTS After adjusting for potential confounding factors (i.e., age, gender, body mass index/BMI, and surgical site), the Tinetti assessment score was optimized when the degree of correction was 53.67%, with the β-value on the left and right sides of the inflection point of 0.49 (confidence interval, CI: 0.20, 0.78, P = 0.0009) and- 0.26 (95% CI: - 0.30, - 0.22, P < 0.0001), respectively. The KSS score was optimized when the degree of correction was 55.45%, with the β-value on the left and right sides of the inflection point of 2.77 (95% CI: 1.64, 3.90, P < 0.0001) and - 1.18 (95% CI: - 1.46, - 0.91, P < 0.0001), respectively. The VAS score was the lowest when the degree of correction was 55.00%, with the β-value on the left and right sides of the inflection point of - 0.16 (95% CI: - 0.29, - 0.03, P = 0.0146) and 0.08 (95% CI: 0.05, 0.10, P < 0.0001), respectively. Stratified analysis showed that the BMI affected the Tinetti assessment score (β = - 0.14, 95% CI: - 0.24, - 0.04, P = 0.0071). According to the smooth-curve fitting results, when the BMI was > 28, the Tinetti assessment score showed a negative trend. CONCLUSION The degree of lower-limb mechanical axis correction correlated with the functional status of the knee joint after MOW HTO. When the ratio of the medial tibial plateau width to the total tibial plateau width was approximately 55%, the post-MOW HTO outcomes were optimized and the patients experienced the highest satisfaction. In addition, very high BMI was not conducive for the postoperative recovery of the knee joint function. LEVEL OF EVIDENCE III Case-control study/Retrospective comparative study.
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Affiliation(s)
- Long Yuan
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Shuaishuai Niu
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Chuanxing Zhai
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Sen Li
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Jichao Bian
- Department of Clinical, Jining Medical University, Jining, Shandong, China
| | - Xiaowei Zhao
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yuanmin Zhang
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Guodong Wang
- Department of Orthopedics and Joints, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
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Kang BY, Lee DK, Kim HS, Wang JH. How to achieve an optimal alignment in medial opening wedge high tibial osteotomy? Knee Surg Relat Res 2022; 34:3. [PMID: 35135631 PMCID: PMC8822774 DOI: 10.1186/s43019-021-00130-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.
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Affiliation(s)
- Byoung Youl Kang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyeon Soo Kim
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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11
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Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees. Knee Surg Sports Traumatol Arthrosc 2022; 30:680-687. [PMID: 33423093 DOI: 10.1007/s00167-020-06426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare alignment parameters between patients undergoing high tibial osteotomy (HTO) for knee osteoarthritis (OA) and non-arthritic controls. METHODS Pre-operative computed tomography images from 194 patients undergoing HTO for medial knee OA and 118 non-arthritic controls were utilized. All patients had varus knee alignment (mean age: 57 ± 11 years; 45% female). The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and non-weight-bearing joint line convergence angle (nwJLCA) were compared between "control group" and "HTO group". Femoral and tibial phenotypes were also assessed and compared between groups. Variables found on univariate analysis to be different between the groups were entered into a binary logistic regression model. RESULTS The mean age was lower (Δ = 4 ± 6 years, p = 0.024), body mass index (BMI) was higher (Δ = 1.1 ± 2.8 kg/m2, p = 0.032) and there were more females (Δ = 14%, p = 0.020) in the HTO group. The HTO group had more overall varus (7° ± 4.7° vs 4.8° ± 1.3°, p < 0.001). There was a significant difference in the mean mLDFA between the two groups with the HTO group having more femoral varus (88.7 ± 3.2° vs 87.3 ± 1.8°, p < 0.001). MPTA was similar between the groups (p = 0.881). Age was found to be a strong determinant for femoral varus (p = 0.03). CONCLUSION Patients undergoing HTO for medial knee OA have more femoral varus compared to non-arthritic controls while tibial morphology was similar. This will be an important consideration in pre-operating planning for realignment osteotomy in patients presenting with medial knee OA and warrants further investigation. LEVEL OF EVIDENCE III, retrospective comparative study.
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12
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Fortier LM, Gursoy S, Knapik DM, Chahla J. Three-Dimensional Patient Specific Instrumentation and Cutting Guide for Medial Closing Wedge High Tibial Osteotomy to Correct Valgus Malalignment. Arthrosc Tech 2022; 11:e13-e23. [PMID: 35127424 PMCID: PMC8807722 DOI: 10.1016/j.eats.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023] Open
Abstract
Achievement of appropriate mechanical knee alignment is crucial to ensure optimal clinical outcomes following osteotomy procedures about the knee. The use of patient-specific instrumentation (PSI) to assist in preoperative planning and intraoperative realignment has gained increasing popularity. The purpose of this article is to describe a surgical technique involving a medial closing wedge high tibial osteotomy performed using three-dimensional (3D) PSI and cutting guide to revise residual valgus deformity following failed distal femoral osteotomy. The correction angle, 3D position of the hinge and wedge, as well as final plate and screw position are planned preoperatively using virtual software and computed tomography imaging to allow precise surgical execution.
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Affiliation(s)
- Luc M. Fortier
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
| | - Safa Gursoy
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
| | | | - Jorge Chahla
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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13
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Presutti M, Goderecci R, Palumbo P, Giannetti A, Mazzoleni MG, Randelli FMN, Angelozzi M, Calvisi V, Fidanza A. A novel biplanar medial opening-wedge high tibial osteotomy: the Z-shaped technique. A case series at 7.2 years follow-up. J Orthop Traumatol 2021; 22:53. [PMID: 34905126 PMCID: PMC8671589 DOI: 10.1186/s10195-021-00617-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background High tibial osteotomy (HTO) provides reliable and good long-term results, if performed with correct indications, but different techniques and types of fixation have been described. The purpose of this study is to present a novel modified biplanar medial opening-wedge (MOW) HTO technique where the osteotomies are performed in a Z-shaped fashion, and to present the medium-term clinical and radiographic results. Materials and methods We present a case series of 75 patients (80 knees) with mean age of 45.8 years, affected by isolated medial knee osteoarthritis and symptomatic varus knee malalignment, who underwent novel biplanar Z-shaped MOWHTO. Clinical and radiological outcomes were collected, retrospectively before surgery and at median follow-up of 7.2 years (95% CI 5.6–9.2 months) after surgery. Clinical results and satisfaction were assessed by visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Likert scale. Radiological assessment involved the evaluation of the medial proximal tibial angle (MPTA), tibial slope (TS), Caton–Deschamps index, and knee osteoarthritis grade according to Ahlbäck classification. Pre- and postoperative results were compared using the two-tailed t-test or Wilcoxon’s test of independent samples for paired data or nonparametric analog. P < 0.05 was considered significant. Results At medium-term follow-up, Z-shaped MOWHTO showed a survival rate of 95 ± 1.7% with failure occurring in four knees due to symptom recurrence and osteoarthritis progression. No perioperative complications were observed (intraarticular fracture, delayed union or nonunion, and neurological injury). Mean bone healing time was 12 weeks. Clinical scores showed significant improvement at last follow-up and a good grade of satisfaction. MPTA increased significantly, while Caton–Deschamps index decreased significantly. No significant TS increase was found. Conclusions Modified biplanar Z-shaped MOWHTO is a safe and reliable technique that offers satisfactory clinical and radiological medium-term outcomes with low knee arthroplasty conversion rate. The unique three-dimensional geometrical conformation potentially provides a favorable environment for bone healing, increased anteroposterior and rotational stability, and safer opening-wedge loading force application with low lateral hinge fracture risk. Level of evidence Level IV, retrospective observational case series study. Trial registration The study protocol was approved by the Internal Review Board of our Institution (authorization number 54/2019, 20 November 2019).
