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Chang SS, Lin SC, Chan YS, Wu CT, Hsu KY, Chen CM, Hsu CP. How do lateral hinge and distraction affect three-dimensional rotation in open wedge high tibial osteotomy? J Orthop Sci 2021; 26:1056-1063. [PMID: 33183940 DOI: 10.1016/j.jos.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/04/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Open-wedge high tibial osteotomy (OWHTO) has extensively been used for the correction of medial knee osteoarthritis. The proximal tibia is osteotomized and distracted to enable the rotation of tibial fragments around the lateral hinge. Both, wedge inclination on the medial side and saw progression near the lateral cortex determine the hinge orientation. This study focused on the interaction between hinge orientation and distraction sites on the coronal, sagittal, and horizontal planes of the distracted plateau. METHODS Three parameters of wedge inclination, saw progression, and distraction site (i.e., posterior, middle, and anterior) were systematically varied. Using a three-dimensional (3D)-printing technique, the osteotomized tibiae were manufactured as the specimens for the in vitro experiments. In total, 27 variations (3 × 3 × 3) were tested. After distraction, the specimens were scanned by computed tomography and spatially registered with the original tibia to compare the 3D angles of the distracted plateaus. RESULTS Coronal rotation is the main purpose of OWHTO; therefore, all the values of the coronal angles were positive and significantly higher than the other two. The sagittal and horizontal angles had relatively similar values. Distraction in the middle site seems to have the least impact on sagittal rotation. Large angles of hinge orientation show the superior ability in adjusting the sagittal rotation than small angles. However, the larger the horizontal angles the greater the wedge inclination. CONCLUSIONS The wedge inclination, saw progression, and distraction site constitute a complex mechanism that affects 3D rotations of the distracted plateau. The coronal angles are sensitive to hinge orientation and distraction site. The intraoperative planning of manipulating hinge orientation is an effective method to adjust sagittal rotation. A large angle of wedge inclination is an indicator of horizontal rotation, and it should be carefully mitigated to reduce the risk of cracking in the lateral hinge.
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Affiliation(s)
- Shih-Sheng Chang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan; Department of Orthopedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shang-Chih Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery Division of Sports Medicine and Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Ming Chen
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chi-Pin Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan; High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taiwan
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Choi HG, Kim JS, Jung YS, Yoo HJ, Lee YS. Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations. Am J Sports Med 2021; 49:2942-2954. [PMID: 34328812 DOI: 10.1177/03635465211028985] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral hinge fracture (LHF) is a major complication of opening wedge high tibial osteotomy (OWHTO) and may result in poor outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to develop preventive strategies by identifying factors that affect LHFs. We hypothesized that (1) each LHF type would have different affecting factors and that (2) specific operative strategies that can contribute to the prevention of each LHF type can be developed. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We retrospectively analyzed 261 consecutive knees treated with biplanar OWHTO between March 2014 and December 2017. Perioperative radiological variables that can affect LHFs were measured and divided into 2 categories: unmodifiable and modifiable. A regression model was developed, and subgroup analyses involving comparisons between the non-LHF group and each LHF group were performed. The weightbearing line (WBL) ratio was measured at 2 weeks and 1 year after surgery to determine the serial changes in each LHF type. RESULTS A total of 66 knees (25.3%) were diagnosed with LHFs. From these, 26 (39.4%), 13 (19.7%), 15 (22.7%), and 12 (18.2%) showed type I, II, III, and I-variant LHFs, respectively. In the subgroup analysis, a larger posterior gap and distance X and a smaller fibular height (FH) were significant unmodifiable factors, while the retrotubercular thickness was a significant modifiable factor, for type I LHF. For type II LHF, a smaller lateral condylar slope and a larger distance X were significant unmodifiable factors, while the lateral distal fragment thickness and the osteotomy-condylar angle were significant modifiable factors. For type III LHF, a larger lateral condylar width and distance X and a smaller FH were significant unmodifiable factors, while the lateral proximal fragment thickness and the retrotubercular angle (RA) were significant modifiable factors. A smaller FH and a larger distance X were significant unmodifiable factors for type I-variant LHFs, while the lateral thickness ratio and the RA were significant modifiable factors. Between postoperative week 2 and 1 year, the WBL ratio decreased in cases with type I LHFs (P < .001) and increased in those with type II (P = .001) and type I-variant (P = .006) LHFs. CONCLUSION Unmodifiable and modifiable factors for the development of LHFs after OWHTO differ among LHF types. To prevent LHFs, the causes of each LHF must be identified, the patient's specific geometry be considered in the preoperative planning, and the surgical technique be modified according to the modifiable factors. In addition, during the rehabilitation period after OWHTO, specific caution and close observation are necessary for alignment changes related to each LHF type.
