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Miltenberg B, Puzzitiello RN, Ruelos VCB, Masood R, Pagani NR, Moverman MA, Menendez ME, Ryan SP, Salzler MJ, Drager J. Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review. Am J Sports Med 2024; 52:258-268. [PMID: 36779579 DOI: 10.1177/03635465221142868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. PURPOSE To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. RESULTS A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). CONCLUSION Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
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Affiliation(s)
| | | | | | - Raisa Masood
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nicholas R Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael A Moverman
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Scott P Ryan
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew J Salzler
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Justin Drager
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Clinical Outcome after Medial Open-Wedge High Tibial Osteotomy: Comparison of Two Angular Stable Locking Plates—TomoFix™ versus LOQTEQ® HTO Plate. J Pers Med 2023; 13:jpm13030472. [PMID: 36983654 PMCID: PMC10053608 DOI: 10.3390/jpm13030472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
This study evaluated bony healing and clinical results after medial open-wedge HTO to compare the outcome of the LOQTEQ® HTO plate and the TomoFix™ internal plate fixator. A prospective, non-randomised, comparative study was undertaken. The same surgical technique for the medial open-wedge HTO was used in two treatment groups. In Group 1, the TomoFix™ implant was used for osteosynthesis, and, in Group 2, the LOQTEQ® HTO plate was used. All patients were examined before surgery (T0) and then at 12 months (T1) and at 24 months (T2) postoperatively. The primary outcome measure was the KOOS pain subscore. The secondary outcome criteria were other KOOS subscales, the Tegner score, radiological healing (RUST), and incision length. The KOOS pain subscale and the other KOOS subscores increased significantly in both groups from T0 to T1 and T2 without a significant group difference at each timepoint. The activity measured with the Tegner scale increased significantly from T0 to T2 without a significant group difference. No radiological signs of implant failure were observed in any case at the one-year X-ray, and no patient fulfilled the criteria for non-union. There was no significant difference in the frequency of adverse effects between the two treatment groups. The length of the incision was significantly shorter in the LOQTEQ® HTO group than in the TomoFix™ group. The results of this study show that patient-related outcome scores (KOOS, Tegner) increased after medial open-wedge HTO. There was no difference in clinical outcome or radiological healing between the treatment groups. Both plates are suitable for the osteosynthesis of open-wedge HTO.
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Superior survivorship and plate-related results of TomoFix compared to Puddu plate fixation for opening-wedge high tibial osteotomy: A systematic review of the literature. Knee 2023. [PMID: 36863116 DOI: 10.1016/j.knee.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE This systematic review aimed to compare survivorship and plate-related results of Puddu and TomoFix plates in opening-wedge high tibial osteotomy (OWHTO). METHODS PubMed, Scopus, EMBASE, and CENTRAL databases were searched from January 2000 until September 2021 for clinical studies involving patients with medial compartment knee disease and varus deformity undergoing OWHTO using the Puddu or TomoFix plating systems. We extracted survival data, plate-related complications, and functional and radiological outcomes. The risk of bias assessment had been carried out using Cochrane Collaboration's quality assessment tool for randomised controlled trials (RCTs) and Methodological Index for Non-Randomised Studies (MINORS). RESULTS Twenty-eight studies were included. The total number of knees was 2568 in 2372 patients. The Puddu plate was used in 677 knees, while the TomoFix plate was used in 1891. The follow-up ranged from 5.8 to 147.6 months. Both plating systems were able to delay conversion to arthroplasty at different follow-up intervals. However, osteotomies fixed by the TomoFix plate achieved higher survival rates, especially at mid-term and long-term follow-ups. In addition, fewer complications were reported with the TomoFix plating system. Although both implants achieved satisfactory functional outcomes, high scores could not be maintained throughout long-term intervals. Regarding radiological results, TomoFix plate was able to achieve and maintain larger degrees of varus deformity, while preserving the posterior tibial slope. CONCLUSIONS This systematic review demonstrated the superiority of the TomoFix over the Puddu system as a safer and more effective fixation device in OWHTO. Nevertheless, these results should be interpreted with caution due to the lack of comparative evidence through high-quality RCTs.
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Ping H, Wen J, Liu Y, Li H, Wang X, Kong X, Chai W. Unicompartmental knee arthroplasty is associated with lower pain levels but inferior range of motion, compared with high tibial osteotomy: a systematic overview of meta-analyses. J Orthop Surg Res 2022; 17:425. [PMID: 36153554 PMCID: PMC9509560 DOI: 10.1186/s13018-022-03319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to overview the findings of reported meta-analyses on unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 (PRISMA 2020) guidelines were followed. Two independent reviewers conducted a literature search of PubMed, Embase, the Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses comparing UKA and HTO that were published prior to September 2021. Literature screening, data extraction, and article quality appraisal were performed according to the study protocol registered online at PROSPERO (CRD42021279152). Results A total of 10 meta-analyses were identified, and different studies reported different results. Five of the seven meta-analyses showed that the proportion of subjects with excellent or good functional results was higher for UKA than for HTO. All three meta-analyses showed that UKA was associated with lower pain levels, and all six of the studies that included an analysis of range of motion (ROM) reported that UKA was inferior to HTO. Four of the eight meta-analyses found that total complication rates were lower for UKA. Only 3 of the 10 meta-analyses found that UKA had lower revision rates. Moreover, in the subgroup analysis, the revision and complication rates of UKA were similar to those of opening-wedge HTO but much lower than those of closing-wedge HTO. Conclusions Compared to HTO, UKA was associated with lower pain levels but inferior postoperative ROM. The results were inconclusive regarding whether UKA yielded better knee function scores and lower revision or complication rates than HTO. Accurate identification of indications and appropriate patient selection are essential for treating individuals with OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03319-7.