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Affiliation(s)
- Marcello Presutti
- Unit of Orthopaedic Surgery, "Casa Di Cura Villa Esther", Bojano (Cb), Italy
| | - Remo Goderecci
- Unit of Orthopaedics and Traumatology, "G. Mazzini" Civil Hospital of Teramo, ASL 4 Teramo, Piazza Italia 1, 64100, Teramo, Italy.
| | - Pietro Palumbo
- Unit of Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria - Ospedali Riuniti, Foggia (FG), Italy
| | - Alessio Giannetti
- Department of Life, Health and Environmental Sciences, Unit of Orthopaedics and Traumatology, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila (AQ), Italy
| | - Manuel Giovanni Mazzoleni
- Department of Life, Health and Environmental Sciences, Unit of Orthopaedics and Traumatology, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila (AQ), Italy
| | | | - Massimo Angelozzi
- Department of Life, Health and Environmental Sciences, Unit of Orthopaedics and Traumatology, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila (AQ), Italy
| | - Vittorio Calvisi
- Department of Life, Health and Environmental Sciences, Unit of Orthopaedics and Traumatology, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila (AQ), Italy
| | - Andrea Fidanza
- Department of Life, Health and Environmental Sciences, Unit of Orthopaedics and Traumatology, University of L'Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L'Aquila (AQ), Italy
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Van Genechten W, Van Tilborg W, Van den Bempt M, Van Haver A, Verdonk P. Feasibility and 3D Planning of a Novel Patient-Specific Instrumentation Technique in Medial Opening-Wedge High Tibial Osteotomy. J Knee Surg 2021; 34:1560-1569. [PMID: 32443162 DOI: 10.1055/s-0040-1710379] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A novel approach for opening-wedge high tibial osteotomy (OWHTO) with patient-specific instrumentation (PSI) was evaluated for its safety, feasibility, and accuracy. Next, the mechanical medial proximal tibial angle (mMPTA) was assessed as a potential planning angle by investigating the relation with the mechanical femorotibial angle (mFTA). Ten OWHTO cases were 3D planned using the mMPTA and operated with a customized 3D-printed wedge and cast which resembled the intended osteotomy opening. Patients were closely monitored for intraoperative and postoperative complications up to 1 year after surgery. Radiological assessment was conducted on full leg standing radiographs and supine lower limb computed tomography-scans preoperatively and 3 months after surgery. No intraoperative complications or logistical issues during PSI processing were observed. Absolute accuracy outcomes showed a correction error of 1.3° ± 1.1 mMPTA and 0.9° ± 0.6 mFTA with all osteotomies falling in (-2°; + 2°) mFTA around the target. The mMPTA and mFTA were found to have a strong correlation in both 3D (r = 0.842, p = 0.002) and 2D (r = 0.766, p = 0.01) imaging for effective correction. The study confirmed the development of a safe and feasible PSI technique in OWHTO with excellent accuracy outcomes. The strong correlation between the mMPTA and mFTA indicated that soft tissue changes after OWHTO are of minor significance to the final alignment in ligament-stable patients. Finally, the mMPTA was found to be a reliable planning angle in 3D software for obtaining the intended lower limb realignment and its use can therefore be recommended in modern OWHTO planning.
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Affiliation(s)
- Wouter Van Genechten
- Faculty of Medicine, Antwerp University, Antwerp, Belgium.,More Foundation, AZ Monica, Antwerp, Belgium
| | | | | | | | - Peter Verdonk
- Faculty of Medicine, Antwerp University, Antwerp, Belgium.,More Foundation, AZ Monica, Antwerp, Belgium.,ORTHOCA, Antwerp, Belgium
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15
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Tseng TH, Hsu KH, Wang JH. Focal proximal fibular angle: A potential indicator of the tibial mechanical axis in opening-wedge high tibial osteotomy. Knee 2021; 32:30-36. [PMID: 34365227 DOI: 10.1016/j.knee.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/05/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND For opening-wedge high tibial osteotomy, correct alignment is essential for a better prognosis. It is difficult to evaluate the mechanical axis of the lower extremity or tibia using a single fluoroscopic image. This study aimed to discuss the use of focal proximal fibular angle (FPFA), which can be assessed by a single fluoroscopic image, as an intraoperative indicator. METHODS Eligible for analyses were 111 consecutively treated patients; for the final analyses 96 patients were included. The preoperative and postoperative medial proximal tibial angle (MPTA) and FPFA were measured. The relationship between these two angles, correction amount, weight-bearing line ratio and patient characteristics were analyzed. RESULTS The preoperative FPFA and MPTA were 96.5 ± 3.8° (mean ± standard deviation, SD) and 84.8 ± 3.0°, while the postoperative FPFA and MPTA were 87.6 ± 4.1° and 94.0 ± 3.5°, respectively. The preoperative and postoperative sums of the MPTA and FPFA were constant. The discrepancy was less than 3° in all knees, less than 2° in 92.7% knees and less than 1° in 68.8% knees. It was not correlated with age, sex, weight-bearing line ratio, or correction amount. CONCLUSION The study findings confirmed the constancy of the sum of the MPTA and FPFA. The FPFA can be easily evaluated on a single fluoroscopic image of the knee. Use of the FPFA as guidance may simplify the procedure of opening-wedge high tibial osteotomy and approximately predict the tibial mechanical axis.
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Affiliation(s)
- Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kuan-Hung Hsu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
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16
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MacLeod AR, Peckham N, Serrancolí G, Rombach I, Hourigan P, Mandalia VI, Toms AD, Fregly BJ, Gill HS. Personalised high tibial osteotomy has mechanical safety equivalent to generic device in a case-control in silico clinical trial. COMMUNICATIONS MEDICINE 2021; 1:6. [PMID: 35602226 PMCID: PMC9053187 DOI: 10.1038/s43856-021-00001-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Background Despite favourable outcomes relatively few surgeons offer high tibial osteotomy (HTO) as a treatment option for early knee osteoarthritis, mainly due to the difficulty of achieving planned correction and reported soft tissue irritation around the plate used to stablise the osteotomy. To compare the mechanical safety of a new personalised 3D printed high tibial osteotomy (HTO) device, created to overcome these issues, with an existing generic device, a case-control in silico virtual clinical trial was conducted. Methods Twenty-eight knee osteoarthritis patients underwent computed tomography (CT) scanning to create a virtual cohort; the cohort was duplicated to form two arms, Generic and Personalised, on which virtual HTO was performed. Finite element analysis was performed to calculate the stresses in the plates arising from simulated physiological activities at three healing stages. The odds ratio indicative of the relative risk of fatigue failure of the HTO plates between the personalised and generic arms was obtained from a multi-level logistic model. Results Here we show, at 12 weeks post-surgery, the odds ratio indicative of the relative risk of fatigue failure was 0.14 (95%CI 0.01 to 2.73, p = 0.20). Conclusions This novel (to the best of our knowledge) in silico trial, comparing the mechanical safety of a new personalised 3D printed high tibial osteotomy device with an existing generic device, shows that there is no increased risk of failure for the new personalised design compared to the existing generic commonly used device. Personalised high tibial osteotomy can overcome the main technical barriers for this type of surgery, our findings support the case for using this technology for treating early knee osteoarthritis.
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Affiliation(s)
| | - Nicholas Peckham
- Oxford Clinical Trials Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Gil Serrancolí
- Department of Mechanical Engineering, Polytechnic University of Catalonia, Barcelona, Catalunya Spain
| | - Ines Rombach
- Oxford Clinical Trials Research Unit, NDORMS, University of Oxford, Oxford, UK
| | | | | | | | | | - Harinderjit S. Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, UK
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17
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Kim MS, Koh IJ, Sung YG, Park DC, Han SB, In Y. Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy. BMC Musculoskelet Disord 2021; 22:585. [PMID: 34172033 PMCID: PMC8235825 DOI: 10.1186/s12891-021-04475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Methods Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery. Results The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05). Conclusion Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO. Level of evidence Level III.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Bin Han
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Neirynck J, van Beek N, Claes T, Claes S, Bartholomeeusen S. Simultaneous bilateral opening-wedge high tibial osteotomy with structural allograft impaction results in excellent early recovery and pain reduction similar unilateral osteotomy. Knee 2021; 30:283-290. [PMID: 33984747 DOI: 10.1016/j.knee.2021.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients suffering from bilateral combined medial osteoarthritis and varus alignment of the knee are eligible for bilateral high tibial osteotomy (HTO) in two-staged surgery. The impact of bilateral HTO surgery on rehabilitation and early outcomes have not yet been reported in the literature, even though these features are decisive in establishing whether a patient is preferably treated in one or two stages. METHODS A total of 29 patients were followed after simultaneous bilateral HTO surgery. Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS) and Lysholm scores were recorded at 3, 6 and 12 months. Results were compared with outcomes of unilateral HTO surgery to asses the additional impact of simultaneous bilateral HTO surgery on the early rehabilitation and recovery of simultaneous bilateral HTO surgery. RESULTS Three months after surgery, NRS pain scores decreased from 60.5 to 40.9 and subsequently to 30.4 and 24.3 after 6 and 12 months, respectively. KOOS-PS scores improved from 50.0 to 44.3 after 3 months, to 33.9 and 29.8 after 6 and 12 months, respectively. Lysholm scores did not improve after 3 months (45.2-44.2), but significantly improved after 6 and 12 months (66.1 and 75.7, respectively). Compared with unilateral HTO surgery, similar improvements were seen after 6 and 12 months. CONCLUSION Simultaneous bilateral HTO surgery generates similar clinical outcomes compared with unilateral HTO surgery and moreover it does not excessively prolong time to achieve these outcomes. It is safe and presumably a more effective approach to treat patients suffering bilateral medial osteoarthritis and varus alignment of the knee compared with two-staged surgery.
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Affiliation(s)
- J Neirynck
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - N van Beek
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - T Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - S Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - S Bartholomeeusen
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.