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Affiliation(s)
- Han Gyeol Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Yonsei Sulgee Hospital, Seoul, Republic of Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - You Sun Jung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
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Lee YS. Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy. Arthroscopy 2021; 37:2189-2190. [PMID: 34226008 DOI: 10.1016/j.arthro.2021.03.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
The tibial slope usually increases after open-wedge high tibial osteotomy (OWHTO) because of several factors. The anteromedial cortex of the proximal tibia is angulated 45° relative to the posterior cortex, whereas the lateral cortex is nearly perpendicular. Therefore, an OWHTO with equal anterior and posterior gaps will increase the tibial slope. In addition, an anteromedial approach to the proximal tibia because of concern about neurovascular injury results in the failure to perform a proper osteotomy of the posterolateral cortex. Slope-optimization methods include a sagittally oriented hinge, posterior bone grafting, posterior plating, and forcefully extending the knee to compress the anterior gap sagittally oriented hinge, posterior positioning of the wedged plate, and knee extension during fixation. However, if the tibial slope is easily controlled using knee extension, this may indicate fracture of the lateral hinge, whereas a preserved lateral hinge is a prerequisite for a successful OWHTO. Most of all, a proper posterior cortical osteotomy is the key step to preventing increased tibial slope in OWHTO. Again, if an incomplete osteotomy is performed posterolaterally, the opening gap is increased anteriorly, leading to an unnecessary increase in posterior tibial slope; for biplanar osteotomy, retrotubercular osteotomy should be performed close to the patellar tendon and not be advanced to the posterolateral side of the hinge.
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Affiliation(s)
- Yong Seuk Lee
- Seoul National University College of Medicine and Seoul National University Bundang Hospital
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Effect of increased posterior tibial slope on the anterior cruciate ligament status in medial open wedge high tibial osteotomy in an uninjured ACL population. Orthop Traumatol Surg Res 2019; 105:1085-1091. [PMID: 31186181 DOI: 10.1016/j.otsr.2019.05.003] [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: 02/01/2019] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to clarify the relationship between posterior tibial slope angle (PTSA) and anterior cruciate ligament (ACL) status in medial open wedge high tibial osteotomy (OWHTO). Our hypothesis was that even though OWHTO may improve anteroposterior laxity of the knee, an increase in PTSA after OWHTO would be associated with ACL degeneration. METHODS Seventy-five patients treated with OWHTO were retrospectively analyzed. PTSA were evaluated radiographically pre- and postoperatively. The ACL was evaluated during the index arthroscopy at the time of OWHTO and a second-look arthroscopy during the plate removal, and scored from 1 (normal ACL) to 4 (complete tear). An anterior tibial translation (ATT) test was performed. RESULTS The mean time period from the index to second-look arthroscopy was 15.0±4.4months. PTSA significantly increased from 5.3±3.4° preoperatively to 7.5±4.0° postoperatively (p<0.001). The average ACL score significantly increased from 1.9±0.5 at the index arthroscopy to 2.2±0.5 at the second-look arthroscopy (p=0.0025). The average ATT on the operated side significantly decreased from 7.1±2.6mm preoperatively to 5.3±2.3mm at the second-look arthroscopy (p<0.0001). There was a significant positive correlation between the increase in PTSA and the change of ACL grade [correlation coefficient (r)=0.221, p<0.05]. CONCLUSION Even though OWHTO reduces anteroposterior knee laxity, an increase in PTSA is associated with ACL degeneration. It is important for the surgeon to avoid an increase in PTSA during the intervention to prevent ACL degeneration after OWHTO. LEVEL OF EVIDENCE IV, therapeutic retrospective case series.
