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Song SJ, Bae DK, Park SH, Park CH. Surgical accuracy of coronal and sagittal alignment in conventional closed-wedge high tibial osteotomy after computer-assisted surgery experience. Knee Surg Relat Res 2023; 35:29. [PMID: 38129921 PMCID: PMC10740261 DOI: 10.1186/s43019-023-00205-2] [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: 07/31/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Although intraoperative navigation can improve the surgeon's proficiency, no studies have analyzed postoperative outcomes of high tibial osteotomy (HTO) after computer-assisted surgery (CAS) experience. The present study compared the clinical and radiographic results between conventional and CAS closed-wedge (CW) HTOs after CAS experience. METHODS Each of the 50 conventional and CAS CW HTOs performed by single surgeon between 2015 and 2017 were included. The surgeon had experience of 140 cases of CAS CW HTOs before the study period. The groups were not different in terms of demographics. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were investigated. Radiographically, the mechanical axis (MA), change in posterior tibial slope angle (PTS), and parallel angle were evaluated. The proportions of inlier groups for the postoperative MA (within valgus 2° ± 3°), change in the PTS (within ± 3°), and parallel angle (< 3°) were compared. RESULTS There were no significant differences in postoperative clinical results between the conventional and CAS groups. The MA was appropriately corrected in both groups (2.4° versus 2.9°, p = 0.317). The amount of change in PTS was significantly greater in the conventional group (-2.2° versus -0.8°, p = 0.018). The parallel angle was 5.3° in the conventional groups and 3.1° in the CAS group (p = 0.003). The proportion of inlier group was not significantly different in the postoperative MA (72% versus 78%) and change in the PTS (52% versus 66%). The proportion of inlier for the parallel angle was significantly lower in the conventional group (36% versus 60%, p = 0.027). CONCLUSIONS The surgical proficiency after CAS experience could cover the advantages of an intraoperative navigation in coronal adjustment, not in the sagittal adjustments in CW HTOs. A larger cohort with multiple surgeons in multiple centers would be required to identify the general trend. STUDY DESIGN Level of evidence III.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Se Hwan Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea.
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Mabrouk A, An JS, Glauco L, Jacque C, Kley K, Sharma A, Ollivier M. The joint line convergence angle (JLCA) correlates with intra-articular arthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5673-5680. [PMID: 37884727 DOI: 10.1007/s00167-023-07616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Knees with unicompartmental varus osteoarthritis (OA) usually display a combination of tibiofemoral bony deformity and increased joint line convergence angle (JLCA). The JLCA is a product of intra-articular deformity and lateral soft tissue laxity. This study aims to define the correlation between the JLCA and progression of OA. METHODS A retrospective radiological analysis of 501 patients, who underwent either high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA), was performed. The preoperative OA grade was reported based on the Ahlbäck and the Kellgren-Lawrence (KL). The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the mechanical lateral distal femoral angle (mLDFA) and the joint line convergence angle (JLCA) were recorded. The primary outcome was the relationship between the JLCA values and the OA grade. The secondary outcomes were comparing the JLCA and other alignment parameter values between HTO and UKA groups. RESULTS A total of 501 (59.3% females n = 297) cases were included, comprising 293 cases of HTO and 208 cases of UKA. Patients had a mean age of 57.63 ± 8.97 years, a mean BMI of 28.37 ± 7.39 kg/m2. Patients with Ahlbäck grade 2 represented 49.3% of all patients (n = 247) and patients with KL grade 3 represented 54.7% of all patients (n = 274). A high JLCA was observed in both groups. The reported mean JLCA in the UKA group was 3.69 ± 2.1°, and in the HTO group was 2.93 ± 1.82. There was a significant association between the increase in the JLCA and the progression of OA based on both the Ahlbäck and KL grades (both p values < 0.001). The mean JLCA in patients with Ahlbäck grades 1 and 4 was 1.48 ± 1.32°, and 7 ± 0.93°, respectively. The mean JLCA in patients with KL grades 1 and 4 was 1.77 ± 1.42°, and 4.89 ± 1.73°, respectively. The mean recorded preoperative HKA angle in the UKA group was 175.06 ± 3.08°, and in the HTO group was 173.26 ± 3.02°, whereas the mean MPTA was 88.63 ± 1.72° for the UKA group and 89.31 ± 2.29° for the HTO group. CONCLUSION The JLCA progressively increases with osteoarthritis progression in patients with unicompartmental varus knee osteoarthritis. The JLCA can potentially be used as a grading parameter for osteoarthritis progression akin to Ahlbäck and Kellgren-Lawrence grading systems.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, UK
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Jae-Sung An
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Loddo Glauco
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Christophe Jacque
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | | | | | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France.
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Kim YM, Joo YB, Park YC, Lee SH, Song JH. Postoperative change in the joint-line convergence angle is associated with inaccurate correction in open-wedge high tibial osteotomy. J Orthop Surg Res 2023; 18:773. [PMID: 37833793 PMCID: PMC10571238 DOI: 10.1186/s13018-023-04248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE Accurate correction is a prerequisite for the favorable outcomes of open-wedge high tibial osteotomy (OWHTO). However, previous studies have reported disappointing results regarding correction accuracy despite the use of intra-operative navigation, which implies that a certain factor other than bony components is involved in the inaccurate correction (mainly overcorrection). The joint-line convergence angle (JLCA) can represent soft tissue effects in OWHTO. This study tried to determine whether the postoperative change in the JLCA (∆JLCA) led to inaccurate correction. METHODS Medical records of 78 OWHTO patients from 2005 to 2021 were retrospectively reviewed. The hip-knee-ankle angle (HKA) was measured with a positive value indicating varus alignment. Inaccurate correction was defined as postoperative HKA < - 3°. The JLCA was measured before and 6 months after surgery on long-standing hip-to-ankle radiographs, and ∆JLCA was defined as the difference between the preoperative and 6-month postoperative JLCAs. ∆JLCA was compared between the accurate correction group and the inaccurate correction group, and a receiver operating characteristic (ROC) curve was used to obtain the cutoff ∆JLCA at which the sensitivity and the specificity for inaccurate correction were maximized. Clinical outcomes were also compared between the groups using the knee injury and osteoarthritis outcome score (KOOS) at final follow-up (60.9 ± 53.3 months postoperatively). RESULTS Of the 78 patients, inaccurate correction was noted in 10 patients. The overall preoperative and postoperative HKAs were 7.0 ± 3.1° and - 0.4 ± 1.5°, respectively. The accurate correction group and the inaccurate correction group had a difference in ∆JLCA (p = 0.010). However, no significant difference was found in the preoperative HKA (p = 0.529). An ROC curve showed that the cutoff ∆JLCA was 1.9°. In the patients having ∆JLCA ≥ 1.9°, the mean JLCA was 4.9 ± 1.6° preoperatively and 1.7 ± 1.2° postoperatively. In the other patients having ∆JLCA < 1.9°, the mean preoperative and postoperative JLCA were 2.5 ± 1.8° and 2.3 ± 1.8°, respectively. The difference in the preoperative JLCA was significant (p < 0.001). The postoperative KOOS subscales did not differ according to correction accuracy. CONCLUSION Inaccurate correction in OWHTO, specifically valgus overcorrection, is associated with large ∆JLCA which represents the postoperative change of soft tissue effects. Overcorrection should be checked in cases of large preoperative JLCAs.
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Affiliation(s)
- Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young Cheol Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Seung-Ho Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, 30099, Republic of Korea.
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Aygün Ü, Bölükbaşı M, Yamak K, Çiçek AC. Comparison of the Miniaci and Dugdale techniques on functional outcomes in medial open wedge high tibial osteotomy. J Exp Orthop 2023; 10:86. [PMID: 37615790 PMCID: PMC10449725 DOI: 10.1186/s40634-023-00653-5] [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: 06/15/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To compare the correction angles determined by the Miniaci and Dugdale techniques in patients treated with medial open wedge high tibial osteotomy (MOWHTO) and show their impact on clinical outcomes. METHODS Seventy-four patients constituted the study group. The correction angles in Group 1 were measured using the Miniaci technique, and those in Group 2 were measured using the Dugdale technique. The clinical evaluations included the Tinetti Gait and Balance Assessment (TGBA), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and the Visual Analogue Scale (VAS). The effect of the correction angle on the patient's clinical outcomes was evaluated. Measurement techniques were also changed between groups for comparison. RESULTS Seventy-four patients (62 females, 12 males) with a mean age of 53.7 ± 4.9 years were followed up for a mean of 67.4 ± 5.5 months. The TGBA, WOMAC, and VAS scores were improved at the last follow-up compared to the preoperative scores (p < 0.05). The preoperative TGBA and WOMAC scores were not significantly different between the two groups, but the last follow-up TGBA and WOMAC scores in Group 2 were worse than those in Group 1 (p < 0.05). When measuring techniques were changed, the preoperative correction angle (PCA) value and the last follow-up correction angle (LFCA) value were lower in Group 1 measured with the Dugdale technique but higher in Group 2 measured with the Miniaci technique (p < 0.05). CONCLUSION Since the correction angle values measured with the Miniaci technique in MOWHTO are higher than those measured with the Dugdale technique; the functional results are better. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Ümit Aygün
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Ağrı İbrahim Çeçen University, Ağrı, Türkiye.
| | - Murat Bölükbaşı
- Department of Orthopaedics and Traumatology, VM Medical Park Samsun Hospital, Samsun, Türkiye
| | - Kamil Yamak
- Buca Seyfi Demirsoy Training and Research Hospital, Orthopedics and Traumatology Clinic, İzmir, Türkiye
| | - Ali Can Çiçek
- Ağrı Training and Research Hospital, Orthopaedics and Traumatology Clinic, Ağrı, Türkiye
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Yang HY, Seon JK. Editorial Commentary: Alignment for Open-Wedge High Tibial Osteotomy Can Be Planned Using the Hip-Knee-Ankle Angle and the Weightbearing Line. Arthroscopy 2023; 39:1232-1234. [PMID: 37019535 DOI: 10.1016/j.arthro.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 04/07/2023]
Abstract
Correct alignment of the limb mechanical axis is a principal goal of open-wedge high tibial osteotomy and determines successful postoperative outcomes. Excessive postoperative joint line obliquity must be avoided. A mechanical medial proximal tibial angle (mMPTA) less than 95° results in poor outcomes. Preoperative planning is commonly performed using a picture archiving and communication system; however, this is time-consuming and sometimes inaccurate because many landmarks and parameters need to be confirmed manually. Hip-knee-ankle (HKA) angle and weightbearing line (WBL) percentage are perfectly correlated to the Miniaci angle when planning open-wedge high tibial osteotomy, and ΔmMPTA and ΔWBL percentage are nearly perfectly correlated with the ΔHKA angle. Surgeons can easily measure the Miniaci angle according to the preoperative HKA and preoperative WBL percentage without digital software, and mMPTA greater than 95° can be avoided. Finally, bony and soft tissue components must be considered during preoperative planning. Medial soft tissue laxity must be specifically avoided.