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Kondo E, Yabuuchi K, Joutoku Z, Matsubara S, Iwasaki K, Matsuoka M, Onodera T, Momma D, Inoue M, Yagi T, Iwasaki N, Yasuda K. Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy. Am J Sports Med 2022; 50:2439-2452. [PMID: 35762976 DOI: 10.1177/03635465221104708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies have reported that medial opening wedge (OW) high tibial osteotomy (HTO) induces patella baja, resulting in degenerative changes in the patellofemoral joint. We have developed an inverted V-shaped (iV) HTO, which is classified as a neutral wedge osteotomy. HYPOTHESES The study hypotheses were as follows: (1) patellar height, posterior tibial slope, and tibial length will not change between pre- and postoperative evaluations after iV-HTO; (2) the lateral shift ratio of the patella and the distance between the tibial tubercle and the trochlear groove may be significantly decreased after iV-HTO. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 191 patients (220 knees) who underwent HTO for medial osteoarthritis were enrolled retrospectively in this study: 107 knees underwent OW-HTO and 113 knees underwent iV-HTO. Clinical and radiological evaluations were performed before and at least 3 years after surgery. RESULTS Postoperatively, the mean Caton-Deschamps ratio was significantly decreased (P < .0001) from 0.95 to 0.79 in the OW group, while there were no significant changes in the iV group. The mean posterior tibial slope was significantly increased (P < .0001) from 8.5° to 10.5° in the OW group, while there were no significant differences in the iV group. Although the entire leg length was significantly increased (P < .0003) in both groups after HTO, there were no significant differences in tibial length between the pre- and postoperative periods in the iV group. Regarding the congruity of the patellofemoral joint, the mean lateral shift ratio did not significantly change in the OW group, whereas it was significantly decreased (P = .0012) from 11.5% to 8.8% in the iV group. The mean tibial tubercle-trochlear groove distance was significantly decreased (P < .0001) from 12.8 to 9.7 mm in the iV group, while it was significantly increased in the OW group (P < .0001). Concerning the clinical outcome, the Japanese Orthopaedic Association (JOA) and Lysholm knee scores at final follow-up (OW vs iV: JOA, 91.2 vs 90.1; Lysholm, 92.5 vs 89.0) were significantly increased (P < .0001) as compared with the preoperative values (OW vs iV: JOA, 68.3 vs 66.8; Lysholm, 67.9 vs 61.0). CONCLUSION Patellar height, posterior tibial slope, and tibial length did not change after the iV-HTO, while they were significantly changed after the OW-HTO. Although the preoperative degrees of varus knee and patellofemoral osteoarthritis were more severe in the iV group than the OW group, the iV-HTO led to altered patellofemoral joint congruity.
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Affiliation(s)
- Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Yabuuchi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Zenta Joutoku
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinji Matsubara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Sapporo, Japan
| | - Tomonori Yagi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Yasuda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, Sapporo, Japan
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Miettinen SSA, Miettinen HJA, Jalkanen J, Joukainen A, Kröger H. Long-term follow-up results of medial opening wedge high tibia osteotomy with a pre-countered non-locking steel plate. Arch Orthop Trauma Surg 2022; 142:3111-3121. [PMID: 33977314 PMCID: PMC9522840 DOI: 10.1007/s00402-021-03927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/29/2021] [Indexed: 12/04/2022]
Abstract
INTRODUCTION This retrospective study investigated the long-term follow-up results of medial opening wedge high tibial osteotomy (MOWHTO) with a pre-countered non-locking steel plate implant (Puddu plate = PP) used for medial knee osteoarthrosis (OA) treatment. MATERIALS AND METHODS Consecutive 70 MOWHTOs (66 patients) were performed between 01.01.2004 and 31.12.2008 with the mean follow-up time of 11.4 (SD 4.5; range 1.2-16.1) years. The Kaplan-Meier survival analysis was used to evaluate the cumulative survival of the implant in terms of age (< 50 years old and ≥ 50 years old) and gender. Adverse events were studied and Cox regression analysis was used to evaluate risk factors [age, gender, body mass index (BMI), preoperative mechanical axis, severity of OA, use of bone grafting or substitution and undercorrection of mechanical axis from varus to valgus] for revisions. RESULTS The estimates for the cumulative survival with no need for TKA after MOWHTO were 86% at 5 years, 67% at 10 years and 58% at 16.1 years (SE 0.6, CI 95% 11.1-13.5). A total of 33/70 (47%) adverse events occurred and 38/70 (54%) knees required some revision surgery during the follow-up. Cox regression did not show any statistically significant risk factors for revision. CONCLUSIONS The PP has feasible MOWHTO results with a cumulative survival of 67% at 10 years with no need for conversion to TKA. Many adverse events occurred and revision rate due to any reason was high. Age or gender did not have statistically significant differences in terms of survival.
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Affiliation(s)
- Simo S A Miettinen
- Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland.