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Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S. Open-wedge high tibial osteotomy using intraoperative control of joint line convergence angle with reference to preoperative supine radiograph. Arch Orthop Trauma Surg 2021; 141:645-653. [PMID: 33417031 DOI: 10.1007/s00402-020-03738-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Preoperative supine joint line convergence angle (JLCA) correlates with postoperative standing JLCA. Here, we compared the radiographic and clinical outcomes of knees with preoperative JLCAs of ≥ 4° and < 4° in open-wedge high tibial osteotomy (OWHTO). We hypothesized that the postoperative coronal alignment in both groups would not be affected by a change in JLCA if this change could predict before surgery. MATERIALS AND METHODS Eighty-four patients with medial knee osteoarthritis who underwent OWHTO were enrolled retrospectively. A weight-bearing line (WBL) ratio of 62% and a JCLA equivalent to the preoperative supine JLCA were anticipated in preoperative planning. These were intraoperatively set using an alignment rod and a radiolucent protractor under fluoroscopy. Soft tissue correction was defined as correction angle minus bone correction. The participants with preoperative JLCAs of < 4° (low-JLCA group) and ≥ 4° (high-JLCA group) were compared. RESULTS No significant difference in the coronal alignment was found between the groups after OWHTO. No significant differences in correction angle or bone correction were found between the groups, but the soft tissue correction in the high-JLCA group was higher than that in the low-JLCA group after OWHTO (p = 0.013). CONCLUSIONS When we controlled intraoperative JLCA, the postoperative coronal alignment was not affected by the change in JLCA and the differences in soft tissue correction between the low-JLCA and high-JLCA groups. However, overcorrection compared with the target coronal alignment remained in both groups. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yasushi Akamatsu
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan. .,Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan.
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Hideo Kobayashi
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan.,Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Shuntaro Muramatsu
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan
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20
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Micicoi G, Jacquet C, Sharma A, LiArno S, Faizan A, Kley K, Parratte S, Ollivier M. Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database. Knee Surg Sports Traumatol Arthrosc 2021; 29:849-858. [PMID: 32372282 DOI: 10.1007/s00167-020-06030-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype. METHODS A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype. RESULTS The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment. CONCLUSION Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus. LEVEL OF CLINICAL EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Grégoire Micicoi
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France.,Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Christophe Jacquet
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Akash Sharma
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | | | | | - Kristian Kley
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,The London clinic, 20 Devonshire Pl, Marylebone, London, W1G 6BW, UK
| | - Sébastien Parratte
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,Adult Reconstructive Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Matthieu Ollivier
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France. .,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
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Kim JI, Kim BH, Han HS, Lee MC. Rotational Changes in the Tibia After High Tibial Valgus Osteotomy: A Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy. Am J Sports Med 2020; 48:3549-3556. [PMID: 33090892 DOI: 10.1177/0363546520960114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After high tibial valgus osteotomy (HTO), rotational changes in the tibia may occur, which can affect the biomechanics of the patellofemoral joint and may lead to anterior knee pain. PURPOSE To compare the rotational changes in the tibia between closing wedge HTO (CWHTO) and opening wedge HTO (OWHTO). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Among the patients who underwent HTO between May 2012 and August 2015, 53 (28 CWHTO and 25 OWHTO) who had computed tomography scans before and at 1 year after the HTO were included. The following parameters were compared between CWHTO and OWHTO: (1) tibial torsion angle, (2) knee rotation angle, and (3) tibial tuberosity-trochlear groove (TT-TG) distance. During the last follow-up, patients were asked to rate their anterior knee pain when climbing the stairs, using the visual analog scale. RESULTS The tibial torsion angle significantly decreased (internal rotation of the distal fragment) after CWHTO (mean ± SD, -2.1°± 4.1°; P = .019) and OWHTO (-1.8°± 3.3°; P = .029). The knee rotation angle significantly decreased (external rotation of the proximal fragment) after OWHTO (-1.8°± 3.4°; P = .039) but was not changed after CWHTO (0.1°± 3.1°; P = .859). The mean TT-TG distance significantly decreased after CWHTO (-3.1 ± 3.0 mm; P < .001) but increased after OWHTO (2.0 ± 4.3 mm; P = .012). At the final follow-up (minimum, 4 years), the visual analog scale pain score during stair climbing was significantly higher after OWHTO than after CWHTO (3.1 ± 1.4 vs 2.2 ± 1.3, P = .024). CONCLUSION Internal rotation of the distal fragment occurred after both CWHTO and OWHTO. However, external rotation of the proximal fragment and increased TT-TG distance occurred after OWHTO. Because such rotational changes could affect anterior knee pain, further studies are warranted to investigate the definite relationship between tibial rotational changes and anterior knee pain after HTO.
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Affiliation(s)
- Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Bo Hyun Kim
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyuk Soo Han
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Ogino T, Kumagai K, Yamada S, Akamatsu T, Nejima S, Sotozawa M, Inaba Y. Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy. BMC Musculoskelet Disord 2020; 21:675. [PMID: 33046054 PMCID: PMC7549202 DOI: 10.1186/s12891-020-03703-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). METHODS A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. RESULTS CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P < 0.05), and a greater soft tissue correction than OWHTO (P < 0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P < 0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. CONCLUSIONS The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.
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Affiliation(s)
- Takahiro Ogino
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomotaka Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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吴 敏, 王 照, 周 平, 张 宽, 陈 笑, 肖 玉, 官 建. [Early effectiveness analysis of lateral hinge fracture during medial opening-wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:854-861. [PMID: 32666728 PMCID: PMC8180413 DOI: 10.7507/1002-1892.202001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/05/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the clinical and radiologic effectiveness in patients with versus without lateral hinge fracture during medial opening-wedge high tibial osteotomy (MOWHTO) to evaluate the effect of lateral hinge fracture on short-term effectiveness. METHODS The clinical data of 84 patients (97 knees) with medial compartment osteoarthritis who treated with MOWHTO between September 2015 and July 2018 was retrospectively analyzed. There were 10 males (10 knees) and 74 females (87 knees). The age ranged from 45 to 65 years with an average of 57.7 years. Lateral hinge fracture was recognized by the intraoperative fluoroscopy or immediate postoperative X-ray film. Fractures were classified into types Ⅰ, Ⅱ, and Ⅲ according to the Takeuchi classification. The healing of osteotomy was observed by radiographs during follow-up; the femur tibia angle (FTA), medialproximal tibial angle (MPTA), and hip-knee-ankle angle (HKA) were also calculated. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score and knee society score (KSS). RESULTS The incision healed by first intention. All patients were followed up 15-48 months with an average of 24.8 months. No hinge fracture occurred in 78 knees (80.41%, group A), and lateral hinge fractures were observed in 19 knees (19.59%, group B) and were divided into the type Ⅰ (13 knees, 13.40%) and type Ⅲ (6 knees, 6.19%) groups. Type Ⅰ fractures were not additionally treated, type Ⅲ fractures were anatomic reduced fixed with additional lag screws. X-ray film and CT examination showed that all patients had bone healing at 3 months after operation without delayed healing or nonunion. During follow-up, there was no loosening or fracture of internal fixation plates and screws. HKA, FTA, and MPTA of patients in group A and group B (type Ⅰ and Ⅲ) were significantly improved at each time point after operation compared with preoperative values ( P<0.05); there was no significant difference between groups at each time point before and after operation ( P>0.05). After operation, the pain of knee joint was alleviated and the function of joint was improved. At last follow-up, KSS score and HSS score of groups A and B were significantly improved compared with those before operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). CONCLUSION The lateral hinge fracture may occur during MOWHTO. As long as the treatment and rehabilitation were guided according to the fracture classification of the hinge, the effectiveness can be similar to those without the hinge fracture.
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Affiliation(s)
- 敏 吴
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
| | - 照东 王
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
| | - 平辉 周
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
| | - 宽宽 张
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
| | - 笑天 陈
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
| | - 玉周 肖
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
| | - 建中 官
- 蚌埠医学院第一附属医院骨科 组织移植安徽省重点实验室(安徽蚌埠 233003)Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P.R.China
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Tian X, Han C, Wang J, Tan Y, Zhu G, Lei M, Ma S, Hu Y, Li S, Chen H, Huang Y. Distal tibial tuberosity high tibial osteotomy using an image enhancement technique for orthopedic scans in the treatment of medial compartment knee osteoarthritis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105349. [PMID: 32146210 DOI: 10.1016/j.cmpb.2020.105349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To observe the efficacy of distal tibial tuberosity high tibial osteotomy in treating medial compartment osteoarthritis of the knee. In the experiment, a medical image enhancement algorithm based on shear wave domain improved Gamma correction was implemented to process medical images in order to diagnose patients more effectively. METHODS Sixty-five patients (13 males and 52 females) were included in the study who were treated with distal tibial tuberosity high tibial osteotomy, and the mean age of the patients was 63±6 years (range 49-73). All patients received X-Ray and MRI before surgery. We carefully studied and analyzed the findings, MRI findings and medical characteristics after using the shearlet domain to improve the Gamma correction method in order to enhance diagnostic accuracy. The improved image help us to judge the damage of the medial and lateral compartment more accurately. Weight bearing line (WBL) and femora-tibial Angle (FTA) were measured to evaluate the lower limb alignment before and 12 months after surgery. Visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, the Westrn Ontario and Mcmaster Universities (WOMAC) scores were recorded to evaluate knee pain and function before surgery, 3 months and 6 months after surgery. RESULTS The X-Ray and MRI scans of the patients were analyzed. After the shear wave shearlet domain is implemented, the image effect is significantly improved. 12 months after surgery, WBL was improved from 16.34±2.18% to 60.32±2.89% (p<0.05), FTA was improved from 171.17±1.87° to 179.83±2.14° (p<0.05). At 3 months and 12 months after surgery, VAS, HSS and WOMAC scores were significantly improved compared with baseline (p<0.05). CONCLUSION Distal tibial tuberosity high tibial osteotomy is able to correct varus deformity, relieve knee pain and the functional dysfunction, indicating which had a significant short-term efficacy. The shear wave shearlet domain incorporates the Gamma correction method to effectively preserve the image details, which to achieve a more accurate diagnosis, and help us to judge the damage of the medial and lateral compartment more accurately.