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Koh DTS, Soong J, Yeo W, Tan MWP, Teo SJ, Wilson A, Lee KH. Large Versus Small Opening Wedge High Tibial Osteotomies Performed With a Protective Wire Over the Lateral Hinge: Incidence of Lateral Hinge Fracture and Early Clinical Outcomes. Am J Sports Med 2023; 51:672-677. [PMID: 36856282 DOI: 10.1177/03635465221148496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND The incidence of lateral hinge fractures (LHFs) during medial opening wedge high tibial osteotomy (MOW-HTO) is unacceptably high, especially with distractions >10 mm. LHFs result in malunion, loss of correction, and recurrence of symptoms adversely affecting clinical outcomes. PURPOSE (1) To investigate the incidence of LHF when a protective guide wire is utilized during MOW-HTO in small and large corrections and (2) to study the effect of correction size on early clinical outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed of 96 knees that underwent MOW-HTO between 2019 and 2020. A protective wire applied intraoperatively across the lateral hinge point before opening wedge distraction was performed for all patients. Patients were divided into 2 groups based on opening wedge sizes: group A (opening distraction <10 mm) and group B (opening distraction ≥10 mm). LHF and wound complications were recorded. Prospective Knee Score and Function Score (Knee Society), Oxford Knee Score, and Physical and Mental Component Summaries of the 36-Item Short Form Health Survey questionnaire were recorded preoperatively and at 6 months and 2 years after surgery. RESULTS Incidence of LHF was low in group A (n = 2; 6.1%) and group B (n = 3; 9.1%). A single case of intraoperative LHF was noted in each group, with each case resulting in a type 1 fracture. The incidence of postoperative fractures was comparable between groups (groups A vs B, n = 1 vs 2). At 6 months, clinical outcomes in group A were superior to those of group B (Knee Score, 85.7 ± 14.7 vs 73.1 ± 20.3, P = 0.028; Function Score, 73.5 ± 16.5 vs 63.1 ± 19.5, P = 0.047; Oxford Knee Score, 20.2 ± 4.7 vs 25.6 ± 8.5, P = 0.008; Physical Component Summary, 46.8 ± 8.1 vs 40.2 ± 10.9, P = 0.018). However, clinical outcomes were comparable at 2 years (P > .05). CONCLUSION A protective wire was associated with a low incidence of LHF, even in larger MOW-HTO corrections. Large corrections had poorer clinical outcomes as compared with small corrections at 6 months. However, clinical outcomes between groups were comparable at 2 years.
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Affiliation(s)
| | - Junwei Soong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Shao Jin Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Adrian Wilson
- London Osteotomy Centre, Harley Street Specialist Hospital, London, UK.,Department of Sports and Exercise, University of Winchester, Winchester, UK
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Morita Y, Kuriyama S, Yamawaki Y, Nakamura S, Nishitani K, Ito H, Matsuda S. Opening-Wedge High Tibial Osteotomy With High Hinge Position Risks Lateral Hinge Fracture in Men With Posterolateral Tibial Condyle Protrusion. Arthroscopy 2023; 39:324-334. [PMID: 35961443 DOI: 10.1016/j.arthro.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the 3-dimensional morphology of the proximal tibia around the osteotomy plane in open-wedge high tibial osteotomy, focusing on the posterolateral (PL) and posteromedial (PM) tibial condyles, and to clarify the changes in morphologic parameters due to differences in patient characteristics and hinge position. The secondary aim was to examine whether morphologic features were associated with insufficient osteotomy, which increases the risk of lateral hinge fracture (LHF). METHODS The PL and PM anteroposterior distance, asymmetry ratio, and discrepancy between PL and PM distances along the tibial osteotomy plane were measured. We investigated changes in the parameters due to differences in patient characteristics and hinge position. Osteotomy configurations and LHFs were evaluated using postoperative computed tomography scans. RESULTS The 3-dimensional preoperative plans of 117 knees (male, 41 knees; female, 76 knees) were evaluated. PL distances were larger than PM distances in almost all cases. The average asymmetry ratio was 1.35, and the standard deviation was 0.22. Higher hinge position was associated with a larger asymmetry ratio and discrepancy (P < .001). The asymmetry ratio and discrepancy were independently positively correlated with male sex (P = .002 and P = .001, respectively) and gentle posterior tibial slope (P < .001 and P < .001, respectively). Osteotomies with type III LHFs showed lower osteotomy sufficiency than osteotomies without LHFs (P < .001). CONCLUSIONS PL tibial condyle protrusion was more pronounced in male patients and those with a high hinge position, and may result in insufficient PL osteotomy, which is a risk factor for type III LHF during open-wedge high tibial osteotomy. The optimal hinge position was located approximately 15 mm and 20 mm distal to the lateral tibial plateau in female and male patients, respectively. LEVEL OF EVIDENCE IV: retrospective case series.
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Affiliation(s)
- Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
| | - Yusuke Yamawaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
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Xu K, Wang W, Wang Q, Sun J, Fang C, Sun Y, Shi T, Wu X, Yan Q. Comparison of computer-assisted navigated technology and conventional technology in high tibial osteotomy (HTO): a meta-analysis. Comput Assist Surg (Abingdon) 2022; 27:63-73. [PMID: 35882055 DOI: 10.1080/24699322.2022.2078739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Though some studies have reported navigated high tibial osteotomy (HTO) is a useful procedure to correct knee deformity. There is still great controversy whether navigated HTO can achieve better accuracy of limb alignment and greater clinical outcomes. Current meta-analysis was conducted to investigate whether better radiographic outcomes and clinical outcomes could be acquired in navigated HTO compared with the conventional procedure. METHOD We conducted a literature search in the electronic databases, including Medline, Embase, the Cochrane Library, and Web of Science. We identified studies published before August 2020. We also checked the references of the related articles for any relevant studies. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review. This research was performed using Review Manager 5.4 software. RESULTS Fourteen articles were included, involving 1399 knees. Our meta-analysis indicated that patients undergoing navigated HTO had significantly better outcomes in outliers of aimed limb alignment (RD=-0.24, 95% CI: =-0.34 to -0.13, p < 0.01), outliers of aimed tibial posterior slope (TPS) (RD=-0.41, 95% CI: -0.51 to -0.30, p < 0.01), Range of Motion (ROM) (MD = 6.37, 95%CI: 0.83-11.91, p = 0.02), and American knee society knee score (AKS knee score) (MD = 3.88, 95%CI: 1.37-6.39, p = 0.002). No significant differences were found in Lysholm score (MD = 1.30, 95%CI: -0.31 to 2.90, p = 0.11), American knee society function score (AKS function score) (RD = 1.42, 95%CI: -0.15 to 2.99, p = 0.08), complications (RD=-0.01, 95% CI: = -0.05 to 0.04, p = 0.77), delayed union (RD=-0.01, 95% CI: = -0.02 to 0.03, p = 0.59), and reoperation (RD = 0, 95% CI: -0.09 to 0.10, p = 0.98) between the two groups. The operation time in the navigated group was 15.46 min longer than in the conventional group. CONCLUSION Navigated HTO provided more accurate and reproducible radiographic outcomes in the correction of the malalignment than conventional techniques, and there is no difference in the risk of complications compared with conventional HTO. However, it is unclear whether navigation HTO can achieve better clinical results. More randomized controlled trials (RCTs) with high quality, large sample size, and sufficient follow-up period are required.
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Affiliation(s)
- Keteng Xu
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Weichao Wang
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Qin Wang
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Jun Sun
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Chen Fang
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Yusheng Sun
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Tulong Shi
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Xun Wu
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Qing Yan
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
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Clinical efficacy and feasibility of laser correction technology with an ordinary laser pen and surgical instrument box in open-wedge high tibial osteotomy. BMC Musculoskelet Disord 2022; 23:1019. [PMID: 36435822 PMCID: PMC9701429 DOI: 10.1186/s12891-022-05993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
The clinical outcomes of open-wedge high tibial osteotomy (OWHTO) for medial knee osteoarthritis primarily depend on the corrective precision. The present study aimed to determine the efficacy and feasibility of laser correction technology with an ordinary laser pen and surgical instrument box.
Methods
This prospective and randomized trial included 71 patients randomly divided into laser (n = 36) and traditional groups (n = 35). In the laser group, the hip centre, knee (Fujisawa point), and ankle centre were located preoperatively using the surgical instrument box lid. The leg was aligned with an ordinary laser pen. In the traditional group, the lower limb alignment was corrected by a metal cable. Radiation exposure, operative time, and rate of outliers (lower limb force line does not pass through 62–66% of the lateral tibial plateau) were evaluated. The visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. After 24 months, the femoral tibial angle (FTA), medial proximal tibial angle (MPTA), and posterior slope angle (PSA), were recorded. The Kaplan-Meier method was used to evaluate the survival time of affected knees, and postoperative complications were recorded.
Results
The radiation exposure, operative time and rate of outliers were lower in the laser correction group (P < 0.05). Six months postoperatively, the VAS and WOMAC scores were significantly improved in both groups (P < 0.001). At 24 months, the FTA, MPTA, and PSA were corrected in both groups (P < 0.001). There were no differences in the postoperative knee survival time from OWHTO to knee arthroplasty between the groups or postoperative complications (P = 0.53; P = 0.61).
Conclusions
Laser correction technology can effectively reduce radiation exposure, the operative time, and the rate of outliers (trial identification number (retrospectively registered): ChiCTR2200060480; date of register: 03/06/2022).