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.
| | - Hannu J A Miettinen
- Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
| | - Jussi Jalkanen
- Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
| | - Antti Joukainen
- Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
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Balta O, Eren MB, Öztürk T, Altınayak H. Long-term results of the subtubercle tibial osteotomy using the circular external fixator for medı̇al compartment osteoarthrı̇tı̇s of knee. Knee 2022; 34:147-155. [PMID: 34922316 DOI: 10.1016/j.knee.2021.11.011] [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: 06/01/2021] [Revised: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND We evaluated the long-term clinical and radiographic outcomes of patients who underwent subtubercular tibial osteotomy (STO) with Ilizarov external fixation used for high tibial osteotomy for medial knee osteoarthritis (MKOA). METHODS Between October 2003 and December 2011, 42 knees of 40 patients who had undergone STO with Ilizarov external fixator with a diagnosis of MKOA were evaluated. Survival analysis was performed by examining the duration of total knee arthroplasty (TKA). Clinical and radiological variables were collected at the time of admission after removal of the fixator and at outpatient follow up. RESULTS Mean age was 49.3 ± 5.68 (range 37-61) years, mean postoperative follow up time was 14.22 ± 2.93 (range 9-18) years, and mean fixator duration was 14.6 (range 13-20) weeks. Survival analysis showed 100% at 5 years, 95.2% at 10 years and 88.1% at 15 years. Clinical examination of the patients showed significant improvement in American Knee Society score (KSS), KSS functional score and Oxford Knee Score (OKS) score (P = 0.005). In the study, it was observed that the patients' knee osteoarthritis had progressed over time. On examination, radiographic measurements including mechanical axis deviation, medial proximal tibial angle, femorotibial angle, and joint line alignment angle improved significantly after deformity correction (P = 0.001). CONCLUSION STO using the Ilizarov method offers long-term survival. It provides effective treatment in young patients with isolated MKOA. Achieving the desired amount of correction in the coronal and sagittal planes can be presented as a surgical technique for the treatment of MKOA as an effective method in clinical and radiological correction.
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Affiliation(s)
- Orhan Balta
- Gaziosmanpaşa University, School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Mehmet Burtaç Eren
- Gaziosmanpaşa University, School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Tahir Öztürk
- Gaziosmanpaşa University, School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Harun Altınayak
- Health Sciences University, Samsun Training and Research Hospital, Department of Orthopedics and Traumatology, Samsun, Turkey.
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Okimura S, Teramoto A, Watanabe K, Nuka S, Kamiya T, Yamashita T. Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block. J Knee Surg 2021; 34:997-1001. [PMID: 31931551 DOI: 10.1055/s-0039-1700977] [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] [Indexed: 02/07/2023]
Abstract
We developed a new internal fixator: a rigid T: -shaped plate with locking screws and wedge-shaped spacer block for high tibial osteotomy. The purpose of the present study was to evaluate the radiographic outcome of opening-wedge high tibial osteotomy (OWHTO) using this new internal fixator. Sixty OWHTOs were performed in patients with medial compartment osteoarthritis and varus deformity (28 males and 23 females). Patients' mean age was 60.4 years. Preoperative and postoperative radiographs were obtained. The paired t-test was used to evaluate the differences over time with respect to radiographic variables. Union of the osteotomy gap was obtained in all patients, and no implant breakage was found. On anterior-posterior radiographs, a significant difference was observed (p < 0.01) between the preoperative and postoperative mean values of femorotibial angles (179.6 ± 3.2 vs. 170.6 ± 2.5 degrees), weight-bearing line ratios (23.8 ± 13.5 vs. 60.5 ± 11.5%), anatomical medial proximal tibial angles (84.8 ± 2.5 vs. 91.0 ± 2.6 degrees), and joint line coverage angles (3.6 ± 2.0 vs. 2.4 ± 1.7 degrees). On lateral radiographs, posterior tibial slopes were 11.5 ± 3.9 degrees preoperatively and 12.2 ± 4.0 degrees postoperatively (p < 0.01), and Insall-Salvati ratios were 1.04 ± 0.12 preoperatively and 1.06 ± 0.13 postoperatively (p = 0.24). Performing OWHTO using a new internal fixator with a wedge-shaped spacer achieves adequate correction of lower limb alignment without implant-related complications. This is a Level IV, case series study.
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Affiliation(s)
- Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan
| | - Satoshi Nuka
- Department of Orthopaedic Surgery, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Kameda T, Kondo E, Onodera T, Iwasaki K, Onodera J, Yasuda K, Iwasaki N. Changes in the Contact Stress Distribution Pattern of the Patellofemoral Joint After Medial Open-Wedge High Tibial Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry. Orthop J Sports Med 2021; 9:2325967121998050. [PMID: 33997060 PMCID: PMC8072873 DOI: 10.1177/2325967121998050] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Medial open-wedge high tibial osteotomy (OWHTO) theoretically causes distalization and lateralization of the tibial tuberosity and the patella. PURPOSE/HYPOTHESIS The purpose of the study was to identify any changes in the stress distribution of subchondral bone density across the patellofemoral (PF) joint before and after OWHTO through the use of computed tomography (CT) osteoabsorptiometry. We hypothesized that OWHTO would alter the distribution of contact stress in the PF joint. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 17 patients (17 knees) who underwent OWHTO were enrolled in this study between September 2013 and September 2015. All patients underwent radiologic examination preoperatively and at 1 year postoperatively, and the distribution patterns of subchondral bone density through the articular surface of the femoral trochlea and patella were assessed preoperatively and >1 year postoperatively using CT osteoabsorptiometry. The quantitative analysis of the obtained mapping data focused on location of the high-density area (HDA) through the articular surface of the PF joint. The percentage of HDA at each divided region of the articular surface of the femoral trochlea and the patella was calculated. RESULTS In the radiologic evaluation, the Blackburne-Peel ratio was significantly reduced (P < .001) after surgery, and the tilting angle of the patella was significantly decreased (P < .001). On CT evaluation, the percentage of HDA in the lateral notch and lateral trochlea of the femur and in the medial portion of the lateral facet of the patella increased significantly after OWHTO surgery (P ≤ .038). CONCLUSION OWHTO significantly increased the stress distribution pattern of the lateral trochlea of the femur and the medial portion of the lateral facet of the patella. The procedure significantly lowered the patellar height and significantly decreased the patellar tilting angle after surgery.