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Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO. Knee Surg Sports Traumatol Arthrosc 2019; 27:2910-2916. [PMID: 29804186 DOI: 10.1007/s00167-018-4991-6] [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: 01/29/2018] [Accepted: 05/23/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The purpose of this study was to investigate the causes of retro-tubercular gap widening and to confirm whether this widened gap causes instability of the osteotomy configuration during open-wedge high tibial osteotomy (OWHTO). METHODS Operative records and radiologic findings of patients who underwent biplanar medial OWHTO between 2014 and 2016 were retrospectively evaluated. To identify the osteotomy configuration including lateral hinge fracture, postoperative simple radiographs and CT images were analyzed. Postoperative CT scan was used to evaluate the widening of the retro-tubercular gap, thickness, and axial angle of retro-tubercular osteotomy, as well as the ratios of anterior and posterior osteotomy, and hinge length. The correlation of each factor was evaluated and analyzed in accordance with the lateral hinge fracture (LHF). RESULTS Widening of the retro-tubercular gap showed a significant correlation with the axial angle of retro-tubercular osteotomy, anterior osteotomy ratio, and opening gap distance, but not with the thickness of retro-tubercular osteotomy, posterior osteotomy ratio, and hinge length ratio. The LHF group showed significantly larger value than the non-LHF group with respect to the thickness of retro-tubercular osteotomy (P = 0.003), axial angle of retro-tubercular osteotomy (P = 0.033), retro-planar gap distance (P = 0.001), anterior osteotomy ratio (P = 0.000), and opening gap distance (P = 0.003). The hinge length ratio was smaller in the LHF group than in the non-LHF group (P = 0.001). However, the posterior osteotomy ratio was not different between the two groups (n.s.). CONCLUSION Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap distance, which can be related to LHF. Therefore, anterior cortical osteotomy may also be an important factor for preventing instability of the proximal fragment in biplanar OWHTO. LEVEL OF EVIDENCE Case-control study, Level III.
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Kim TW, Lee SH, Lee JY, Lee YS. Effect of Fibular Height and Lateral Tibial Condylar Geometry on Lateral Cortical Hinge Fracture in Open Wedge High Tibial Osteotomy. Arthroscopy 2019; 35:1713-1720. [PMID: 31078358 DOI: 10.1016/j.arthro.2019.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether the fibular position and lateral proximal tibial geometry affect the osteotomy configuration and lateral hinge fracture (LHF) during open wedge high tibial osteotomy (OWHTO). METHODS From March 2014 to January 2016, patients who underwent OWHTO for isolated medial compartment osteoarthritis of the knee were retrospectively reviewed. To identify whether the fibular position and lateral proximal tibial geometry affect the osteotomy configuration, the fibular height, fibular anteroposterior position, lateral tibial condylar width, and lateral tibial condylar slope were evaluated on plain radiograph or computed tomography (CT). Thereafter, the correlation of these parameters with the thickness of the proximal fragment around the osteotomy end and LHFs was determined. RESULTS A total of 123 OWHTOs including 30 LHFs (24.3%) were evaluated. High fibular head and small tibial condylar width and slope were related to thin thickness of the proximal tibial fragment, particularly on the posterior side (fibular height, P = .005; condylar width, P = .002; condylar slope, P = .01). The fibular height was shorter in the LHF group than in the non-LHF group on both plain radiography and CT (fibular height [plain radiography], 18.3 ± 1.6 vs 20.2 ± 2.1 mm; P < .001; fibular height [CT], 17.4 ± 1.1 vs 19.6 ± 2.0 mm; P < .001). The lateral tibial condylar width and slope were also smaller in the LHF group compared with the non-LHF group (tibial condylar width, 21.2 ± 4.9 vs 23.4 ± 4.5 mm; P = .023; tibial condylar slope, 37.7 ± 6.6 vs 41.3 ± 7.6 mm; P = .027). CONCLUSIONS The fibular position and lateral proximal tibial geometry affect the osteotomy configuration and LHFs. A highly positioned fibula was related to a small lateral tibial condyle, which induced a thin proximal fragment. This finding was related to a higher risk of LHFs. Therefore, understanding the fibular height and lateral proximal tibial geometry may be helpful for the prediction of the osteotomy configuration and development of LHFs. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Seung Hoon Lee