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Affiliation(s)
- Xiangdong Tian
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China.
| | - Changxiao Han
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
| | - Jian Wang
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Yetong Tan
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Guangyu Zhu
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Ming Lei
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Sheng Ma
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Yuanyi Hu
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Shuwen Li
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
| | - Handong Chen
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
| | - Ye Huang
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
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Shin KH, Jung JK, Nam JJ, Jang KM, Han SB. Preoperative Supine Radiographs Are More Accurate Than Standing Radiographs for Preoperative Planning in Medial Open-Wedge High Tibial Osteotomy. Arthroscopy 2020; 36:1655-1664. [PMID: 32061970 DOI: 10.1016/j.arthro.2020.01.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To verify the accuracy of supine nonweight-bearing radiography versus standing radiography in preoperative planning and to determine the predictors of unintended limb alignment correction in medial open-wedge high tibial osteotomy (OWHTO). METHODS Consecutive patients who underwent medial OWHTO for medial osteoarthritis of the knee with varus alignment were retrospectively reviewed. The analyzed pre- and postoperative radiologic measurements included postoperative mechanical axis deviation (MAD) on standing whole-leg radiographs (WLRs), the predicted value of the postoperative MAD on the preoperative supine (predicted MADsupine) radiograph, and standing WLRs (predicted MADstand). Multiple linear regression analysis was used to identify variables predicting the postoperative MAD and unintended MADstand correction, defined as the difference between predicted MADstand and postoperative MAD. RESULTS Predicted MADsupine showed statistically greater reliability in predicting postoperative MAD than predicted MADstand (intraclass correlation coefficient, 0.82 vs 0.45). Postoperative MAD was correlated with the predicted MADsupine and the difference in hip-knee-ankle angle between preoperative standing and supine WLRs (ΔHKA anglestand-supine) (R =763, R2 = 0.582, adjusted R2 = 0.569, P < .001) and did not differ significantly from the predicted MADsupine, with a mean difference of 0.28% ± 5.11% (P = .656). The mean unintended MADstand correction was 6.52% ± 8.66%. The difference in preoperative MAD between standing and supine WLRs was a significant predictor for unintended MADstand correction (β = -0.350, P = .004). CONCLUSIONS Preoperative planning with supine WLRs can predict postoperative limb alignment in medial OWHTO more accurately than standing radiographs. The clinical significance of the ΔHKA anglestand-supine for the risk of overestimation of postoperative limb alignment might be low because of the low power in the prediction model and small value of the ΔHKA anglestand-supine. Preoperative soft-tissue laxity was significantly correlated with unintended correction of postoperative limb alignment resulting from preoperative planning with standing radiographs. LEVEL OF EVIDENCE Level IV, retrospective comparative study.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jae-Kyun Jung
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jae-Jun Nam
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
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A computer simulation study for preserving the tibial posterior slope in open-wedge high tibial osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1285-1291. [DOI: 10.1007/s00590-020-02703-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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Open Versus Closing Wedge Osteotomy and Application to Mandibular Reconstruction. J Craniofac Surg 2020; 31:e380-e384. [PMID: 32282471 DOI: 10.1097/scs.0000000000006344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction. METHODS A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms 'osteotomy' and 'mandibular reconstruction.' RESULTS Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized. CONCLUSIONS Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.
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Early experience of lateral hinge fracture during medial opening-wedge high tibial osteotomy: incidence and clinical outcomes. Arch Orthop Trauma Surg 2020; 140:161-169. [PMID: 31273455 DOI: 10.1007/s00402-019-03237-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 02/09/2023]
Abstract
PURPOSE Lateral hinge fracture (LHF) during a medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be the main cause of instability, further displacement, loss of correction, malunion, and nonunion. The purposes of this study were to evaluate whether the incidence of LHFs during MOWHTOs has decreased as the number of cases performed over time has increased, and whether the radiographic and clinical outcomes of patients with LHFs were worse than those of patients without LHFs. MATERIALS AND METHODS During the period of July 2013 to January 2017, 132 MOWHTOs were performed by a single surgeon using a locking plate (TomoFix®, DePuySynthes, Solothurn, Switzerland) for the treatment of medial compartment osteoarthritis, with LHFs postoperatively detected in 32 knees (24.2%). To evaluate trends in the incidence of LHFs occurring during MOWHTOs over time, all 132 cases were divided chronologically into four groups of 33 cases and compared. The time for bony union and loss of correction were compared between the LHF group and the non-LHF group using an osteotomy filling index, hip-knee-ankle (HKA) angles, medial proximal tibial angles (MPTA), weight-bearing line (WBL) ratios, and posterior tibial slope (PTS) angles on radiographs. Clinical outcomes were also compared using the Knee Society Scores (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores 1 year post-surgery. RESULTS The incidence of LHFs in each group of 33 cases did not decrease over time (21.2%, 27.3%, 24.2%, and 24.2%, respectively, p = 0.954). The time to union was significantly different between the non-LHF group (5.0 months) and the LHF group (7.3 months) (p < 0.001). However, there were no immediate or 1-year postoperative differences in the HKA angles, MPTAs, WBL ratios, or PTS angles between the non-LHF and LHF groups (all p > 0.05). The KSS and WOMAC scores were significantly improved in both groups (all p < 0.001) 1 year post-surgery, without any differences between the groups (p = 0.997 and p = 0.122, respectively). CONCLUSIONS LHFs during MOWHTO procedures occurred consistently, with a similar incidence over time. Although patients with LHFs required more time to bony union, they showed similarly favorable radiographic and clinical results as the patients without LHFs 1 year after surgery.
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The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2019; 27:2410-2416. [PMID: 30361756 DOI: 10.1007/s00167-018-5216-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to detect the pre- and intra-operative influential factors for lower limb alignment correction error in open-wedge high tibial osteotomy (OWHTO). METHODS This study involved 69 patients (71 knees) undergoing OWHTO for primary medial osteoarthritis. The weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured on radiographs preoperatively and at 1 month after surgery, and the differences between the pre- and postoperative values were calculated. The correction angle during surgery was also investigated. The radiological correction angle was defined as the difference between the pre- and postoperative MPTA. The correction error was defined as the difference between the correction angle during surgery and the radiological correction angle. The ideal correction angle was defined as when the postoperative WBL passed through Fujisawa's point (WBL = 62.5%), and the alignment error was defined as the difference between the postoperative WBL ratio and 62.5. The correlations among the alignment error, the correction error, correction angle during surgery, pre- and postoperative WBL ratio, MPTA, and JLCA and the differences between the pre and postoperative WBL ratio, MPTA, and JLCA were investigated. In addition, the factor most influential on the alignment error was determined. RESULTS The preoperative MPTA was the only predictor of the alignment error after OWHTO. The alignment error was positively correlated with the correction error and correction angle during surgery, and negatively correlated with pre- and postoperative WBL ratio, MPTA, and differences between the pre- and postoperative WBL ratio and JLCA. CONCLUSION The preoperative MPTA was the only pre- and intra-operative predictor of the alignment error after OWHTO. The larger the correction angle, the greater the alignment error. The MPTA was recommended as an indicator for improving the correction accuracy. Accurate correction based on the MPTA provides good lower limb alignment and better clinical results. LEVEL OF EVIDENCE III Case-control study/Retrospective comparative study.
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30
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Cheng X, Liu F, Xiong F, Huang Y, Paulus AC. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res 2019; 14:179. [PMID: 31200743 PMCID: PMC6570851 DOI: 10.1186/s13018-019-1222-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 06/04/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis is to examine changes in radiological variables and clinical outcomes between open and closed wedge high tibial osteotomy (OWHTO and CWHTO, respectively), which have ongoing controversial issues in numerous quantitative clinical studies. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for suitable controlled trials between Jan 1, 1999, and Feb 2, 2018. The inclusion criteria included studies written in English, studies with a level of evidence of I-IV, and studies presenting comparisons between OWHTO and CWHTO. The main clinical and radiographic results were extracted and pooled using Stata 12.0. RESULTS After searching for and screening trials, 28 trials involving 2840 knees were eligible for the meta-analysis. After OWHTO or CWHTO, clinical scores, including the American Knee Society Score, Hospital for Special Surgery Knee Score, Lysholm score, and Visual Analog Scale pain score, improved (p < 0.05), but the range of motion was unchanged (p > 0.05). The anatomical femorotibial angle (SMD 0.04, 95% CI - 0.66 to 0.74) and hip-knee-ankle angle (SMD 0.11, 95% CI - 0.11 to 0.33) data suggested that the OWHTO and CWHTO groups were similar in function of correction. Posterior tibial slope increased (SMD - 0.71, 95% CI - 1.04 to - 0.37) after OWHTO but decreased (SMD 0.72, 95% CI 0.35 to 1.08) after CWHTO. OWHTO decreased patellar height (p < 0.05), while patellar height did not change significantly after CWHTO (p > 0.05). CONCLUSION This meta-analysis indicates that compared with CWHTO, OWHTO increases the posterior slope, decreases the patellar height, and provides a similar accuracy of correction; however, CWHTO leads to a decreased posterior slope and an unchanged patellar height. Therefore, programs should be personalized and customized for the specific situation of each patient.