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MacLeod A, Mandalia V, Mathews J, Toms A, Gill H. Personalised 3D Printed high tibial osteotomy achieves a high level of accuracy: ‘IDEAL’ preclinical stage evaluation of a novel patient specific system. Med Eng Phys 2022; 108:103875. [DOI: 10.1016/j.medengphy.2022.103875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
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Kobayashi H, Saito S, Akamatsu Y, Kumagai K, Nejima S, Inaba Y. The relationship between the ''Fujisawa point'' and anatomical femorotibial angle following simulated open wedge high tibial osteotomy. BMC Musculoskelet Disord 2022; 23:776. [PMID: 35971089 PMCID: PMC9377135 DOI: 10.1186/s12891-022-05734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the relationship between the weight-bearing line (WBL) ratio and anatomical femorotibial angle (FTA) by simulated open wedge high tibial osteotomy (OWHTO). This study evaluated the correlation between the ‘‘Fujisawa point’’ and FTA, and identified factors which caused deviations between the two measurement methods. We hypothesized that the Fujisawa point corresponded with 170° of the FTA. Methods Preoperative antero-posterior full-length lower limb radiographs of 82 patients were obtained for the OWHTO to place the WBL ratio at a target of 62.5% of the width of the tibial plateau (Fujisawa point). The coronal alignment was measured pre- and post-planning. The patients were divided into two groups by the post-planning FTA: a correspondence group (168.5°≦FTA≦171.5°) and a non-correspondence group (FTA < 168.5°, 171.5° < FTA). The relationship between the Fujisawa point and the FTA was analyzed with multivariate regression analysis. Results The post-planning FTA was 169.8 ± 1.1° and within 170 ± 1.5° in 69 cases (84.1%) when the WBL ratio was 62.5%. The neck shaft angle was 128.1 ± 5.2° in the correspondence group, and 122.3 ± 6.3° in the non-correspondence group. The multivariate linear regression analysis revealed that the neck shaft angle was the only factor that predicted the correspondence of the Fujisawa point with the FTA at 170° (p = 0.006, odd 1.28). Conclusions The post-planning FTA converged at 170° when the WBL ratio passed through the Fujisawa point and the neck shaft angle was the only predictor. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05734-7.
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Affiliation(s)
- Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan. .,Department of Orthopaedic Surgery, Yokohama Hodogaya Central Hospital, Yokohama, Japan. .,Department of Orthopaedic Surgery, International University of Health and Welfare Atami Hospital, Atami, Japan.
| | - Suguru Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Yasushi Akamatsu
- Department of Joint Surgery, Fureai Yokohama Hospital, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan
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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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13
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Bodendorfer BM, Knapik DM, Kerzner B, Gursoy S, Hevesi M, Chahla J. Basics of Coronal Plane Deformity Correction. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Van fraeyenhove B, Oussedik S. Navigation Guided Corrective Osteotomy (based on surgical technique). OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Saragaglia D, Horteur C, Refaie R. "One millimetre equals one degree": a simple way to achieve in 92% of cases the desired correction after opening proximal tibial osteotomy for genu varum. Arch Orthop Trauma Surg 2022; 143:2395-2400. [PMID: 35488920 DOI: 10.1007/s00402-022-04458-6] [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: 02/17/2022] [Accepted: 04/15/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION When performing a high tibial osteotomy (HTO) for genu varum deformity, it is not always easy to obtain the correct amount of overcorrection. The aims of this study were to review the results of a simple and reproducible method of correction that we have called "1 mm equals 1°". We have applied this technique to the medial opening wedge osteotomy. Our hypothesis was that one degree of correction corresponded with one degree of opening. METHODS 97 proximal medial opening wedge osteotomies were measured intraoperatively with a navigation system and at 3 months with long-leg X-rays. The hip-knee-ankle (HKA) angle preoperatively was on average 173.8 ± 2.3° (170°-177°). In most cases, an opening of 4° greater than the initial varus was performed using our formula that one degree varus was equal to 1 mm of opening. In other words, when the varus was 6°, an opening of 10 mm was performed. The void left by the opening wedge was filled with a calcium triphosphate wedge and the construct fixed and held with a locking plate. RESULTS Aiming for a knee axis of 184 ± 2°, which corresponds to 2°-6° of overcorrection, we obtained the following results: HKA intraoperatively measured angle with navigation was on average 183.5 ± 0.9° (182°-184°) and HKA radiologically postoperatively angle was 182.5° ± 1.6° (179°-189°). We therefore achieved the desired overcorrection of 2°-6° in 92% of cases based on our postoperative radiographs and in 100% cases based on intraoperative measurements with computer navigation. CONCLUSION The method of "1 mm equals 1°" is a simple, reliable, and reproducible method to achieve in 92% of cases the desired overcorrection (i.e., 184 ± 2°) with valgising proximal medial opening wedge osteotomy in genu varum.
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Affiliation(s)
- Dominique Saragaglia
- Faculty of Medicine, University Grenoble-Alpes, 23 Av. Des Maquis du Grésivaudan, 38700, La Tronche, France. .,, 3 Allée du Joanny, 38640, Claix, France.
| | - C Horteur
- CHU Grenoble-Alpes, South Teaching Hospital, Kimberley avenue, 38130, Echirolles, France
| | - R Refaie
- Department of Trauma and Orthopaedics, South Tees NHS Foundation Trust, Middlesbrough, UK
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Bardot LP, Micicoi G, Favreau H, Zeman P, Khakha R, Ehlinger M, Ollivier M. Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes. Knee Surg Sports Traumatol Arthrosc 2022; 30:715-720. [PMID: 33486561 DOI: 10.1007/s00167-021-06446-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity. MATERIAL AND METHODS This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA). RESULTS From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01). CONCLUSION Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA. LEVEL OF CLINICAL EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Léo-Pôhl Bardot
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
| | - Grégoire Micicoi
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - Henri Favreau
- Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Petr Zeman
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Raghbir Khakha
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
- Guys and St Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, England
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France.
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Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 30:688-697. [PMID: 33433634 DOI: 10.1007/s00167-020-06430-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/23/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the radiographic, clinical, and arthroscopic outcomes of varus osteoarthritic knees treated with an open-wedge high tibial osteotomy (OWHTO) alone or with a double-level osteotomy (DLO). It was hypothesized that treatment with DLO would maintain the joint line obliquity (JLO) and acquire better arthroscopic and clinical outcomes after surgery than OWHTO alone. METHODS Knees with predicted medial proximal tibial angle (MPTA) > 95° were treated with OWHTO alone or with DLO. Preoperatively, age, body mass index, and hip-knee-ankle angle (HKA) differed between the two groups. Therefore, after adjustment for those factors, 34 knees with OWHTO alone and 34 knees with DLO were compared. On whole-leg radiographs for a single leg, HKA, weightbearing line (WBL) ratio, lateral distal femoral angle (LDFA), MPTA, and JLO were measured before and 2 years after surgery. Clinical outcomes were evaluated by the Knee Society Score (KSS) knee, KSS function, Lysholm, and Knee injury and Osteoarthritis Outcome Score (KOOS) scores before and 2 years after surgery. Arthroscopic findings were obtained before and 1 year after surgery. Various factors were compared between the two groups. RESULTS JLO increased significantly from 1.4° to 6.3° in the OWHTO group (p < 0.001) and changed from 1.0° to 1.3° in the DLO group (n.s.). Postoperative MPTA and JLO in the OWHTO group were significantly higher than those in the DLO group (both p < 0.001). There were no significant differences in the KSS knee, KSS function, and KOOS scores between the two groups. Postoperative Lysholm score in the DLO group was higher than that in the OWHTO group (p < 0.025). Femoral and tibial cartilage regeneration in the medial condyles and deterioration in the lateral condyles did not differ between the two groups on second-look arthroscopy. CONCLUSIONS JLO was not significantly changed after surgery in the DLO group. DLO enabled the acquisition of physiological JLO compared with OWHTO alone. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Kandhari V, Angadi D, Myat D, Fritsch B, Parker D, Coolican M. Long Term Outcomes of Computer-Navigated Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Knee Arthrosis. Rev Bras Ortop 2022; 57:96-102. [PMID: 35198115 PMCID: PMC8856845 DOI: 10.1055/s-0040-1716765] [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: 05/17/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The primary aim of the present study was to evaluate the long-term outcomes including survivorship of computer navigated distal femoral lateral opening wedge osteotomy (DFLOWO). The secondary aim was to identify the potential factors that may influence its survivorship. Methods A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated DFLOWO from December 2006 to November 2012 was performed. The International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were analyzed for outcome measures. Conversion to arthroplasty during the follow-up was the end point. Results A total of 19 DFLOWOs were performed in 17 patients with a mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1° (2-11°) valgus to a mean of 2.1° (0.5°-3°) varus. The IKDC scores improved from mean of 39 preoperatively to 53 at the mean long-term follow-up of 9.1 years. The mean KOOS scores at the long-term follow-up were pain 71, symptoms 56, activities of daily living 82, sports and recreation 59, quality of life 43. Survivorship of the DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 according to the International Cartilage Repair Society (ICRS) cartilage degeneration in the medial compartment of the knee and >7° preoperative valgus deformity were strongly correlated with conversion to total knee arthroplasty (TKA) at the long-term follow-up ( r = 0.66). Conclusions Computer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7° preoperative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.