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Affiliation(s)
- Toshiaki Kameda
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Jun Onodera
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Kazunori Yasuda
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Igarashi K, Yamamoto N, Hayashi K, Matsubara H, Takeuchi A, Miwa S, Tsuchiya H. Distal Tibial Tuberosity Focal Dome Osteotomy Combined With Intra-Articular Condylar Osteotomy (Focal Dome Condylar Osteotomy) for Medial Osteoarthritis of the Knee Joint. Arthrosc Tech 2020; 9:e1079-e1086. [PMID: 32874886 PMCID: PMC7451708 DOI: 10.1016/j.eats.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/02/2020] [Indexed: 02/03/2023] Open
Abstract
High tibial osteotomy for medial-compartment knee osteoarthritis (OA) is an established biological knee reconstruction surgical procedure. In open- and closed-wedge high tibial osteotomy, the angulation correction axes are away from the center of rotation and angulation. This results in translation deformity, which alters the orientation of the adjacent joint and the length of the limb. In the present study, we combined the distal tibial tuberosity focal dome osteotomy centered on the center of rotation and angulation with the longitudinal condylar osteotomy (focal dome condylar osteotomy) for knee OA. The advantages of this procedure are as follows: physiological orientation of adjacent joint is achieved; limb length is maintained; joint stabilization in the coronal plane is achieved; patella infra is prevented; sufficient bone contact between the medial and posterior cortex is achieved; early weight-bearing walking is possible; and fibular osteotomy is not required. This study describes the details of the surgical procedure, including our compass cutter for accurate dome osteotomy and the postoperative rehabilitation program for patients with knee OA and moderate-to-severe varus deformity.
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Affiliation(s)
- Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | | | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
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Kang T, Lee DW, Park JY, Han HS, Lee MC, Ro DH. Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:1365-1371. [PMID: 30809721 DOI: 10.1007/s00167-019-05439-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/22/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Popliteal artery injury is a rare but devastating complication of open-wedge high tibial osteotomy (OWHTO). The objectives of this study were: to document the location of the artery in the virtual osteotomy plane (VOP), to measure the minimal distance between the popliteal artery and three virtual saw-progression lines (VSLs), and to present a safe sawing technique for OWHTO. METHOD In total, 45 computed tomography angiographies were reconstructed and virtual osteotomy was simulated using 3D image-processing software. The VOP was defined as an inclined plane commencing 3.5 cm below the articular plane towards the fibular head. VSLs were defined as saw-progression guidelines that lie on the VOP: "VSL-mid" runs from the midpoint of the tibial medial cortex towards the fibular head; "VSL-ant" starts from the same point as VSL-mid, but runs 10° anterior to the fibular head; and "VSL-post" runs 10° posterior to the fibular head. The distances between the popliteal artery and the three VSLs were measured, and the risk of injury was assessed. RESULTS The popliteal artery was located 20.7° posterior to VSL-mid and 51 mm from the starting point. The minimum distance between the popliteal artery and VSL-mid was 18 mm (99% confidence interval 9-27 mm). When the saw was moved along VSL-mid, 42% of the arteries were susceptible to injury. However, when it followed VSL-ant, there was no risk of injury. CONCLUSIONS Sawing toward the fibular head carries a risk of popliteal artery injury and should not be performed. When sawing in OWHTO, the recommended target should be 10° anterior to the fibular head. This technique eliminates the risk of popliteal artery injury.
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Affiliation(s)
- Taehoon Kang
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jae Young Park
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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High Tibial Osteotomy: Review of Techniques and Biomechanics. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:8363128. [PMID: 31191853 PMCID: PMC6525872 DOI: 10.1155/2019/8363128] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022]
Abstract
High tibial osteotomy becomes increasingly important in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. HTO produces a postoperative valgus limb alignment with shifting the load-bearing axis of the lower limb laterally. However, maximizing procedural success and postoperative knee function still possess many difficulties. The key to improve the postoperative satisfaction and long-term survival is the understanding of the vital biomechanics of HTO in essence. This review article discussed the alignment principles, surgical technique, and fixation plate of HTO as well as the postoperative gait, musculoskeletal dynamics, and contact mechanics of the knee joint. We aimed to highlight the recent findings and progresses on the biomechanics of HTO. The biomechanical studies on HTO are still insufficient in the areas of gait analysis, joint kinematics, and joint contact mechanics. Combining musculoskeletal dynamics modelling and finite element analysis will help comprehensively understand in vivo patient-specific biomechanics after HTO.