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Affiliation(s)
- Xiangyun Cheng
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Fanxiao Liu
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Fei Xiong
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Yijiang Huang
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Alexander Christoph Paulus
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
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Day M, Wolf BR. Medial Opening-Wedge High Tibial Osteotomy for Medial Compartment Arthrosis/Overload. Clin Sports Med 2019; 38:331-349. [PMID: 31079766 DOI: 10.1016/j.csm.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medial opening-wedge high tibial osteotomy has become increasingly popular for treating isolated, medial compartment arthrosis in younger, more active patients. Relative indications include age younger than 55 to 60 years, normal weight, preserved range of motion, and isolated medial compartment osteoarthritis or overload. Several surgical techniques exist for stabilization of the osteotomy with similar outcomes. Complication rates after medial opening-wedge high tibial osteotomy vary from 29% to 37%, with highest risk of nonunion, fracture, stiffness, and loss of correction. Good long-term outcomes can be achieved, with 5- and 10-year survivorship rates ranging from 75% to 98.7% and 51% to 97.6%, respectively.
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Affiliation(s)
- Molly Day
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Brian R Wolf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, University of Iowa Athletics, 2701 Prairie Meadow Drive, Iowa City, IA 52240, USA
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Sarman H, Isik C, Uslu M, Inanmaz ME. HIGH TIBIAL OSTEOTOMY USING A LOCKING TITANIUM PLATE WITH OR WITHOUT AUTOGRAFTING. ACTA ORTOPEDICA BRASILEIRA 2019; 27:80-84. [PMID: 30988651 PMCID: PMC6442715 DOI: 10.1590/1413-785220192702164465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To postoperatively evaluate knee scores, radiological assessment results, deficit correction, patellar height change, bone healing time, and weight bearing time in patients undergoing high tibial osteotomy (HTO) with/without autologous iliac bone grafting. Methods: This retrospective examination of treated controls from a randomized controlled study included 63 knees of 58 patients aged 46–59 years who underwent HTO with locking open wedge osteotomy plates. The patients were divided into two groups: Group A, HTO with autologous iliac bone grafts (n = 31); and Group B, HTO without autologous iliac bone grafts (n = 32). Clinical and radiological data were evaluated prospectively at the preoperative consultation and again at 6, 9, and 12 weeks, 6 months, and 1 year after the surgery (and annually thereafter). Results: There were no significant intergroup differences in the radiological assessment, deficit correction, patellar height change, bone-healing time, and weight-bearing time at any time after surgery. The knee scores changed positively in both groups (p < 0.001). Conclusions: There was no difference in the results of patients undergoing HTO with open wedge osteotomy titanium locking plates with or without autografting, and comorbidities resulting from autografts were eliminated with the use of locking plates. Level of evidence III, Retrospective Study.
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33
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Erquicia J, Gelber PE, Perelli S, Ibañez F, Ibañez M, Pelfort X, Monllau JC. Biplane opening wedge high tibial osteotomy with a distal tuberosity osteotomy, radiological and clinical analysis with minimum follow-up of 2 years. J Exp Orthop 2019; 6:10. [PMID: 30820763 PMCID: PMC6395462 DOI: 10.1186/s40634-019-0176-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background High tibial osteotomy is an established and helpful treatment for unicompatimental osteoarthritis associated with varus deformity. However, asupratubercle high tibial osteotomy leads to a decrease in patellar height making the technique not suitable in case of concomitant patella baja. Moreover, this kind of osteotomy can change in situ forces at patellofemoral joint and the lateral patellar tilt. With the aim to widen the indication of high tibial osteotomy was proposed a biplane opening wedge high tibial osteotomy with a distal tuberosity osteotomy (B-OWHTO). This technique provide that the tibial tuberosity remains joined to the tibial metaphysis so as not to theoretically alter the patellar height. However, some Authors claim that BOWHTO could lead to an increase in tibial slope. The purpose of the present study was to assess the tibial slope, patella-femoral changes and axial correction as well as functional outcomes following a B-OWHTO. Methods Patients operated on with a B-OWHTO and a minimum 24 months of follow-up were included. The mechanical alignment of the lower limb, patellar height, lateral patellar tilt and posterior tibial slope were calculated preoperatively, immediately after surgery and at the 24-month follow-up. The clinical results were evaluated using the Lysholm, Kujala and Hospital for Special Surgery knee scores. The possible postoperative development of patellofemoral pain or radiologic patellofemoral alteration was also evaluated. Results Twenty-three patients were included with a mean follow-up of 33 months (range 27-41). The mechanical alignment of the lower limb shifted from a mean 9.3º ± 2.5 varus preoperatively to a mean 0.2º ± 2.2 valgus postoperatively. No changes in patellar height, lateral patellar tilt or in the posterior tibial slope were observed. The mean Lysholm and HSS scores improved from 68.3 ± 9.1 and 64.2 ± 5.2 preoperatively to 93.2 ± 2.1 and 94.1 ± 3.6 at final follow-up (p < 0.01). The mean Kujala score improved from 67.3 ± 9.8 to 86.4 ± 7.6 at final follow up (p < 0.01). No patients developed both radiological or clinical symptoms at patellofemoral joint. Conclusions Open wedge high tibial osteotomy with a dihedral L-cut distal and posterior to the tibial tubercle accurately corrected axial malalignment without any change at patella-femoral joint or any modification to the posterior tibial slope while providing improved knee function at short-term follow-up. The radiographic as well as the clinical results support the use of this technique to treat medial compartment knee osteoarthritis and varus malalignment in young and middle-aged patients with a normal-to-low patellar height. Level of evidence Case series with no comparison group, Level IV.
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Affiliation(s)
- Juan Erquicia
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain
| | - Pablo Eduardo Gelber
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain.,Department of Orthopaedic Surgery, Hospital de la Sta Creu i Sant Pau, UAB, Carrer de Sant Quintí, 89, Barcelona, 08026, Spain
| | - Simone Perelli
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain.
| | - Federico Ibañez
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain
| | - Maximiliano Ibañez
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain
| | - Xavier Pelfort
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain.,Department of Orthopaedic Surgery, Consorci Sanitari de l'Anoia, Hospital de Igualada, Av. Catalunya, 11, Barcelona, Spain
| | - Juan Carlos Monllau
- ICATME, Hospital Universitari Dexeus, UAB, Carrer de Sabino Arana, 5, Barcelona, 08028, Spain.,Department of Orthopaedic Surgery, Hospital del Mar. Universitat Autònoma de Barcelona (UAB), Passeig Marítim, 25, Barcelona, 08003, Spain
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Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, Magnitskaya N, Mukhanov V, Neyret P, Solomin LN, Sorokin E, Staubli AE, Stone KR, Vilenskiy V, Zayats V, Pape D, Korolev A. Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019; 6:9. [PMID: 30805738 PMCID: PMC6389998 DOI: 10.1186/s40634-019-0177-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/13/2019] [Indexed: 01/03/2023] Open
Abstract
Corrective lower limb osteotomies are innovative and efficient therapeutic procedures for restoring axial alignment and managing unicompartmental knee osteoarthritis. This review presents critical insights into the up-dated clinical knowledge on osteotomies for complex posttraumatic or congenital lower limb deformities with a focus on high tibial osteotomies, including a comprehensive overview of basic principles of osteotomy planning, biomechanical considerations of different implants for osteotomies and insights in specific bone deformity correction techniques. Emphasis is placed on complex cases of lower limb osteotomies associated with ligament and multiaxial instability including pediatric cases, computer-assisted navigation, external fixation for long bone deformity correction and return to sport after such osteotomies. Altogether, these advances in the experimental and clinical knowledge of complex lower limb osteotomies allow generating improved, adapted therapeutic regimens to treat congenital and acquired lower limb deformities.