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Affiliation(s)
- Vikram Kandhari
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Darshan Angadi
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Darli Myat
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Brett Fritsch
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - David Parker
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Myles Coolican
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
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Cerciello S, Ollivier M, Corona K, Kaocoglu B, Seil R. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:555-566. [PMID: 32910222 DOI: 10.1007/s00167-020-06253-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Medial open-wedge high tibial osteotomy (MOWHTO) is an accepted option in the treatment of medial compartment osteoarthritis of the knee in young and active patients. Functional results are closely correlated to the correction of the mechanical axis of the lower limb. Although several angular and geometrical methods and values have been proposed in the past, the ideal target is still debated. In addition, it is important to have a deep correlation between the planned correction and the achieved correction after surgery. The aim of the present systematic review was to identify the ideal coronal correction after MOWHTO and the most accurate method to achieve it. METHODS A systematic review of the literature was completed on July 3rd 2020 in the Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the Medical Subject Headings (MeSH) terms: "high tibial osteotomy" AND "accuracy" OR "planning". RESULTS 28 studies were included; 18 were focused on computer-assisted surgery (CAS) and 10 on patient-specific instrumentation (PSI). There were 598 patients in the CAS group and 501 in the control group; the rate of outliers was 16% and 38.2% respectively (P = 0.04), while there was no significant difference between the two groups (SMD = - 0.10; 95% CI 1.31 to 1.12; P = n.s.) in terms of coronal accuracy. Likewise, there were 318 patients in the PSI group and 40 in the control group; the rate of outliers was 15% and 40% respectively (P = 0.98), while there was no significant difference between the two groups (SMD = 0.01; 95% CI 0.58 to 0.59; P = 0.98). CONCLUSIONS A statistically significant reduced outlier rate and a non-significant increased accuracy emerged with the use of CAS when compared to the traditional surgical technique, whereas the results of PSI were still inconclusive. In addition, it emerged clearly that no consensus still exists on the ideal correction target to be achieved after surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S Cerciello
- Casa di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy
| | - M Ollivier
- Department of Orthopedics and Traumatology, Institute for Locomotion, Sainte-Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Marseille, France
| | - K Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - B Kaocoglu
- Department of Orthopaedics and Traumatology, Acibadem University, İstanbul, Turkey
| | - R Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
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Ryu DJ, Lee SS, Jung EY, Kim JH, Shin TS, Wang JH. Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211034151. [PMID: 34631902 PMCID: PMC8495530 DOI: 10.1177/23259671211034151] [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: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction. Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated. Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months (P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient (R2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle – 0.255 × ΔJLCAvalgus. Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle – ⅓ΔJLCAvalgus, while the Miniaci method showed a relatively low ICC value of 0.875. Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Joo Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Joon Ho Wang, MD, PhD, Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea ()
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Kim HJ, Shin JY, Lee HJ, Jung CH, Park KH, Oh CW, Kyung HS. Open-wedge high tibial osteotomy in patients with discoid lateral meniscus. J Orthop Surg (Hong Kong) 2021; 29:23094990211017355. [PMID: 34114526 DOI: 10.1177/23094990211017355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There are concerns about the progression of the lateral osteoarthritis (OA) should be taken into account when high tibial osteotomy (HTO) is performed in patients with discoid lateral meniscus (LM). This study evaluated the clinical results of HTO in patients with discoid LM and elucidated factors affecting the results. METHODS This study evaluated 32 female patients with varus deformity and medial OA. Patients with discoid LM (8 patients) or without discoid LM (24 patients) underwent open-wedge HTO. The mean age was 53.5 years and the mean follow-up period was 35 months. Clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), were evaluated. The progression of OA in the lateral compartment was also evaluated. Finally, we evaluated the factors affecting the clinical results and OA progression in the lateral compartment. RESULTS Between two groups, all clinical scores were not different (p = 0.964, 0.963, and 0.559, respectively). Three of eight patients (37.5%) in the discoid group developed OA in the lateral compartment, whereas 2 of 24 patients (8.3%) in the control group developed such; however, this was not significantly different (p = 0.085). In discoid group, patients with undercorrection has higher KS relative to patients with acceptable correction (p = 0.044). Other clinical results and OA change in the lateral compartment were not affected by evaluated factors. CONCLUSIONS Patients who underwent open-wedge HTO showed the satisfactory clinical results and lateral OA progression regardless of the presence or absence discoid LM. However, when discoid LM was present, patients with undercorrection showed higher KS in comparison with patients with acceptable correction.
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Affiliation(s)
- Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chul-Hee Jung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Soo Kyung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Wang X, Shi L, Zhang R, Wang W, Kong L, Zhao H, Xu J, Kang Q. Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy. J Orthop Surg Res 2021; 16:451. [PMID: 34261504 PMCID: PMC8278751 DOI: 10.1186/s13018-021-02597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results. MATERIALS AND METHODS Sixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy. RESULTS During the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and - 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05). CONCLUSION Compared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.
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Affiliation(s)
- Xiaoyu Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Li Shi
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Rui Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Wenbo Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Lingchi Kong
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Haoyu Zhao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jia Xu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Qinglin Kang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Jeong SH, Samuel LT, Acuña AJ, Kamath AF. Patient-specific high tibial osteotomy for varus malalignment: 3D-printed plating technique and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:845-855. [PMID: 34148123 DOI: 10.1007/s00590-021-03043-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We report our experience with a 3D patient-specific instrument (PSI) in an opening-wedge tibial osteotomy for the correction of varus malalignment in a patient with prior anterior cruciate ligament reconstruction. Previous studies have not reported the use of 3D PSI in patients with prior knee surgeries. METHODS A pre-operative CT was used to create a 3D model of the lower extremity using Bodycad Imager. The pre-operative medial proximal tibial angle (MPTA), lateral distal femoral ankle, hip-knee-ankle (HKA), and tibial slope were calculated. The Bodycad Osteotomy software package was used to create a simulated osteotomy and correction. The resulting 3D patient-specific surgical guide and plate were used to conduct the high tibial osteotomy. Radiographic measurements and range of motion were evaluated at 6-week follow-up. RESULTS The arthroscopy and open portions of the procedure were performed in 65 min, with only three fluoroscopy shots taken intraoperatively. At 6-week follow-up, the patient had 125° of flexion and minimal pain. The angular correction of the bone was achieved within 1.9° (planned MPTA 91.9° vs. actual 90°); the HKA angle was achieved with an error of 0.7° (planned 2.4° vs. actual 1.7°); and there was no change in the posterior tibial slope (planned 13.5° vs 13.8° actual). CONCLUSION Three-dimensional PSI can be successfully used for the accurate and efficient correction of varus malalignment while accommodating pre-existing hardware, with good short-term clinical outcomes.
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Affiliation(s)
- Stacy H Jeong
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Tardy N, Steltzlen C, Bouguennec N, Cartier JL, Mertl P, Batailler C, Hanouz JL, Rochcongar G, Fayard JM. Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy? Orthop Traumatol Surg Res 2020; 106:S231-S236. [PMID: 32943382 DOI: 10.1016/j.otsr.2020.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Preoperative planning in high tibial osteotomy (HTO) is a critical step for achieving the desired correction and a clinically satisfactory outcome. Conventional radiography, navigation assistance and patient-specific instrumentation (PSI) are the 3 means of planning, but no prospective studies have compared precision between the 3. The aims of the present study were: (1) to analyze and compare correction precision between the 3 planning approaches at 1 year's follow-up; (2) to compare results to those reported in the literature; and (3) to analyze factors influencing the achievement of planned correction. HYPOTHESIS The study hypothesis was that PSI provides more precise and reproducible planned correction than conventional methods or navigation. MATERIAL AND METHOD Between June 2017 and June 2018, a multicenter non-randomized prospective observational study was conducted in 11 centers. One hundred and twenty-six patients with Ahlbäck grade I, II or III idiopathic medial tibiofemoral osteoarthritis with stable knee were included and allocated to 3 preoperative planning groups: conventional (group 1), navigation (group 2) and PSI (group 3). Mean age at surgery was 51.2 years (range, 19-69 years; median, 53.2 years); 100 male, 26 female. Complete weight-bearing radiographic work-up was performed preoperatively and at 1 year's follow-up. The PSI group also underwent CT as part of guide production. Target angular correction and mechanical Hip-Knee-Ankle (HKA) axis were set preoperatively. The main endpoint was the difference between planned HKA and HKA at a minimum 12 months. RESULTS Mean HKA difference was 1.1±3 in group 1, 2.1±2.6 in group 2 and 0.3±3.1 in group 3. Precision was better with PSI, but not significantly when comparing all 3 groups together. On pairwise intergroup comparison, there was a significant difference only between groups 2 and 3, in favor of PSI (P=0.011). DISCUSSION None of the 3 techniques demonstrated superiority in achieving target correction at 1 year. The study hypothesis was thus not confirmed. All 3 techniques proved reliable and precise in HTO planning. LEVEL OF EVIDENCE III, prospective non-randomized comparative study.
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Affiliation(s)
- Nicolas Tardy
- Centre Ostéo-Articulaire des Cèdres, Clinique des Cèdres, 5, rue des Tropiques, 38130 Echirolles, France.
| | - Camille Steltzlen
- Service de Chirurgie Orthopédique, Hôpital Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges-Nègrevergne, 33700 Mérignac, France
| | - Jean-Loup Cartier
- Clinique Des Alpes Du Sud, 3, rue Antonin Coronat, 05000 Gap, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique, CHU Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France
| | - Cécile Batailler
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, 103, grande rue de la Croix Rousse, 69317 cedex 04 Lyon, France
| | - Jean-Luc Hanouz
- Service d'Anesthésie Réanimation, CHU de Caen, avenue Côte De Nacre, 14033 Caen, France
| | - Goulven Rochcongar
- Département de Chirurgie Orthopédique et Traumatologique, Niveau 11, Inserm U1075 COMETE "Mobilité: Attention, Orientation & Chronobiologie", Université de Caen, Basse-Normandie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Jean-Marie Fayard
- Ramsay Générale de Santé, Hôpital Privé Jean-Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
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- 15 rue Ampère, 92500 Rueil Malmaison, France
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25
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Zhang Z, Liu M, Wen X, Liu S, Zhang G, Yang C. The relationship between the posterior tibial slope and the sagittal femoral condylar shape: Two circles and ellipses. Clin Anat 2020; 33:1075-1081. [PMID: 31880335 DOI: 10.1002/ca.23543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/11/2019] [Accepted: 12/17/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Whether the posterior tibial slope (PTS) is associated with the femoral condylar shape has remained unclear. Classical anatomical studies considered the sagittal profiles of femoral condyles to consist of two circles. Recently, an elliptical method was described to simplify the "two circles" model. Our purpose was to analyze the relationship between the PTS and the shape of the sagittal femoral condyle, that is, two circles and two ellipses, using magnetic resonance imaging (MRI) scans. METHODS Eighty right knees of healthy subjects were scanned by MRI at full extension. The medial and lateral PTS were measured (mPTS and lPTS). On the distal-most medial and lateral slices, the femoral condylar articular surfaces were best fitted by circles or ellipses, respectively. The radii of the medial and lateral posterior circles and inferior circles (rm and rl , Rm and Rl , respectively), the semi-major axes and the semi-minor axes of the medial and lateral ellipses (am and al , bm and bl , respectively), and the rm /Rm , bm /am , rl /Rl , bl /al ratios were measured and calculated. RESULTS mPTS correlated significantly with the parameters of the medial condyle (all p < .05) and the ratios bm /am and rm /Rm (p = .017 and p = .027, respectively). However, the lPTS did not correlate with the parameters of the lateral condyle (all p > .05) or the ratios bl /al and rl /Rl (p = .461 and p = .241, respectively). CONCLUSION The mPTS is associated with the sagittal shape of the medial femoral condyle but the lPTS is not. Both two circles and two ellipses are feasible ways to represent the sagittal femoral condylar shape.