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Kim YS, Kim YB, Koh YG. Prognostic Factors Affecting Correction Angle Changes After Supramalleolar Osteotomy Using an Opening Wedge Plate for Varus Ankle Osteoarthritis. J Foot Ankle Surg 2019; 58:417-422. [PMID: 30745268 DOI: 10.1053/j.jfas.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 02/03/2023]
Abstract
Supramalleolar osteotomy (SMO) has been suggested as an effective salvage treatment for varus ankle osteoarthritis. To identify the prognostic factors affecting the correction angle changes after SMO, a total of 53 consecutive patients (58 ankles) were evaluated retrospectively. Clinical and radiologic outcomes were evaluated, and statistical analyses were performed to identify the prognostic factors associated with the clinical and radiologic outcomes. The mean visual analogue scale scores and the American Orthopaedic Foot and Ankle Society scores improved significantly at the final follow-up (both p <.001). The mean tibial-ankle surface (TAS), talar tilt (TT), and tibial-lateral surface angles improved significantly after surgery, compared with the preoperative assessments (all, p <.001). However, at the final follow-up, these angles had changed significantly, compared with their immediate postoperative values (all p <.001), and the changes in the TAS and TT angles significantly influenced the clinical outcomes at the final follow-up (both p <.05). Male sex, high body mass index (≥26.4 kg/m2), and the existence of the lateral cortex breakages were significantly associated with the changes in the TAS and TT angle (all p <.05). Therefore, surgeons should consider these prognostic factors before performing SMO.
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Affiliation(s)
- Yong Sang Kim
- Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
| | - Yong Beom Kim
- Professor, Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Yong Gon Koh
- Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
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Han SB, In Y, Oh KJ, Song KY, Yun ST, Jang KM. Complications Associated With Medial Opening-Wedge High Tibial Osteotomy Using a Locking Plate: A Multicenter Study. J Arthroplasty 2019; 34:439-445. [PMID: 30503322 DOI: 10.1016/j.arth.2018.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group. METHODS This study enrolled 209 patients who underwent medial opening-wedge high tibial osteotomy between 2010 and 2015. Patients with a follow-up period of at least 2 years were enrolled. Medical records and radiologic data were retrospectively reviewed. The complications were assessed up to postoperative 2 years and categorized into major and minor complications. The preoperative and postoperative clinical statuses were assessed using the Western Ontario McMaster University Osteoarthritis Index. RESULTS The mean patient age was 56.4 ± 5.9 years. Overall complication rate was 29.7%. Minor complications included undisplaced lateral hinge fracture (12.0%), hardware irritation (1.4%), displaced lateral hinge fracture (2.4%), delayed wound healing (1.9%), undisplaced lateral tibial plateau fracture (1%), and superficial wound infection (1%). Major complications were symptomatic hardware which needed hardware removal (4.8%), deep wound infection (1.9%), hardware failure with correction loss (1%), nonunion (0.5%), and early conversion to arthroplasty (0.5%). Most complications occurred intraoperatively (30.6%) and within 3 months postoperatively (40.3%). The major complication group showed a statistically higher Western Ontario McMaster University Osteoarthritis Index score than did other groups at postoperative 1 year (P = .013) and 2 years (P = .001). CONCLUSION The overall complication rate was 29.7%. Most complications were minor. The most common complication was undisplaced lateral hinge fracture. Major complications occurred in 8.6%. The major complication group showed significantly worse clinical outcomes than did the uncomplicated and minor complication groups.
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University School of Medicine, Seoul, South Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Kwang Jun Oh
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Kwang Yun Song
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Seok Tae Yun
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University School of Medicine, Seoul, South Korea
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Kondo E, Yasuda K, Yabuuchi K, Aoki Y, Inoue M, Iwasaki N, Yagi T. Inverted V-Shaped High Tibial Osteotomy for Medial Osteoarthritic Knees With Severe Varus Deformity. Arthrosc Tech 2018; 7:e999-e1012. [PMID: 30377579 PMCID: PMC6203232 DOI: 10.1016/j.eats.2018.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/08/2018] [Indexed: 02/03/2023] Open
Abstract
A hemi-closing-wedge and hemi-opening-wedge, inverted V-shaped high tibial osteotomy with local bone graft has been reported to be an effective surgical procedure for medial osteoarthritis of the knee. In this procedure, an inverted V-shaped osteotomy is made and a thin wedged bone block is resected from the lateral side and implanted in the medial opening space created after valgus correction. This procedure can provide sufficient valgus correction of the knee with severe varus deformity more easily than can closing-wedge high tibial osteotomy. The inverted V-shaped osteotomy does not change the posterior tibial slope, the patellar height, or the length of the lower limb at all because the center of tibial alignment correction by the inverted V-shaped osteotomy is located near the center of rotation of angulation of the lower-limb deformity. We recently modified this procedure by performing biplanar osteotomy, developing useful cutting guides, and fixing the tibia with a lateral locking compression plate. The surgical technique is described to enable the reproducible creation of the hemi-closing-wedge and hemi-opening-wedge, inverted V-shaped osteotomy with the locking plate for medial osteoarthritic knees with moderate or severe varus deformity.