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Affiliation(s)
- Liang Gao
- Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany.,Cartilage Net of the Greater Region, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany. .,Cartilage Net of the Greater Region, Homburg/Saar, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Dmitrii V Chugaev
- Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg State University, St. Petersburg, Russia
| | - Matteo Denti
- Department of Knee Surgery and Sports Traumatology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Aleksandr Frolov
- People's Friendship University of Russia, Moscow, Russia.,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Mikhail Burtsev
- People's Friendship University of Russia, Moscow, Russia.,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Nina Magnitskaya
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Victor Mukhanov
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Philippe Neyret
- Healthpoint, Abu Dhabi Knee & Sports Medicine Center, Zayed Sports City, Abu Dhabi, United Arab Emirates
| | - Leonid N Solomin
- Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg State University, St. Petersburg, Russia
| | - Evgeniy Sorokin
- Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg State University, St. Petersburg, Russia
| | | | | | - Viktor Vilenskiy
- Department of Bone Pathology, The Turner Scientific and Research Institute for Children's Orthopedics, St. Petersburg, Russia
| | - Vitaliy Zayats
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Dietrich Pape
- Cartilage Net of the Greater Region, Homburg/Saar, Germany.,Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Centre Médical de La Fondation Norbert Metz, Luxembourg, Luxembourg
| | - Andrey Korolev
- People's Friendship University of Russia, Moscow, Russia.,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
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35
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Zhang K, Wu M. [Study on lateral hinge fracture during open wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:110-114. [PMID: 30644270 DOI: 10.7507/1002-1892.201807049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. Methods To review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. Results The lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the "safe zone" internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. Conclusion The intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.
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Affiliation(s)
- Kuankuan Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - Min Wu
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000,
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MacLeod AR, Serrancoli G, Fregly BJ, Toms AD, Gill HS. The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates: An experimental and finite element study. Bone Joint Res 2019; 7:639-649. [PMID: 30662711 PMCID: PMC6318751 DOI: 10.1302/2046-3758.712.bjr-2018-0035.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives Opening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure. Materials and Methods A 10° opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of osteotomy gap healing simulating up to six weeks postoperatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (TomoFix). Results For both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared with the TomoFix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy. Conclusion We demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure. Cite this article: A. R. MacLeod, G. Serrancoli, B. J. Fregly, A. D. Toms, H. S. Gill. The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates: An experimental and finite element study. Bone Joint Res 2018;7:639–649. DOI: 10.1302/2046-3758.712.BJR-2018-0035.R1.
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Affiliation(s)
- A R MacLeod
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - G Serrancoli
- Department of Mechanical Engineering, Polytechnic University of Catalonia, Barcelona, Catalunya, Spain
| | - B J Fregly
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - A D Toms
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS, Exeter, UK
| | - H S Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK
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Lee DK, Kim KK, Ham CU, Yun ST, Kim BK, Oh KJ. The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method. Knee Surg Relat Res 2018; 30:303-310. [PMID: 29715716 PMCID: PMC6254867 DOI: 10.5792/ksrr.17.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 11/05/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO). Materials and Methods One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM). Results The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased. Conclusions Surgical experience may improve the surgeon’s competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Kwang Kyoun Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Chang Uk Ham
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok Tae Yun
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Kag Kim
- Department of Orthopaedic Surgery, Joint Center, SungMin Hospital, Incheon, Korea
| | - Kwang Jun Oh
- Department of Orthopaedic Surgery, Joint Center, SungMin Hospital, Incheon, Korea
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Donnez M, Ollivier M, Munier M, Berton P, Podgorski JP, Chabrand P, Parratte S. Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study. J Orthop Surg Res 2018; 13:171. [PMID: 29986731 PMCID: PMC6038309 DOI: 10.1186/s13018-018-0872-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this in vitro study was to assess the accuracy of three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy (OWHTO) to provide the planned correction in both frontal and sagittal planes. Methods Ten cadaveric tibias underwent OWHTO performed using a patient-specific cutting guide based on 3D preoperative planning. An initial CT scan of the tibias was performed, and after segmentation, 3D geometrical models of the pre-OWHTO tibias were obtained. Reference planes were defined, and OWHTO virtually planned to then design patient-specific cutting guides. OWHTO were performed using the patient-specific cutting guides. The patient-specific cutting guide controls the cut and the correction of the OWHTO in both planes. 3D models of post-OWHTO tibias were created after a postoperative CT scan. Geometrical post-OWHTO 3D models were superimposed on pre-OWHTO 3D models. Mechanical medial proximal tibial angle (mMPTA) in the frontal plane and posterior tibial slope (PTS) in the sagittal plane were compared between planned-OWHTO and post-OWHTO 3D reconstructions relative to the pre-OWHTO reference planes and axis. Pearson’s and Lin’s correlation tests were performed to assess precision and accuracy of patient-specific cutting guides. Results The mean difference between post-OWHTO and planned-OWHTO was 0.2° (max 0.5°, SD 0.3°) in the frontal plane and − 0.1° (max 0.8°, SD 0.5°) in the sagittal plane. Statistically significant correlations were found between the planned-OWHTO and post-OWHTO configurations for the mMPTA (p < 0.0001) and PTS (p < 0.0001) measurements, and the bias correction factor was 0.99 in both planes. Conclusions 3D patient-specific cutting guides for OWHTO-based 3D virtual planning is a reliable and accurate method of achieving multiplanar correction in both frontal and sagittal planes.
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Affiliation(s)
- Mathias Donnez
- Aix Marseille Univ, CNRS, ISM, Marseille, France. .,Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France. .,Newclip Technics, Haute-Goulaine, France.
| | - Matthieu Ollivier
- Aix Marseille Univ, CNRS, ISM, Marseille, France.,Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France
| | - Maxime Munier
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France
| | | | | | - Patrick Chabrand
- Aix Marseille Univ, CNRS, ISM, Marseille, France.,Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France
| | - Sébastien Parratte
- Aix Marseille Univ, CNRS, ISM, Marseille, France.,Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France
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Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D, Frank S, Schulz-Jahrsdörfer M, Richter J. Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment. Am J Sports Med 2018; 46:1362-1370. [PMID: 29589953 DOI: 10.1177/0363546518758016] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants. PURPOSE To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed. STUDY DESIGN Case series; Level of evidence, 4. METHODS From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result. RESULTS Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (<40) were associated with decreased survival. High preoperative TBVA was associated with better and an overcorrected MPTA (>95°) with inferior functional outcome at final follow-up, respectively. CONCLUSION Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.
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Affiliation(s)
- Philipp Schuster
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
| | - Markus Geßlein
- Paracelsus Medical Private University, Clinic Nuremberg, Department of Orthopedics and Traumatology, Nuernberg, Germany
| | - Michael Schlumberger
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
| | - Philipp Mayer
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
| | - Raul Mayr
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
| | - Damian Oremek
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
| | - Sebastian Frank
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
| | - Martin Schulz-Jahrsdörfer
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany.,OPM Inntal, Oberaudorf, Germany
| | - Jörg Richter
- Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Markgroeningen, Germany
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Martay JL, Palmer AJ, Bangerter NK, Clare S, Monk AP, Brown CP, Price AJ. A preliminary modeling investigation into the safe correction zone for high tibial osteotomy. Knee 2018; 25:286-295. [PMID: 29395747 DOI: 10.1016/j.knee.2017.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/10/2017] [Accepted: 12/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) re-aligns the weight-bearing axis (WBA) of the lower limb. The surgery reduces medial load (reducing pain and slowing progression of cartilage damage) while avoiding overloading the lateral compartment. The optimal correction has not been established. This study investigated how different WBA re-alignments affected load distribution in the knee, to consider the optimal post-surgery re-alignment. METHODS We collected motion analysis and seven Tesla MRI data from three healthy subjects, and combined this data to create sets of subject-specific finite element models (total=45 models). Each set of models simulated a range of potential post-HTO knee re-alignments. We shifted the WBA from its native alignment to between 40% and 80% medial-lateral tibial width (corresponding to 2.8°-3.1° varus and 8.5°-9.3° valgus), in three percent increments. We then compared stress/pressure distributions in the models. RESULTS Correcting the WBA to 50% tibial width (0° varus-valgus) approximately halved medial compartment stresses, with minimal changes to lateral stress levels, but provided little margin for error in undercorrection. Correcting the WBA to a more commonly-used 62%-65% tibial width (3.4°-4.6° valgus) further reduced medial stresses but introduced the danger of damaging lateral compartment tissues. To balance optimal loading environment with that of the historical risk of under-correction, we propose a new target: WBA correction to 55% tibial width (1.7°-1.9° valgus), which anatomically represented the apex of the lateral tibial spine. CONCLUSIONS Finite element models can successfully simulate a variety of HTO re-alignments. Correcting the WBA to 55% tibial width (1.7°-1.9° valgus) optimally distributes medial and lateral stresses/pressures.
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Affiliation(s)
- Jennifer Lb Martay
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK.