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Affiliation(s)
- Zheng Zhang
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, China
- Department of Bone and Joint Surgery, Weifang Traditional Chinese Hospital, Weifang, Shangdong, China
| | - Mingyang Liu
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xiaoyu Wen
- Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Shiwei Liu
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, China
| | - Guanpeng Zhang
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, China
| | - Chen Yang
- Department of Bone and Joint Surgery, The First Hospital of Jilin University, Changchun, China
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Managing intra-articular deformity in high Tibial osteotomy: a narrative review. J Exp Orthop 2020; 7:65. [PMID: 32902758 PMCID: PMC7481321 DOI: 10.1186/s40634-020-00283-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.
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27
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Tsuji M, Akamatsu Y, Kobayashi H, Mitsugi N, Inaba Y, Saito T. Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2020; 140:707-715. [PMID: 31468134 DOI: 10.1007/s00402-019-03245-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Using a navigation system in open-wedge high tibial osteotomy (OWHTO) has higher accuracy than using the conventional method. However, unintentional over- and under-correction still exist. This study aimed to compare various factors related to over- and under-correction and to assess their predictive factors in the preoperative radiographs. MATERIALS AND METHODS This study involved 96 knees. The difference in the hip-knee-ankle angle (HKA) between the intraoperative navigation system and postoperative radiograph was termed navigation correction loss (NCL). Knees with absolute values of NCL (|NCL|) ≦ 1.5° and |NCL| > 1.5° were categorised into acceptable (n = 46) and outlier (n = 50) groups, respectively. The differences in joint line convergence angle (JLCA) between varus and valgus radiographs, varus JLCA, valgus JLCA, standing JLCA and standing HKA were compared between the two groups. Clinical results were evaluated using the American Knee Society (AKS) scores. RESULTS The mean intraoperative HKA in the navigation system was - 3.8 ± 1.8°, and that in the postoperative standing radiograph was - 4.2 ± 2.5° (p = 0.033). Preoperative varus, valgus and standing JLCA were higher in the outlier group (p = 0.018, p = 0.020 and p = 0.001, respectively). Logistic regression analyses for preoperative factors of |NCL| ≦ 1.5° showed that standing JLCA was a determining factor, with an odds ratio of 1.334 (confidence interval was 1.087-1.637, p = 0.006). AKS score was higher in the acceptable group (p = 0.040) postoperatively. CONCLUSIONS Higher preoperative standing JLCA was the predictive factor of |NCL| > 1.5°. This factor reduced the rates of under- and over-correction and resulted in better AKS score in OWHTO.
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Affiliation(s)
- Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naoto Mitsugi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urahunecho, Minami-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Classical target coronal alignment in high tibial osteotomy demonstrates validity in terms of knee kinematics and kinetics in a computer model. Knee Surg Sports Traumatol Arthrosc 2020; 28:1568-1578. [PMID: 31227865 DOI: 10.1007/s00167-019-05575-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to determine the ideal coronal alignment under dynamic conditions after open-wedge high tibial osteotomy (OWHTO). It was hypothesised that, although the classical target alignment was based on experimental evidence, it would demonstrate biomechanical validity. METHODS Musculoskeletal computer models were analysed with various degrees of coronal correction in OWHTO during gait and squat, specifically with the mechanical axis passing through points at 40%, 50%, 60%, 62.5%, 70%, and 80% of the tibial plateau from the medial edge, defined as the weight-bearing line percentage (WBL%). The peak load on the lateral tibiofemoral (TF) joint, the medial collateral ligament (MCL), and anterior cruciate ligament (ACL) tensions, and knee kinematics with or without increased posterior tibial slope (PTS) were evaluated. RESULTS The classical alignment with WBL62.5% achieved sufficient load on the lateral TF joint and maintained normal knee kinematics after OWHTO. However, over-correction with WBL80% caused an excessive lateral load and non-physiological kinematics. Increased WBL% resulted in increased MCL tension due to lateral femoral movement against the tibia. With WBL80%, abnormal contact between the medial femoral condyle and the medial intercondylar eminence of the tibia occurred at knee extension. The screw-home movement around knee extension and the TF rotational angle during flexion were reduced as WBL% increased. Increased PTS was associated with increased ACL tension and decreased TF rotation angle because of ligamentous imbalance. CONCLUSIONS The classical target alignment demonstrated validity in OWHTO, and over-correction should be avoided as it negatively impacts clinical outcome. LEVEL OF EVIDENCE IV.
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Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, Kim JY. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1411-1418. [PMID: 30980121 DOI: 10.1007/s00167-019-05502-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to determine which preoperative factors affect the postoperative change in the joint line convergence angle (JLCA) by preoperatively quantifying soft tissue laxity. METHODS Thirty-four patients who underwent medial open-wedge high tibial osteotomy (HTO) with a navigation were analysed. The JLCA change after HTO was calculated using standing long-bone anteroposterior radiographs taken preoperatively and 6 months postoperatively. Latent soft tissue laxity was defined as the amount of soft tissue that can be extended to valgus or varus from the weight-bearing position, and calculated by subtracting the JLCA on weight-bearing standing radiographs from that on stress radiographs. Multiple linear regression was performed to determine the preoperative factors that statistically correlated with the postoperative JLCA change. RESULTS In multiple linear regression, JLCA change had a statistically significant correlation with latent medial laxity (R = 0.6) and a statistically borderline significant correlation with correction angle (R = 0.2). These imply that the postoperative JLCA change increased by 0.6° per 1° increase in latent medial laxity, and increased by 0.2° per 1° increase in correction angle. Latent medial laxity was the most crucial factor associated with postoperative JLCA changes. CONCLUSION The JLCA change could be larger in patients with large latent medial laxity or severe varus deformity requiring a large correction, which could lead to unexpected overcorrection in HTO. Postoperative JLCA change should be considered in preoperative surgical planning. Target point shifting within the hypomochlion point could be a strategy to prevent overcorrection, especially in patients with large latent medial laxity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, South Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Yougun Won
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, South Korea
| | - Young Ki Min
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, South Korea
| | - Sagar Jaiswal
- Department of Orthopaedic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University School of Medicine, Daejeon, South Korea
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Kamada S, Shiota E, Saeki K, Kiyama T, Maeyama A, Yamamoto T. Severe varus knees result in a high rate of undercorrection of lower limb alignment after opening wedge high tibial osteotomy. J Orthop Surg (Hong Kong) 2020; 27:2309499019846660. [PMID: 31068080 DOI: 10.1177/2309499019846660] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to clarify the indication for opening wedge high tibial osteotomy (OWHTO) in terms of lower limb alignment to achieve satisfactory clinical results. METHODS Ninety-two patients (98 knees) with medial compartment knee osteoarthritis were investigated in this study. The average follow-up period was 34 months (range, 24-68 months). The average age of the patients at the time of surgery was 63 years (range, 41-77 years). RESULTS The patients were divided into the following two groups according to the preoperative femorotibial angle (FTA) on anteroposterior full-length radiographs of the lower limbs while weight bearing: 29 knees with a preoperative FTA of ≥185° were defined as those with severe varus (S group), and the remaining 69 knees with a preoperative FTA of <185° were defined as those with mild varus (M group). Knees with a postoperative FTA of >175° were defined as undercorrected. The Lysholm score was used to assess the clinical results. The average postoperative FTA was 175.7° ± 4.1° in the S group and 174.6° ± 3.1° in the M group ( p = 0.013). Significantly, more undercorrected knees were observed in the S than M group ( p = 0.00035). The postoperative Lysholm score was 85.6 ± 8.5 in the S group and 88.5 ± 5.7 in the M group at the last follow-up ( p = 0.0033). CONCLUSION Based on these results, we recommend that a preoperative FTA of <185° should be included as a criterion for OWHTO alone.
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Affiliation(s)
- Satoshi Kamada
- 1 Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Etsuji Shiota
- 1 Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazuhiko Saeki
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takahiko Kiyama
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akira Maeyama
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takuaki Yamamoto
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Chernchujit B, Tharakulphan S, Prasetia R, Chantarapanich N, Jirawison C, Sitthiseripratip K. Preoperative planning of medial opening wedge high tibial osteotomy using 3D computer-aided design weight-bearing simulated guidance: Technique and preliminary result. J Orthop Surg (Hong Kong) 2020; 27:2309499019831455. [PMID: 30827173 DOI: 10.1177/2309499019831455] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High tibial osteotomy (HTO) is an established treatment for uni-compartmental osteoarthritis with varus deformity in relatively active young patients with good knee mobility. The most important factor for success and low complications of HTO is the precise correction of osteotomy. The objective of this study was to evaluate the accuracy of pre-operative planning of open-wedge HTO using t3D computer-aided design (CAD) weight-bearing simulated guidance technique for the succession of surgery. MATERIALS AND METHODS Nineteen patients who met the inclusion criteria were recruited between July 2013 and June 2014. 3D CAD weight-bearing simulated guidance technique was obtained from standard anterior-posterior, lateral of hip-to-ankle full leg standing radiographs, and computed tomography (CT) scan provided the weight-bearing corrective axis of preoperative planning and predictive corrective mechanical axis value. Post-operative mechanical axis value was obtained after surgery. RESULTS This comparative study between the predictive corrective, using 3D CAD weight-bearing simulated guidance technique, and post-operative mechanical axis value, analysed with t-test statistical analysis, showed the insignificant difference ( p > 0.05). CONCLUSION We conclude that the 3D CAD weight-bearing simulated guidance technique has good accuracy as preoperative planning of open-wedge HTO for succession surgery.