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Affiliation(s)
- Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Address correspondence to Eiji Kondo, M.D., Ph.D., Department of Advanced Therapeutic Research for Sports Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Kazunori Yasuda
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Koji Yabuuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimitsu Aoki
- Department of Orthopaedic Surgery, Hokushin Orthopaedic Hospital, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomonori Yagi
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
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Corrective osteotomies of the lower limb show a low intra- and perioperative complication rate-an analysis of 1003 patients. Knee Surg Sports Traumatol Arthrosc 2018; 26:1867-1872. [PMID: 28493074 DOI: 10.1007/s00167-017-4566-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/03/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of corrective osteotomies in posttraumatic and congenital deformities is anatomic limb reconstruction and joint preservation. The aim of the present study was to analyse intra- and perioperative complications of osteotomies in the lower limb. METHODS One thousand and three unselected and prospectively registered osteotomies of the long bones of the lower limb, performed between 1995 and 2013, were analysed. In 435 women and 568 men (mean age 39.8 years), 478 correction osteotomies were performed femoral and 525 tibial; 696 osteotomies were performed using the oscillating saw, 42 using the Gigli saw and 265 using drill hole/chisel osteoclasis. A total of 869 deformities were corrected in the acute setting and 134 were corrected continuously via callotaxis. RESULTS Seventeen (1.7%) major complications requiring revision surgeries were detected: 4 arterial injuries, 2 haematomas, 4 compartment syndromes and 7 deep wound infections. All vascular injuries 4 (0.7%) occurred in osteotomies around the knee (n = 563). Nineteen (1.9%) minor complications could be managed by conservative means: 3 (0.3%) deep vein thromboses and 16 (1.6%) superficial wound infections. No osteomyelitis, pulmonary embolism or death occurred. Gigli saw osteotomy was stained by a higher infection rate. In male patients (p = 0.02), posttraumatic deformities (ns) and continuous procedures (p = 0.025) have a higher risk of superficial infections. No further risks were detected for age, weight, smoking habit and anatomic level of surgery. CONCLUSION Osteotomies around the knee show a very low complication rate. Less aggressive oscillating saws, saw blades and drills are recommended. Vascular injuries, compartment syndromes and deep infections are limb-threatening emergencies demanding fast and determined interventions. LEVEL OF EVIDENCE Prospective cohort study, Level III.
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Warner SJ, O'Connor DP, Brinker MR. Subtubercle Osteotomy for Medial Compartment Osteoarthritis of the Knee Using Ilizarov Technique: Survival Analysis and Clinical Outcomes. J Bone Joint Surg Am 2018; 100:e1. [PMID: 29298263 DOI: 10.2106/jbjs.16.01623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High tibial osteotomy with acute correction and internal fixation can be used to correct malalignment and malorientation and reduce symptoms in patients with medial compartment osteoarthritis of the knee. To address the inadequacies of this technique, we performed a series of subtubercle tibial osteotomy (STO) procedures using circular ring fixation to correct knee varus malalignment and joint malorientation. The purpose of this study was to analyze the ability of this technique to delay subsequent knee arthroplasty and decrease symptoms. METHODS Sixty-one patients had a total of 72 STO procedures using the Ilizarov technique to correct a varus deformity of the proximal part of the tibia. Radiographic measurements were performed at the time of presentation and after osseous union and frame removal. Clinical and radiographic variables were compared from presentation to the time of the latest follow-up. We performed a survival analysis, and our primary outcome was the time to conversion to knee arthroplasty. RESULTS Radiographic measurements, including mechanical axis deviation, medial proximal tibial angle, and joint line congruence angle, significantly improved after deformity correction (p < 0.001 for all). In patients with a preoperative flexion contracture, the proximal posterior tibial angle significantly increased toward normal values (mean, 77.8° pretreatment versus 82.4° posttreatment; p = 0.007). Survival analysis demonstrated a rate of native knee-joint survival without conversion to arthroplasty of 94.2% (95% confidence interval [CI], 83% to 98%) at 5 years, 84.0% (95% CI, 69% to 92%) at 10 years, and 51.3% (95% CI, 28% to 71%) at 15 years. In addition, time-trade-off and Brief Pain Inventory outcomes significantly improved (p < 0.001). The complication rate was 8%. CONCLUSIONS STO procedures using the Ilizarov technique for symptomatic varus knee deformity, performed over the course of 18 years, resulted in high knee survival rates without arthroplasty and significant improvement in clinical status. The STO technique provides several advantages over acute correction with internal fixation through a conventional high tibial osteotomy, including maintenance of the patellofemoral relationship, no retained implants, and accurate coronal and sagittal plane corrections. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stephen J Warner
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Mark R Brinker
- Center for Problem Fractures and Limb Restoration, Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas
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Moorman CT, Kirwan T, Share J, Vannabouathong C. Patient Preferences Regarding Surgical Interventions for Knee Osteoarthritis. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2017; 10:1179544117732039. [PMID: 28974919 PMCID: PMC5613842 DOI: 10.1177/1179544117732039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/16/2017] [Indexed: 11/17/2022]
Abstract
Surgical interventions for knee osteoarthritis (OA) have markedly different procedure attributes and may have dramatic differences in patient desirability. A total of 323 patients with knee OA were included in a dual response, choice-based conjoint analysis to identify the relative preference of 9 different procedure attributes. A model was also developed to simulate how patients might respond if presented with the real-world knee OA procedures, based on conservative assumptions regarding their attributes. The “amount of cutting and removal of the existing bone” required for a procedure had the highest preference score, indicating that these patients considered it the most important attribute. More specifically, a procedure that requires the least amount of bone cutting or removal would be expected to be the most preferred surgical alternative. The model also suggested that patients who are younger and report the highest pain levels and greatest functional limitations would be more likely to opt for surgical intervention.