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Neil K Bangerter
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; Electrical & Computer Engineering, Brigham Young University, Provo, UT 84602, USA
| | - Stuart Clare
- Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - A Paul Monk
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Cameron P Brown
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
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Kawata M, Sasabuchi Y, Inui H, Taketomi S, Matsui H, Fushimi K, Chikuda H, Yasunaga H, Tanaka S. Annual trends in knee arthroplasty and tibial osteotomy: Analysis of a national database in Japan. Knee 2017; 24:1198-1205. [PMID: 28797877 DOI: 10.1016/j.knee.2017.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 06/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various nationwide studies have reported differing annual trends in utilization of knee arthroplasty and tibial osteotomy. Using the Diagnosis Procedure Combination database in Japan, the present series examined annual trends and demographics in total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and tibial osteotomy. METHODS All patients were identified who underwent TKA, UKA or tibial osteotomy for osteoarthritis, osteonecrosis or rheumatoid arthritis of the knee between July 2007 and March 2015. RESULTS A total of 170,433 cases of TKA, 13,209 cases of UKA and 8760 cases of tibial osteotomy were identified. The proportion of patients undergoing UKA rose from 4.0% in 2007 to 8.1% in 2014 (P<0.001), and that of tibial osteotomy from 2.6% in 2007 to 5.5% in 2014 (P<0.001); the proportion undergoing TKA fell from 93.4% in 2007 to 86.3% in 2014 (P<0.001). Between 2007 and 2014 the proportions of patients with osteonecrosis who underwent UKA and tibial osteotomy increased from 34.7% and 11.6% to 38.6% and 16.2%, respectively (P=0.001 for UKA and P=0.004 for tibial osteotomy). The proportions of patients with osteonecrosis undergoing UKA or tibial osteotomy were significantly greater than those with other diagnoses (P<0.001 for both). CONCLUSIONS The popularity of UKA and tibial osteotomy in Japan increased during the period 2007-2014 at the expense of TKA. The proportions of UKA and tibial osteotomy in patients with osteonecrosis also increased, and were larger than those in patients with other causative diseases.
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Affiliation(s)
- Manabu Kawata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sasabuchi
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Kim MS, Son JM, Koh IJ, Bahk JH, In Y. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2017; 137:1035-1045. [PMID: 28593581 DOI: 10.1007/s00402-017-2729-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A considerable percentage of outliers with under- or over-correction continue to be reported despite precise preoperative planning and cautious intraoperative correction of lower limb alignment in medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether our novel technique for the intraoperative adjustment of alignment under valgus stress reduces the number of outliers in patients undergoing MOWHTO compared to the conventional technique, which corrects alignment according to the cable method only. MATERIALS AND METHODS One hundred seventeen consecutive knees were enrolled in this case-control study. The first 52 knees (51 patients) were corrected in accordance with preoperative plans using the Dugdale method with modification with an intraoperative cable (group 1). In the other 65 knees (60 patients), the angle was corrected using the Dugdale method and limb alignment was adjusted using the intraoperative cable technique by applying valgus stress to the knee joint (group 2). The postoperative weight bearing line ratios and mechanical axis of the lower limb were compared at postoperative one year. Each knee was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative one year. RESULTS A significant reduction in the number of outliers was seen in group 2 compared to group 1 (group 1 = 48.1%, group 2 = 9.2%, p < 0.001). Nineteen of 52 knees (36.5%) were under-corrected in group 1, whereas 6 of 65 knees (9.2%) were under-corrected in group 2 (p < 0.001). Six of 52 knees (11.6%) were over-corrected in group 1, whereas 0 of 65 knees (0.0%) were over-corrected in group 2 (p = 0.005). At one -year after operation, group 2 showed significantly lower WOMAC score than group 1 (p = 0.014). CONCLUSIONS Intraoperative adjustment of alignment under valgus stress significantly reduced the number of outliers compared to a technique that corrected alignment using the cable method in patients undergoing MOWHTO. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jong Min Son
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hoon Bahk
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea.
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Jang KM, Lee JH, Cho IY, Park BK, Han SB. Intraoperative Fluoroscopic Assessment of Limb Alignment is a Reliable Predictor for Postoperative Limb Alignment in Biplanar Medial Opening-Wedge High Tibial Osteotomy. J Arthroplasty 2017; 32:756-760. [PMID: 27667532 DOI: 10.1016/j.arth.2016.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the reliability of pre-, intra operative, and postoperative limb alignment measurements and investigate the correlation between the measurements in biplanar medial opening-wedge high tibial osteotomy. METHODS This study enrolled 59 knees undergoing biplanar opening-wedge high tibial osteotomy for primary medial osteoarthritis with varus deformity. Preoperative and postoperative standing lower leg radiographs and intraoperative fluoroscopic images were taken. Two independent examiners analyzed the radiologic data to assess lower limb alignment and mechanical axis (MA) deviation (percentage of MA position on tibial plateau). The effect of preoperative hip-knee-ankle angle and MA deviation, age, sex, body mass index (BMI), and joint line convergence angle on the discrepancy between intraoperative and postoperative MA deviation was analyzed. RESULTS The mean preoperative hip-knee-ankle angle and MA deviation were varus 7.7 ± 3.3° and 14.1 ± 15.1%, respectively. After osteotomy, the mean intraoperative postosteotomy MA deviation was 57.9 ± 2.1% in supine position, and the mean post-operative MA deviation increased to 63.9 ± 2.9% on standing radiographs. The mean difference between intraoperative postosteotomy MA deviation and postoperative MA deviation was 6.1 ± 2.2%. Linear regression analysis between intraoperative postosteotomy MA deviation and postoperative MA deviation showed a statistically significant linear relationship (R2 = 0.449; P < .001). Multivariate regression analysis revealed that preoperative joint line convergence angle (β = 0.856; P < .001) and BMI (β = 0.349; P < .001) were significant positive predictors for the difference in MA deviation. CONCLUSION There was a significant linear relationship between intraoperative postosteotomy MA deviation and postoperative MA deviation following biplanar medial opening-wedge high tibial osteotomy. A greater discrepancy between MA deviations was significantly associated with higher BMI and joint line convergence angle.
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Affiliation(s)
- Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Hee Lee
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Il Youp Cho
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Bong-Kyung Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:910-917. [PMID: 26467810 DOI: 10.1007/s00167-015-3817-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 09/24/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of the present study was to examine changes in radiological variables in a prospective randomized study comparing opening wedge (OW) and closing wedge (CW) techniques of high tibial osteotomy (HTO). Our hypothesis was that there would be no differences in joint line angles or correction accuracy between the two groups, that patellar height would increase after CW HTO and decrease after OW HTO, and that leg length and posterior tibial slope would decrease after CW HTO and increase after OW HTO. METHODS Radiological data were collected from 70 patients participating in an ongoing prospective randomized clinical trial comparing OW and CW HTOs. Digital standing hip-knee-ankle (HKA) radiographs as well as lateral radiographs in 30° of flexion were obtained preoperatively and at 6 months for each patient. Joint line angles, HKA angle, leg length, Insall-Salvati index, Miura-Kawamura index and posterior tibial slope were measured using medical planning software. The complete preoperative radiological examinations of the first 50 patients were used in a study of intra- and inter-rater reliability of the measurements. RESULTS The mean posterior slope was reduced by 2.5° in CW HTO, whereas it remained unchanged in OW HTO (p < 0.001). Mean leg length decreased 5.7 mm in CW HTO and increased 3.1 mm in OW HTO (p < 0.001). Changes in joint line angles, patellar height indexes and the correction accuracy showed no significant differences comparing the two techniques. Frontal plane reliability measurement intra- and inter-rater intraclass correlation coefficient (ICC) varied from 0.81 to 0.99. Sagittal plane intra- and inter-rater ICC varied from 0.60 to 0.87. Posterior tibial slope intra- and inter-rater ICC showed the lowest values (0.70 and 0.60, respectively) corresponding to a smallest real difference of 4.5° and 5.5°, respectively. CONCLUSIONS Posterior tibial slope and leg length changes were significantly different in CW compared to OW HTOs. We recommend that possible alterations in tibial slope and leg length are considered when the technique of HTO is to be chosen. Landmark-based medical planning software shows good reliability and can be used in preoperative planning and postoperative evaluations of HTOs. LEVEL OF EVIDENCE I.
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Goshima K, Sawaguchi T, Sakagoshi D, Shigemoto K, Hatsuchi Y, Akahane M. Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:918-923. [PMID: 26531184 DOI: 10.1007/s00167-015-3847-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 10/27/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Open-wedge high tibial osteotomy (OWHTO) is a well-established procedure in the management of medial compartment osteoarthritis and osteonecrosis of the medial femoral condyle. Several studies have evaluated factors that negatively influence outcomes. However, few reports have investigated the effect of age on HTO outcome. We evaluated the influence of the age on the outcome after HTO. METHODS The TomoFix® plate was used to perform 60 consecutive OWHTOs. Twenty-six knees in 23 patients >65 years old (mean age at surgery 68.7 ± 2.9 years; range 65-75 years, group A) were compared with 34 knees in 27 patients <65 years old (mean age at surgery 56.2 ± 7.5 years; range 38-64 years, group B) with respect to the clinical and radiological outcomes after HTO. The clinical evaluation included the Japanese Orthopedic Association Knee Score (JOA score), Oxford Knee Score (OKS) and complications after surgery. RESULTS There were no statistical differences in the background factors between the two groups. Postoperatively, the mean JOA score showed a significant improvement in both groups. The mean OKS after surgery was 41.6 ± 5.9 in group A and 41.4 ± 5.9 in group B. There were no statistical differences in the postoperative knee alignment and clinical outcomes between the two groups. CONCLUSION OWHTO using the rigid long plate was an effective procedure independent of patient's age. The results showed that age did not influence the clinical and radiological outcomes after OWHTO.