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Affiliation(s)
- Bancha Chernchujit
- 1 Department of Orthopedics Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Suthee Tharakulphan
- 1 Department of Orthopedics Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,2 Department of Orthopedics, Khon Kaen Hospital, Khon Kaen, Thailand
| | - Renaldi Prasetia
- 1 Department of Orthopedics Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,3 Department of Orthopedics and Traumatology, Faculty of Medicine, University Padjadjaran, Bandung, Indonesia
| | - Nattapon Chantarapanich
- 4 Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi, Thailand
| | - Choen Jirawison
- 5 Orthopedic Department, Chachoengsao Hospital, Chachoengsao, Thailand
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Lin LJ, Akpinar B, Meislin RJ. Tibial Slope and Anterior Cruciate Ligament Reconstruction Outcomes. JBJS Rev 2020; 8:e0184. [DOI: 10.2106/jbjs.rvw.19.00184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Osteotomies around the knee for treating osteoarthritis or knee instability are currently well-established procedures. Success of these realignment procedures is based on the accuracy and the reliability of correction angles in the coronal and sagittal alignment. In this context of improving precision and adapting the correction to each patient, navigation is currently being widely used. The rationale for its use is based on understanding the advantages and limitations, technical principles, and potential pitfalls. This article describes these areas and the overall clinical outcomes of this system for knee osteotomies.
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Affiliation(s)
- Thomas Neri
- Sydney Orthopaedic Research Institute (SORI), Level 1, The Gallery 445 Victoria Avenue, Chatswood, New South Wales 2067, Australia.
| | - Darli Myat
- Sydney Orthopaedic Research Institute (SORI), Level 1, The Gallery 445 Victoria Avenue, Chatswood, New South Wales 2067, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute (SORI), Level 1, The Gallery 445 Victoria Avenue, Chatswood, New South Wales 2067, Australia
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Dorofeev A, Tylla A, Drescher W, Stangl R. [Complication analysis after angle-stable CW and OW high tibial osteotomy]. DER ORTHOPADE 2019; 49:18-25. [PMID: 31025043 DOI: 10.1007/s00132-019-03724-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a good joint-preserving alternative to joint replacement in the treatment of isolated medial varus gonarthrosis. It is, however, accompanied by a number of complications, which can compromise the outcome of the treatment. OBJECTIVES Analysis and comparison of the complication structure after angle-stable navigated closed wedge (CW) HTO and conventional angle-stable open wedge (OW) HTO, as well as determination of influence factors. MATERIAL AND METHODS 281 HTO (187 CW- and 94 OWHTO) were analyzed retrospectively. Age, sex, BMI, time of surgery and radiological parameters were included as possible influence factors. A statistical analysis was performed with binary logistic regression. RESULTS An overall complication rate of 21.4% was revealed (25.1% after CW- and 13.8% after OWHTO, p = 0.02); the major complications occurred after 13.9% CW- and 10.6% OWHTO (p = 0.27); minor complications were observed after 11.2% CW- and 3.2% OWHTO (p = 0.03). This difference results from complications specific to CWHTO (peroneal lesions and pseudarthrosis fibulae). The incidence of pseudarthrosis tibiae was equal in both procedures (7.5%). Age ≥ 52 years and body mass index (BMI) ≥ 30 kg/m2 were the relevant predictors for mechanical complications after CWHTO; these were not relevant for OWHTO. CONCLUSION The correct patient selection is essential to avoid postoperative complications after HTO. The overall complication rates are lower after OWHTO, mainly through the avoidance of complications typical for CWHTO. OWHTO offers a wider choice with respect to the selection of patients.
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Affiliation(s)
- Anton Dorofeev
- Orthopädisch-unfallchirurgische Klinik, Krankenhaus Rummelsberg Sana AG, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland.
| | - Alfred Tylla
- Orthopädisch-unfallchirurgische Klinik, Krankenhaus Rummelsberg Sana AG, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland
| | - Wolf Drescher
- Orthopädisch-unfallchirurgische Klinik, Krankenhaus Rummelsberg Sana AG, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland.,Klinik für Orthopädie, Universitätsklinikum RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Richard Stangl
- Orthopädisch-unfallchirurgische Klinik, Krankenhaus Rummelsberg Sana AG, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland
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Kuriyama S, Morimoto N, Shimoto T, Takemoto M, Nakamura S, Nishitani K, Ito H, Matsuda S, Higaki H. Clinical efficacy of preoperative 3D planning for reducing surgical errors during open-wedge high tibial osteotomy. J Orthop Res 2019; 37:898-907. [PMID: 30816588 DOI: 10.1002/jor.24263] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
Increases in posterior tibial slope (PTS) with open-wedge high tibial osteotomy (OWHTO) are often related to two surgical errors: Symmetric opening of the osteotomy gap and a tendency to open the gap from the anteromedial direction. The study objective was to define trends in these two errors using computer simulation and clinical effects of their countermeasures. First, 60 knees with varus deformity were assessed with three-dimensional (3D) planning using computed tomography to allow for the mechanical axis to pass through a point at 62.5% of the width of the tibial plateau, defined as the weight-bearing line percentage (WBL%). Anterior and posterior widths of the opening gap to maintain PTS were measured. The effect on PTS when osteotomy gaps were opened from the anteromedial direction up to 30° was evaluated. Mean anterior width (y) was 6.6 mm (range, 2.2-10.9) and mean posterior width (x) was 9.1 mm (range, 3.9-15.7), which can be expressed as y = 0.75x - 0.24. Opening gaps from the anteromedial direction at 10°, 20°, and 30° led to a mean PTS increase of 1.9°, 3.9°, and 5.6°, respectively. In most cases, WBL% with anteromedial opening at 30° passed through a point at less than 60%. In 47 knees that underwent OWHTO using 3D planning, postoperative coronal and sagittal bone corrections were mostly accurate. However, postoperative WBL% was negatively correlated with correction angle because of difficulties in predicting medial joint tightness. Preoperative 3D planning for OWHTO can reduce surgical errors, but postoperative WBL% remains variable. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Naoki Morimoto
- Department of Orthopaedic Surgery, Takashima Municipal Hospital, Shiga, Japan
| | - Takeshi Shimoto
- Faculty of Information Engineering, Department of Information and Systems Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hidehiko Higaki
- Faculty of Life Science, Department of Life Science, Kyushu Sangyo University, Fukuoka, Japan
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Navigation for lower limb alignment during internal fixation of complex tibial-plateau fractures. Orthop Traumatol Surg Res 2018; 104:491-496. [PMID: 29653241 DOI: 10.1016/j.otsr.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/17/2018] [Accepted: 03/20/2018] [Indexed: 02/02/2023]
Abstract
In complex fractures of the proximal tibial metaphysis and epiphysis, possible adverse outcomes after internal fixation include not only joint surface incongruity, but also lower limb malalignment requiring revision surgery. Navigation has been proven effective for the intraoperative control of lower limb alignment during osteotomy and knee arthroplasty. In complex traumatic fractures, temporary fixation by a locking screw plate allows sensor positioning followed by navigation maneuvers to adjust lower limb alignment. If malalignment is found, the construct can be modified economically by altering the diaphyseal fixation without modifying the metaphyseal screws. The objective of this study was to describe the use of navigation in three patients who required internal fixation of tibial-plateau fractures.
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Clinical Experience Using a 3D-Printed Patient-Specific Instrument for Medial Opening Wedge High Tibial Osteotomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9246529. [PMID: 29854810 PMCID: PMC5964591 DOI: 10.1155/2018/9246529] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/10/2018] [Accepted: 02/25/2018] [Indexed: 11/17/2022]
Abstract
Purpose High tibial osteotomy (HTO) has been adopted as an effective surgery for medial degeneration of the osteoarthritis (OA) knee. However, satisfactory outcomes necessitate the precise creation and distraction of osteotomized wedges and the use of intraoperative X-ray images to continually monitor the wedge-related manipulation. Thus HTO is highly technique-demanding and has a high radiation exposure. We report a patient-specific instrument (PSI) guide for the precise creation and distraction of HTO wedge. Methods This study first parameterized five HTO procedures to serve as a design rationale for an innovative PSI guide. Preoperative X-ray and computed tomography- (CT-) scanning images were used to design and fabricate PSI guides for clinical use. The weight-bearing line (WBL) of the ten patients was shifted to the Fujisawa's point and instrumented using the TomoFix system. The radiological results of the PSI-guided HTO surgery were evaluated by the WBL percentage and tibial slope. Results All patients consistently showed an increased range of motion and a decrease in pain and discomfort at about three-month follow-up. This study demonstrates the satisfactory accuracy of the WBL adjustment and tibial slope maintenance after HTO with PSI guide. For all patients, the average pre- and postoperative WBL are, respectively, 14.2% and 60.2%, while the tibial slopes are 9.9 and 10.1 degrees. The standard deviations are 2.78 and 0.36, respectively, in postoperative WBL and tibial slope. The relative errors of the pre- and postoperative WBL percentage and tibial slope averaged 4.9% and 4.1%, respectively. Conclusion Instead of using navigator systems, this study integrated 2D and 3D preoperative planning to create a PSI guide that could most likely render the outcomes close to the planning. The PSI guide is a precise procedure that is time-saving, radiation-reducing, and relatively easy to use. Precise osteotomy and good short-term results were achieved with the PSI guide.