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Affiliation(s)
- Claude T Moorman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tom Kirwan
- Bruno and Ridgway Research Associates, Inc., Lawrenceville, NJ, USA
| | - Jennifer Share
- Bruno and Ridgway Research Associates, Inc., Lawrenceville, NJ, USA
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Polat G, Balcı Hİ, Çakmak MF, Demirel M, Şen C, Aşık M. Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. J Orthop Surg Res 2017; 12:44. [PMID: 28302132 PMCID: PMC5356246 DOI: 10.1186/s13018-017-0547-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/08/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis. METHODS A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments. RESULTS In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan-Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients. CONCLUSIONS HTO has acceptable long-term clinical and functional results that should not be underestimated by orthopedic surgeons under pressure to perform arthroplasty operations.
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Affiliation(s)
- Gökhan Polat
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
| | - Halil İbrahim Balcı
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Mehmet Fevzi Çakmak
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Cengiz Şen
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Mehmet Aşık
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
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Moore J, Mychaltchouk L, Lavoie F. Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:846-852. [PMID: 26724826 DOI: 10.1007/s00167-015-3954-4] [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: 04/21/2015] [Accepted: 12/15/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical potential of a new measurement technique for open-wedge high tibial osteotomy (HTO) based on the medial cortex opening (MCO) associated with the Miniaci preoperative planning technique. METHODS A retrospective review of 97 cases of valgus-producing HTO that were performed between 2008 and 2013, using the intra-operative fluoroscopic mechanical axis technique, was carried out. The Miniaci-based measurement technique was then used as a theoretical point of comparison with the intent to compare the disparity between postoperative and ideal lower extremity (LE) mechanical axis with the measured disparity between postoperative and Miniaci-based planned MCO. RESULTS A significant correlation was observed for the comparison of the disparity between postoperative and Miniaci-based planned MCO and the disparity between postoperative and ideal LE mechanical axis (0.53, P = 0.001). This would suggest that the MCO associated with the Miniaci preoperative planning technique would have resulted in a better alignment had it been the chosen method to guide the amount of osteotomy opening. No significant correlation was observed between perioperative and postoperative LE mechanical axis (n.s.), the variable on which the current technique is based, confirming the poor reliability of the fluoroscopic mechanical axis technique. CONCLUSIONS This study suggests a more accurate and precise technique of realizing the appropriate angular correction when performing a HTO, which could lead to better clinical outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- James Moore
- Orthopedic Surgery Division, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Street East, Montreal, H2L 4M1, Quebec, Canada.
| | - Lydia Mychaltchouk
- Orthopedic Surgery Division, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Street East, Montreal, H2L 4M1, Quebec, Canada
| | - Frédéric Lavoie
- Orthopedic Surgery Division, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Street East, Montreal, H2L 4M1, Quebec, Canada
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Ten-year results of physical activity after high tibial osteotomy in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2017; 25:902-909. [PMID: 26170187 DOI: 10.1007/s00167-015-3693-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose was to describe physical activity with respect to leisure and working activity in patients operated on by high tibial osteotomy using the hemicallotasis technique for knee osteoarthritis (OA), preoperatively and 10 years postoperatively. METHODS Seventy-nine patients, median age 55 (range 35-66), operated on by high tibial osteotomy using the hemicallotasis technique for knee OA 2001-2003 were included. Questionnaires for evaluation of physical and working activity, satisfaction as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) were filled in preoperatively and 2 and 10 years postoperatively. Conversion to knee arthroplasty was obtained through the Swedish Knee Arthroplasty Register. Changes between two postoperative measurements were assessed by Wilcoxon's rank test. RESULTS Twenty-five patients were converted to a total knee arthroplasty, and nine patients were lost to follow-up during the 10 years, resulted in 45 patients available for follow-up. Preoperatively, 33/45 patients were physically active mainly in heavy yard/household work, and 43/45 patients were working active. Ten years after the HCO, 23/45 patients were still active with golf, dancing, hiking, etc., and 23/45 were retired. At 10 years postoperatively compared to 2 years postoperatively, the patients experienced more problems with pain (89 compared to 69, p = <0.0001). Of 45 patients, 36 were satisfied with the high tibial osteotomy surgery in general 10 years postoperatively, while 13/45 were satisfied with their sport and recreational function. CONCLUSIONS The 10-year results indicate that high tibial osteotomy using the hemicallotasis technique for knee OA is an option for selected patients that improves the level of physical activity, with mild deterioration over time, and gives the majority of the patients the possibility to be working active until retirement. LEVEL OF EVIDENCE Level IV.