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Affiliation(s)
- Kenichi Goshima
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan.
| | - Takeshi Sawaguchi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Daigo Sakagoshi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Kenji Shigemoto
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Yu Hatsuchi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Mika Akahane
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
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Wu L, Lin J, Jin Z, Cai X, Gao W. Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis. PLoS One 2017; 12:e0171700. [PMID: 28182736 PMCID: PMC5300239 DOI: 10.1371/journal.pone.0171700] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/09/2017] [Indexed: 12/27/2022] Open
Abstract
High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient.
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Affiliation(s)
- Lingfeng Wu
- Department of Orthopedics, the Fifth Affiliated Hospital & Central Hospital of Lishui City of Wenzhou Medical University, Lishui, China
| | - Jun Lin
- Department of Orthopedics, Qingyuan Country People’s Hospital, Lishui, China
| | - Zhicheng Jin
- Department of Surgery, Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Xiaobin Cai
- Department of Orthopedics, the Fifth Affiliated Hospital & Central Hospital of Lishui City of Wenzhou Medical University, Lishui, China
| | - Weiyang Gao
- Department of Orthopedics, the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- * E-mail:
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Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2016; 24:3704-3712. [PMID: 26154482 DOI: 10.1007/s00167-015-3682-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/18/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE Open-wedge high tibial osteotomy (HTO) cannot always accurately correct limb alignment, resulting in under- or over-correction. This study assessed the relationship between soft tissue laxity of the knee joint and alignment correction in open-wedge HTO. METHODS This prospective study involved 85 patients (86 knees) undergoing open-wedge HTO for primary medial osteoarthritis. The mechanical axis (MA), weight-bearing line (WBL) ratio, and joint line convergence angle (JLCA) were measured on radiographs preoperatively and after 6 months, and the differences between the pre- and post-surgery values were calculated. Post-operative WBL ratios of 57-67 % were classified as acceptable correction. WBL ratios <57 and >67 % were classified as under- and over-corrections, respectively. RESULTS Preoperative JLCA correlated positively with differences in MA (r = 0.358, P = 0.001) and WBL ratio (P = 0.003). Difference in JLCA showed a stronger correlation than preoperative JLCA with differences in MA (P < 0.001) and WBL ratio (P < 0.001). Difference in JLCA was the only predictor of both difference in MA (P < 0.001) and difference in WBL ratio (P < 0.001). The difference between pre- and post-operative JLCA differed significantly between the under-correction, acceptable-correction, and over-correction groups (P = 0.033). Preoperative JLCA, however, did not differ significantly between the three groups. Neither preoperative JLCA nor difference in JLCA correlated with change in posterior slope. CONCLUSIONS Preoperative degree of soft tissue laxity in the knee joint was related to the degree of alignment correction, but not to alignment correction error, in open-wedge HTO. Change in soft tissue laxity around the knee from before to after open-wedge HTO correlated with both correction amount and correction error. Therefore, a too large change in JLCA from before to after open-wedge osteotomy may be due to an overly large reduction in JLCA following osteotomy, suggesting alignment over-correction during surgery. LEVEL OF EVIDENCE II.
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Van den Bempt M, Van Genechten W, Claes T, Claes S. How accurately does high tibial osteotomy correct the mechanical axis of an arthritic varus knee? A systematic review. Knee 2016; 23:925-935. [PMID: 27776793 DOI: 10.1016/j.knee.2016.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 09/09/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to give an overview of the accuracy of coronal limb alignment correction after high tibial osteotomy (HTO) for the arthritic varus knee by performing a systematic review of the literature. METHODS The databases PubMed, MEDLINE and Cochrane Library were screened for relevant articles. Only prospective clinical studies with the accuracy of alignment correction by performing HTO as primary or secondary objective were included. RESULTS Fifteen studies were included in this systematic review and were subdivided in 23 cohorts. A total of 966 procedures were considered. Nine cohorts used computer navigation during HTO and the other 14 cohorts used a conventional method. In seven computer navigation cohorts, at least 75% of the study population fell into the accepted "range of accuracy" (AR) as proposed by the different studies, but only six out of 14 conventional cohorts reached this percentage. Four out of eight conventional cohorts that provided data on under- and overcorrection, had a tendency to undercorrection. CONCLUSIONS The accuracy of coronal alignment corrections using conventional HTO falls short. The number of procedures outside the proposed AR is surprising and exposes a critical concern for modern HTO. Computer navigation might improve the accuracy of correction, but its use is not widespread among orthopedic surgeons. Although HTO procedures have been shown to be successful in the treatment of unicompartmental knee arthritis when performed accurately, the results of this review stress the importance of ongoing efforts in order to improve correction accuracy in modern HTO.
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Affiliation(s)
- Maxim Van den Bempt
- Hasselt University, Hasselt, Belgium; University of Antwerp, Antwerp, Belgium.
| | | | | | - Steven Claes
- AZH Hospital, Herentals, Belgium; University Hospitals, Leuven, Belgium
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Osti M, Gohm A, Schlick B, Benedetto KP. Complication rate following high tibial open-wedge osteotomy with spacer plates for incipient osteoarthritis of the knee with varus malalignment. Knee Surg Sports Traumatol Arthrosc 2015; 23:1943-8. [PMID: 24193218 DOI: 10.1007/s00167-013-2757-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Medial open-wedge high tibial osteotomy (HTO) with spacer plates is recommended to correct varus malalignment of the knee with symptomatic overload of the medial compartment. METHODS Fifty-five knees in 50 patients were assessed. Intra- and post-operative complications were recorded, and Tegner, Lysholm and IKDC scores were used to evaluate functional results. Radiological parameters consisted of medial proximal tibial angle (aMPTA), femorotibial angle (aFTA), posterior proximal tibial angle, lateral distal femur angle, mechanical axis deviation (MAD) and osteoarthritis score (Jäger and Wirth). RESULTS Duration of follow-up was 5.0 ± 1.4 years. Overall and implant-related complication rates were 27.3 and 10.9 %, respectively. No statistical association could be detected between overall and implant-related complication rates and age, gender, wedge size, angle of correction or body mass index. Mean improvement in Lysholm score was 26.8. Overall IKDC scores at follow-up were A25, B26, C2 and D2. Post-operative correction of MPTA and FTA averaged to 89.6° and 173° and to 89° and 173.5° at follow-up, respectively. Initial MAD of 21.8 mm was corrected to 11.8 mm at follow-up. Osteoarthritis score increased from 1.4 ± 0.9 to 1.9 ± 0.9 points. CONCLUSIONS HTO with spacer plates improves knee function and is an effective procedure in selected patients. Overall and implant-related complication rates should be considered and seem to be lower with a smaller angle of correction corresponding to incipient osteoarthritis and less varus deformity. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Michael Osti
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria,
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Lee YS, Won JS, Oh WS, Park HG, Lee BK. Lateral tibial bone mineral density around the level of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc 2014; 22:1678-83. [PMID: 23385881 DOI: 10.1007/s00167-013-2417-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE During open-wedge high tibial osteotomy, fracture occurring in the insufficient osteotomy before distraction of the osteotomy gap is an important complication. The objective of this study was to evaluate bone mineral density (BMD) around the proximal tibiofibular joint (PTFJ) and the osteotomy hinge. The hypotheses of this study were (1) BMD would be higher in the level of PTFJ, compared with that of above--or below--the level of PTFJ, (2) BMD of the posterolateral side of the hinge would be higher than that of the anterior or lateral side. METHODS Computed tomography was used to determine the BMD of the lateral aspect of the proximal tibia around the PTFJ and the osteotomy hinge. The means and standard deviations of the regions of interest were measured. To verify the first hypothesis, a coronal reconstructed image showing the beginning of the fibula head was used and an axial reconstructed image showing the beginning of the fibula head was used for verification of the second hypothesis. RESULTS BMD of the lateral aspect of the proximal tibia at the level of the PTFJ was significantly higher, compared with that of above (P = 0.04)-or below (P < 0.01)--the level of the PTFJ in male patients. In addition, it was also significantly higher, compared with that of below the level of the PTFJ (P < 0.01). BMD of the posterolateral area of the proximal tibia was significantly higher than that of the anterior or lateral area in both male and female patients (P < 0.01). CONCLUSION BMD of the level of the PTFJ was higher, compared with that of above-or below-the level of the PTFJ and that of the posterolateral area of the proximal tibia was significantly higher, compared with that of the anterior or lateral area.
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Affiliation(s)
- Yong Seuk Lee
- Department of Orthopaedic Surgery, Gil Medical Center, School of Medicine, Gil Hospital, Gachon University, 1198 Guwol-dong, Namdong-gu, Inchon, 405-760, Korea,
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