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Comparison of navigated and conventional high tibial osteotomy for the treatment of osteoarthritic knees with varus deformity: A meta-analysis. Int J Surg 2018; 55:211-219. [PMID: 29555521 DOI: 10.1016/j.ijsu.2018.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/12/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a usefully surgical procedure to correct the malalignment and delay the progression of osteoarthritis. It is still controversy whether navigation system can offer more accuracy of targeted alignment and achieve better clinical outcomes than conventional method. The purpose of present meta-analysis was to investigate whether navigation system was superior to conventional method with regard to clinical and radiographic outcomes. METHOD The included studies compared the clinical and radiographic outcomes between navigated HTO group and conventional group. The clinical assessments were Lysholm Score, AKS Function Score and Arc of motion, and the radiographic outcomes were Mechanical axis (MA), Weight bearing line ratio (WBL), Outliers of alignment and Change in TPS used to evaluate alignment correction. The meta-analysis was performed using Review Manager 5.3 software. Downs and Black and the Newcastle-Ottawa Scale (NOS) were used to evaluate the study quality. RESULT Sixteen studies were eligible in present meta-analysis, including thirteen studies concerning opening wedge HTO and three studies involving closing wedge HTO. Clinical outcomes were only reported in studies which used opening wedge HTO. No significant differences were observed in all clinical outcomes between navigated and conventional HTO. Regarding radiographic outcomes, no significant difference in WBL ratio was observed between navigated and conventional HTO. Patients undergoing navigated HTO were associated with significantly greater in MA and lower in Outliers of alignment compared with those undergoing conventional HTO. Compared with conventional HTO, increase in TPS was significantly lower in navigated HTO group using opening wedge HTO, but decrease in TPS was significantly greater in navigated HTO group using closing wedge HTO. CONCLUSION Our meta-analysis demonstrated that navigated HTO offered more accuracy and precision of alignment correction, except WBL ratio. However, better clinical outcomes were not observed in navigation group.
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Effect of Computer Navigation on Accuracy and Reliability of Limb Alignment Correction following Open-Wedge High Tibial Osteotomy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3803457. [PMID: 29130040 PMCID: PMC5654296 DOI: 10.1155/2017/3803457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/06/2017] [Indexed: 11/18/2022]
Abstract
Background It is unclear whether computer navigation can improve the accuracy and reliability of targeted lower limb alignment correction following open-wedge high tibial osteotomy (HTO). This meta-analysis was designed to compare the accuracy and reliability of limb alignment correction between computer navigated and conventional open-wedge HTOs. Methods Studies that compared postoperative coronal alignment, including mechanical axis (MA) and weight bearing line (WBL) ratio, outliers of alignment correction, and change in tibial posterior slope, following open-wedge HTO performed using computer navigated and conventional methods were included. Results Ten studies were included in the meta-analysis. The MA (0.93°; 95% confidence interval [CI]: 0.45–1.41°; P < 0.001) and WBL ratio (1.5%; 95% CI: 0.03–2.98%; P = 0.048) were significantly greater for computer navigated HTO than for conventional HTO. Outliers of alignment correction after surgery were significantly lower in patients who underwent computer navigated HTO than in those who underwent conventional HTO (odds ratio: 0.25; 95% CI: 0.08–0.79; P = 0.02). Changes in posterior tibial slope from before to after surgery, however, were similar for the two approaches. Conclusion Computer navigated HTO resulted in slightly more valgus postoperative alignment and effectively reduced outliers of alignment correction but had no effect on change in posterior tibial slope when compared with conventional HTO.
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Jones LD, Brown CP, Jackson W, Monk AP, Price AJ. Assessing accuracy requirements in high tibial osteotomy: a theoretical, computer-based model using AP radiographs. Knee Surg Sports Traumatol Arthrosc 2017; 25:2952-2956. [PMID: 27056695 DOI: 10.1007/s00167-016-4092-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE High tibial osteotomy (HTO) is a recognised treatment for medial compartment knee arthritis and in recent years has regained popularity. Preoperative planning of wedge opening is based on standing AP radiographs, aiming to deliver the WBL to a desired point. Clinical results can be unpredictable, and this may be due to an inability to deliver the preoperative plan. This study explores the theoretical wedge opening accuracy required to deliver preoperative plans, based on clinical AP radiographs. METHODS A theoretical 2-D model of osteotomy was developed to determine the degree of radiological wedge opening accuracy required to deliver the weight-bearing line to a preoperative target of 62-66 % of the width of the tibial plateau. RESULTS This model suggests that, to deliver the weight-bearing line to the preoperative target on plane radiographs, the theoretical medial wedge must be opened to an accuracy of ±0.9 mm. CONCLUSION Although this study only explores a model of wedge opening based on AP radiographs, with current surgical systems, it is unlikely that the surgeon can achieve this level of accuracy within a real-life surgical setting. Surgical accuracy in HTO is known to be important for both short- and long-term clinical outcomes. This study highlights the need for improved surgical accuracy aids and/or patient stratification to mitigate the effects of surgical errors. LEVEL OF EVIDENCE II.
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Affiliation(s)
- L D Jones
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK.
| | - C P Brown
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - W Jackson
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - A P Monk
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - A J Price
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
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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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Kamada S, Shiota E, Saeki K, Kiyama T, Maeyama A, Yamamoto T. Sports and Physical Activities of Elderly Patients with Medial Compartment Knee Osteoarthritis after High Tibial Osteotomy. Prog Rehabil Med 2017; 2:20170006. [PMID: 32789213 DOI: 10.2490/prm.20170006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/26/2017] [Indexed: 11/09/2022] Open
Abstract
Objective We retrospectively investigated the preoperative and postoperative sports and physical activities (SPA) of elderly patients with medial compartment knee osteoarthritis who underwent opening-wedge high tibial osteotomy (OWHTO). Methods Fifty-six patients (62 knees) with medial compartment knee osteoarthritis were included in the study. The patients comprised 45 women and 11 men with a mean age at surgery of 71.6 years (range, 65-81 years). The mean follow-up period was 51±7 months. Patients who performed SPA to maintain their health for at least 30 min per session more than once a week were defined as SPA cases. The preoperative and postoperative ratios of SPA cases, the time to resuming or starting postoperative SPA, and the frequency of performing postoperative SPA were investigated. Clinical results were assessed using the Lysholm score. Results Fifteen patients (26.7%) performed SPA before OWHTO and 14 (25.0%) performed SPA after OWHTO (P=0.21). The mean time to resuming or starting SPA after surgery was 14.1±10.0 months, and the frequency of postoperative SPA sessions was 4.2±2.1 per week. The mean Lysholm score significantly improved from 60.8±8.9 preoperatively to 92.5±2.5 postoperatively (P<0.0001). Conclusion The ratio of patients who performed SPA after OWHTO was still <30% , and it took a comparatively long time for patients to resume or start SPA after surgery.
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Affiliation(s)
- Satoshi Kamada
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Etuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazuhiko Saeki
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takahiko Kiyama
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Akira Maeyama
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Tsukada S, Wakui M. Is overcorrection preferable for repair of degenerated articular cartilage after open-wedge high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 2017; 25:785-792. [PMID: 26017743 DOI: 10.1007/s00167-015-3655-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 05/19/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE This study was performed to determine whether the overcorrected knee could obtain a higher ratio of articular cartilage repair in the medial compartment of the femorotibial joint after open-wedge high tibial osteotomy (HTO). The hypothesis of the study was that overcorrected knees had a higher ratio of articular cartilage repair than moderately corrected knees. METHODS A total of 71 knees that underwent arthroscopy to evaluate the articular cartilage during open-wedge HTO and second-look arthroscopy were reviewed. The articular cartilage was classified as no repair or repair according to Koshino et al. Overcorrection was defined as knees with femorotibial angle ≤166°. RESULTS Second-look arthroscopy was performed 410 ± 64 days after HTO. Based on arthroscopic observations, 45 knees (63.4 %) showed no repair and 26 knees (36.6 %) showed repair. In terms of the ratio of cartilage repair, there was no difference between overcorrected knees with mean femorotibial angle of 165° ± 1° and moderately corrected knees with mean femorotibial angle of 170° ± 2° (n.s.). CONCLUSIONS No significant differences were found in the ratio of cartilage repair between overcorrected and moderately corrected knees. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo-ku, Niigata, Niigata, 950-1151, Japan.
| | - Motohiro Wakui
- Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo-ku, Niigata, Niigata, 950-1151, Japan
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Chang J, Scallon G, Beckert M, Zavala J, Bollier M, Wolf B, Albright J. Comparing the accuracy of high tibial osteotomies between computer navigation and conventional methods. Comput Assist Surg (Abingdon) 2017; 22:1-8. [PMID: 27981853 PMCID: PMC6262829 DOI: 10.1080/24699322.2016.1271909] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The accuracy of correction has been shown to be an important determinant in long-term outcomes of patients who were treated with a medial open-wedge high tibial osteotomy (HTO) who suffer from unicompartmental osteoarthritis (OA). Computer navigation systems have the potential to improve surgical precision. The purpose of this study was to compare radiographic outcomes between patients treated with a navigation system and those treated through conventional methods of assessing alignment intra-operatively. The null hypothesis was that the method of assessing the alignment intra-operatively would make no difference in the accuracy of correction. METHODS In this retrospective study, 107 patients with medial varus OA who were managed by open-wedge HTO were included. Of the 107 patients, 41 were treated using an intraoperative navigation system and 66 were treated using conventional methods. Pre-operative and post-operative single-leg, long-leg standing alignment films were used to determine the extent of pre-operative varus deformity and the post-surgical correction achieved compared to the predetermined target range. RESULTS The navigational system had eight instances of software malfunction (19.5%) intra-operatively and correction was determined using the cable method. These results were analyzed as part of the conventional group. Post-operative radiographic differences were significant between the two groups. In the navigation group, 75.8% of the patients were corrected within the target range compared to 66.2% in the conventional group. More patients were also under corrected (to the point of remaining in varus) using conventional methods compared to a navigation system. There was no statistically significant difference in the degree of correction in the sagittal plane between the two groups. Regardless of the method used for checking alignment intra-operatively, there was a statistically significant difference in post-operative weight-bearing measurements when the surgeon had intra-operative axial loading versus when they did not. CONCLUSION For coronal plane corrections, the navigation system was shown to have greater success in achieving the desired correction value and in having fewer patients who were under corrected. Despite the measurement technique a surgeon chooses to assess the accuracy of correction, axial loading the extremity in order to simulate the weight-bearing film alignment post-operatively is important to maximize the accuracy of correction needed.