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Ekeland A, Nerhus TK, Dimmen S, Thornes E, Heir S. Good functional results following high tibial opening-wedge osteotomy of knees with medial osteoarthritis: A prospective study with a mean of 8.3years of follow-up. Knee 2017; 24:380-389. [PMID: 28081898 DOI: 10.1016/j.knee.2016.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/07/2016] [Accepted: 12/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To report time dependent functional improvement and predictive risk factors for failure when the load in varus knees with medial osteoarthritis is shifted from the medial to the lateral knee compartment. METHODS Forty-nine consecutive patients (52 knees), mean age 47 (31-64) years, underwent a high tibial opening-wedge valgus osteotomy stabilized with a Puddu plate and bone grafting. The patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at three and six months, one, two, five and 10years postoperatively with a mean follow-up time of 8.3years (2.0-10.6). RESULTS Mean angular correction was 8.0° (four to 12). The five subscores of KOOS increased significantly during the first year by 40-131% from preoperative values, the good results remaining throughout the 10-year follow-up for those with a surviving osteotomy. The outcome was related to the grade of preoperative osteoarthritis. Seven knees were converted to total knee arthroplasty (TKA) mean 6.2years (two to nine) post-operatively, and had a lower KOOS preoperatively than those of surviving osteotomies. The osteotomy survival rate at five years was 94% and at 10years 83%. Patients with KOOS subscore quality of life (QoL) <44 at the two-year follow-up had a 11.7 times higher risk for later TKA than those with QoL ≥44 (P=0.017). CONCLUSION High tibial opening-wedge osteotomy for medial knee osteoarthritis resulted in good functional recovery after one year and favorable mid-term results. It may be a good treatment option for middle-aged patients with varus knees and medial osteoarthritis in order to prevent or postpone TKA.
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Affiliation(s)
- Arne Ekeland
- Martina Hansens Hospital, Box 823, N-1306 Sandvika, Norway.
| | | | - Sigbjørn Dimmen
- Lovisenberg Diaconal Hospital, Lovisenberggata 17, N-0456 Oslo, Norway
| | | | - Stig Heir
- Martina Hansens Hospital, Box 823, N-1306 Sandvika, Norway
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Forster-Horváth C, Artz N, Hassaballa MA, Robinson JR, Porteous AJ, Murray JR, Newman JH. Survivorship and clinical outcome of the minimally invasive Uniglide medial fixed bearing, all-polyethylene tibia, unicompartmental knee arthroplasty at a mean follow-up of 7.3years. Knee 2016; 23:981-986. [PMID: 27506988 DOI: 10.1016/j.knee.2016.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 05/13/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial UKA performed in England and Wales represents seven to 11% of all knee arthroplasty procedures, and is most commonly performed using mobile-bearing designs. Fixed bearing eliminates the risk of bearing dislocation, however some studies have shown higher revision rates for all-polyethylene tibial components compared to those that utilize metal-backed implants. The aim of the study is to analyse survivorship and maximum eight-year clinical outcome of medial fixed bearing, Uniglide unicompartmental knee arthroplasty performed using an all-polyethylene tibial component with a minimal invasive approach. METHODS Between 2002 and 2009, 270 medial fixed UKAs were performed in our unit. Patients were reviewed pre-operatively, five and eight years post-operatively. Clinical and radiographic reviews were carried out. Patients' outcome scores (Oxford, WOMAC and American Knee Score) were documented in our database and analysed. RESULTS Survival and clinical outcome data of 236 knees with a mean of 7.3years follow-up are reported. Every patient with less than 4.93years of follow-up underwent a revision. The patients' average age at the time of surgery was 69.5years. The American Knee Society Pain and Function scores, the Oxford Knee Score and the WOMAC score all improved significantly. The five-year survival rate was 94.1% with implant revision surgery as an end point. The estimated 10years of survival rate is 91.3%. Fourteen patients were revised before the five-year follow-up. CONCLUSION Fixed bearing Uniglide UKA with an all-polyethylene tibial component is a valuable tool in the management of a medial compartment osteoarthritis, affording good short-term survivorship. Level of evidence IV.
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Affiliation(s)
- C Forster-Horváth
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom.
| | - N Artz
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - M A Hassaballa
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - J R Robinson
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - A J Porteous
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - J R Murray
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
| | - J H Newman
- The Bristol Knee Group, Avon Orthopaedic Centre, Southmead Hospital, Southmead Way, Avon, Bristol BS10 5NB, United Kingdom
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Schröter S, Ateschrang A, Ihle C, Stöckle U, Konstantinidis L, Döbele S. [Lateral hinge fractures in open wedge high tibial osteotomy]. DER ORTHOPADE 2015; 43:1000-7. [PMID: 25288100 DOI: 10.1007/s00132-014-3026-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Open wedge high tibial osteotomy (HTO) is an increasingly more common surgical method. A typical problem of this procedure is fracture of the lateral hinge. OBJECTIVES The aims of this article are to present the special issue of fractures of the lateral hinge after HTO and to discuss surgical hints on how to prevent and treat this problem. METHODS The results of recently published clinical studies are summarized and tips from own clinical experiences are given. RESULTS Type II fractures of the lateral hinge are unstable and can create a major problem. Using short spacer plates results in a problem of stability for all types of fractures. CONCLUSION The classification into Takeuchi grades I-III has been proven to be suitable for fractures of the lateral hinge. The TomoFix plate is a safe implant to stabilize the osteotomy in type I and III fractures with which healing can be achieved with no problems. Type II fractures can be stabilized with the TomoFix plate; however, an autologous bone graft has to be taken into consideration. For fractures of the lateral hinge short spacer plates are not recommended due to stability issues.
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Affiliation(s)
- S Schröter
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland,
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W-Dahl A, Lidgren L, Sundberg M, Robertsson O. Introducing prospective national registration of knee osteotomies. A report from the first year in Sweden. INTERNATIONAL ORTHOPAEDICS 2014; 39:1283-8. [DOI: 10.1007/s00264-014-2621-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/25/2014] [Indexed: 11/25/2022]
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