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Affiliation(s)
- Justin Chang
- a University of Iowa Roy J and Lucille A Carver College of Medicine , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Greg Scallon
- b University of Minnesota Twin Cities , Department of Orthopedic Surgery , Minneapolis , MN , USA
| | - Mitch Beckert
- a University of Iowa Roy J and Lucille A Carver College of Medicine , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Jeff Zavala
- a University of Iowa Roy J and Lucille A Carver College of Medicine , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Matthew Bollier
- c University of Iowa Hospitals and Clinics , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Brian Wolf
- c University of Iowa Hospitals and Clinics , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - John Albright
- c University of Iowa Hospitals and Clinics , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
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Suero EM, Hawi N, Westphal R, Sabbagh Y, Citak M, Wahl FM, Krettek C, Liodakis E. The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints. Knee Surg Sports Traumatol Arthrosc 2017; 25:299-305. [PMID: 25743042 DOI: 10.1007/s00167-015-3553-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/24/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Intraoperative fracture of the lateral cortex fractures of the tibia is a potential complication of high tibial osteotomy (HTO), which may result in inadequate rotational alignment of the distal tibia. Our aim was to determine how rotational malalignment of the distal tibial segment distal would affect intraarticular contact pressure distribution in the knee and ankle joints. METHODS A medial, L-shaped opening-wedge HTO was performed on seven human lower body specimens. A stainless steel device with integrated load cell was used to axially load the leg. Pressure-sensitive sensors were used to measure intraarticular contact pressures. Intraoperative changes in alignment were monitored in real time using computer navigation. Measurements were performed in the native knee alignment, after 10° and 15° of alignment correction and with the distal tibia fixed at 15° of external rotation. RESULTS Moderate-to-large alignment changes after medial opening-wedge HTO resulted in a shift in intraarticular contact pressures from the medial compartment of the knee towards the lateral compartment. However, fixation of the distal tibial segment at 15° of external rotation neutralized this intended beneficial effect. In the ankle, external rotation of the distal tibia also caused a reduction in contact pressures and tibiotalar contact area. CONCLUSION Malrotation of the distal tibial fragment negates the intended effect of offloading the diseased compartment of the knee, with the contact pressures remaining similar to those of the native knee. Furthermore, malrotation leads to abnormal ankle contact pressures. Care should be taken to ensure appropriate rotational alignment of the distal tibial segment during intraoperative fixation of HTO procedures.
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Affiliation(s)
- Eduardo M Suero
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nael Hawi
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ralf Westphal
- Institute for Robotics and Process Control, Braunschweig University of Technology, Brunswick, Germany
| | - Yaman Sabbagh
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Musa Citak
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Friedrich M Wahl
- Institute for Robotics and Process Control, Braunschweig University of Technology, Brunswick, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Weinberg DS, Williamson DFK, Gebhart JJ, Knapik DM, Voos JE. Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race. Am J Sports Med 2017; 45:106-113. [PMID: 27587744 DOI: 10.1177/0363546516662449] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the anterior cruciate ligament (ACL) are common, and a number of knee morphological variables have been identified as risk factors for an ACL injury, including the posterior tibial slope (TS). However, limited data exist regarding innate population differences in the TS. PURPOSE To (1) establish normative values for the medial and lateral posterior TS; (2) determine what differences exist between ages, sexes, and races; and (3) determine how internal or external tibial rotation (as occurs during sagittal knee motion) influences the stereotactic perception of the TS. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 545 cadaveric specimens (1090 tibiae) were obtained from the Hamann-Todd osteological collection. Specimens were leveled in the coronal, sagittal, and axial planes using a digital laser. Virtual representations of each bone were created with a 3-dimensional digitizer apparatus. The TS of the medial and lateral tibial plateaus were measured using techniques adapted from previous radiographic protocols. Medial and lateral TS were then again measured on 200 tibiae that were internally and externally rotated by 10° (axially). RESULTS The mean (±SD) medial TS was 6.9° ± 3.7° posterior, which was greater than the mean lateral TS of 4.7° ± 3.6° posterior ( P < .001). Neither the medial nor lateral TS changed with age. Women had a greater mean TS compared with men on both the medial (7.5° ± 3.8° vs 6.8° ± 3.7°, respectively; P = .03) and lateral (5.2° ± 3.5° vs 4.6° ± 3.5°, respectively; P = .04) sides. Black specimens had a greater mean medial TS (8.7° ± 3.6° vs 5.8° ± 3.3°, respectively; P < .001) and lateral TS (5.9° ± 3.3° vs 3.8° ± 3.5°, respectively; P < .001) compared with white specimens. Axial rotation was shown to increase the perception of the medial and lateral TS ( P < .001). CONCLUSION The medial TS was shown to be greater than the lateral TS. Important sex- and race-based differences exist in the TS. This study also highlights the role of axial rotation in measuring the TS.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Drew F K Williamson
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeremy J Gebhart
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - James E Voos
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
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Akamatsu Y, Ohno S, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Coronal subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy. Knee 2017; 24:70-75. [PMID: 27810434 DOI: 10.1016/j.knee.2016.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 07/20/2016] [Accepted: 09/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The coronal subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). METHODS Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The subluxation-C and subluxation-L were converted to a percentage of the tibial plateau width. RESULTS The mean subluxation-C of 6.5% before OWHTO significantly increased to a mean subluxation-C of 7.3% one year after OWHTO. The mean subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in subluxation-L correlated with the change in femorotibial angle and correction loss (r=0.634, P<0.001 and r=0.463, P<0.001, respectively). CONCLUSION The proximal tibia shifted medially relative to the distal femur after OWHTO. This medial shift correlated with the correction loss. The coronal subluxation might be one cause of correction loss.
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Affiliation(s)
- Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Satoshi Ohno
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoshihiro Kusayama
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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Song SJ, Bae DK. Computer-Assisted Navigation in High Tibial Osteotomy. Clin Orthop Surg 2016; 8:349-357. [PMID: 27904715 PMCID: PMC5114245 DOI: 10.4055/cios.2016.8.4.349] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 11/25/2022] Open
Abstract
Computer-assisted navigation is used to improve the accuracy and precision of correction angles during high tibial osteotomy. Most studies have reported that this technique reduces the outliers of coronal alignment and unintended changes in the tibial posterior slope angle. However, more sophisticated studies are necessary to determine whether the technique will improve the clinical results and long-term survival rates. Knowledge of the navigation technology, surgical techniques and potential pitfalls, the clinical results of previous studies, and understanding of the advantages and limitations of the computer-assisted navigation are crucial to successful application of this new technique in high tibial osteotomy. Herein, we review the evidence concerning this technique from previous studies.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3529-3555. [PMID: 27665094 DOI: 10.1007/s00167-016-4327-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates radiographic and clinical outcome reporting following navigated high tibial osteotomy (HTO). Conventional HTO was used as a control to compare outcomes and furthermore investigate the quality of evidence in studies reporting outcomes for navigated HTO. It was hypothesized that navigated HTO will show superior clinical and radiographic outcomes compared to conventional HTO. METHODS Two independent reviewers searched PubMed, Ovid (MEDLINE), EMBASE, and Cochrane databases for studies reporting outcomes following navigated HTO. Titles, abstracts, and full-text were screened in duplicate using an a priori inclusion and exclusion criteria. Descriptive statistics were calculated using Minitab ® statistical software. Methodological Index for Nonrandomized Studies (MINORS) and Cochrane Risk of Bias Scores were used to evaluate methodological quality. RESULTS Thirty-four studies which involved 2216 HTOs were analysed in this review, 1608 (72.6 %) navigated HTOs and 608 (27.4 %) conventional HTOs. The majority of studies were of level IV evidence (16). Clinical outcomes were reported in knee and function scores or range of motion comparisons. Postoperative clinical and functional scores were improved by navigated HTO although it is not demonstrated if there is significant improvement compared to conventional HTO. Most common clinical outcome score reported was Lysholm scores (6) which report postoperative scores of 87.8 (standard deviation 5.9) and 88.8 (standard deviation 5.9) for conventional and navigation-assisted HTO, respectively. Radiographic outcomes reported commonly were weight-bearing mechanical axis, coronal plane angle, and posterior tibial slope angle in the sagittal plane. Studies have shown HTO gives significant correction of mechanical alignment and navigated HTO produces significantly less change in posterior tibial slope postoperatively compared to conventional. The mean MINORS for the 17 non-comparative studies was 9/16, and 15/24 for the 14 non-randomized comparative studies. CONCLUSION Navigation HTO results in improved mechanical axis alignment and demonstrates significantly better control over the tibial slope angle change postoperatively compared to conventional methods; however, these improvements have not yet been reflected in clinical outcome scores. Overall the studies report HTO does create significantly improved knee scores and functions compared to patients' preoperative ratings regardless of technique. Future studies on HTO outcomes need to focus on consistency of outcome reporting. LEVEL OF EVIDENCE IV.
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Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 2016; 24:3410-3417. [PMID: 26801783 DOI: 10.1007/s00167-016-3983-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 01/05/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE Medial opening wedge high tibial osteotomy (MOW HTO) is now a successful operation with a range of indications, requiring an individualised approach to the choice of intended correction. This manuscript introduces the concept of surgical accuracy as the absolute deviation of the achieved correction from the intended correction, where small values represent greater accuracy. Surgical accuracy is compared in a randomised controlled trial (RCT) between gap measurement and computer navigation groups. METHODS This was a prospective RCT conducted over 3 years of 120 consecutive patients with varus malalignment and medial compartment osteoarthritis, who underwent MOW HTO. All procedures were planned with digital software. Patients were randomly assigned into gap measurement or computer navigation groups. Coronal plane alignment was judged using the mechanical tibiofemoral angle (mTFA), before and after surgery. Absolute (positive) values were calculated for surgical accuracy in each individual case. RESULTS There was no significant difference in the mean intended correction between groups. The achieved mTFA revealed a small under-correction in both groups. This was attributed to a failure to account for saw blade thickness (gap measurement) and over-compensation for weight bearing (computer navigation). Surgical accuracy was 1.7° ± 1.2° (gap measurement) compared to 2.1° ± 1.4° (computer navigation) without statistical significance. The difference in tibial slope increases of 2.7° ± 3.9° (gap measurement) and 2.1° ± 3.9° (computer navigation) had statistical significance (P < 0.001) but magnitude (0.6°) without clinical relevance. CONCLUSION Surgical accuracy as described here is a new way to judge achieved alignment following knee osteotomy for individual cases. This work is clinically relevant because coronal surgical accuracy was not superior in either group. Therefore, the increased expense and surgical time associated with navigated MOW HTO is not supported, because meticulously conducted gap measurement yields equivalent surgical accuracy. LEVEL OF EVIDENCE I.
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