- Department of Orthopaedic Surgery, Incheon Medical Center, Seoul, South Korea
| | - Joon Young Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
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Jang YW, Lim D, Seo H, Lee MC, Lee OS, Lee YS. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy. Arch Orthop Trauma Surg 2018; 138:911-920. [PMID: 29546620 DOI: 10.1007/s00402-018-2918-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Open-wedge high tibial osteotomy (OWHTO) is a well-established surgical option for medial compartment osteoarthritis of the varus knee. The initial strength of the fixation plate is critical for successful correction maintenance and healing of the osteotomy site. This study was conducted to verify if a newly designed anatomical plate (LCfit) improves the stability of both the medial implant and lateral hinge area, as well as to evaluate how the metal block contributes to both medial and lateral stability. MATERIALS AND METHODS A finite element (FE) tibial model was combined with TomoFix plate, a LCfit plate with and without a metal block. Data analysis was conducted to evaluate the balanced stability, which refers to the enforced lateral stability resulting from redistribution of overall stress. We assessed the balanced stability of the medial implant and lateral hinge area in three cases using the same Sawbones and loads using the tibia FE model. RESULTS The LCfit plate reduced stress by 23.1% at the lateral hinge compared to the TomoFix plate (TomoFix vs. LCfit: 34.2 ± 23.3 MPa vs. 26.3 ± 17.5 MPa). The LCfit plate with a metal block reduced stress by 40.1% at the medial plate (210.1 ± 64.2 MPa vs. 125.8 ± 65.7 MPa) and by 31.2% (26.3 ± 17.5 MPa vs. 18.1 ± 12.1 MPa) at the lateral hinge area compared to the reduction using the LCfit plate without a metal block. CONCLUSION The newly designed fixation system for OWHTO balanced the overall stress distribution and reduced stress at the lateral hinge area compared to that using a conventional fixation system. The addition of the metal block showed additional benefits for balanced stability between the medial implant and lateral hinge area. However, this conclusion could only be drawn using the FE model in this study. Therefore, further clinical studies are necessary to reveal the clinical effect of reduced lateral stress on the occurrence of the lateral hinge fracture and the biologic effect of the metal block on the healing of the medial cortex.
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Affiliation(s)
| | - DoHyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Hansol Seo
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - O-Sung Lee
- Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2018; 26:1851-1858. [PMID: 28389878 DOI: 10.1007/s00167-017-4526-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to determine the standard hinge position to minimize effects from medial open-wedge high tibial osteotomy (HTO) on the posterior tibial slope. METHODS Sixteen cadaveric knees underwent medial open-wedge osteotomy using either the standard or the low hinge position. To define the standard hinge position, a line 3 cm inferior to the medial tibial plateau towards the fibular head and located its intersection with a longitudinal line 1 cm medial to the fibular shaft was drawn. Low hinge position was defined as the point 1 cm inferior to the standard position. After tibial osteotomy, computed tomography scans of each knee were taken and three-dimensional models were constructed to characterize hinge position orientation and measure the osteotomy site effects on posterior tibial slope, medial proximal tibial angle, and gap ratio (the ratio of the anterior to posterior gap in the opened wedge). RESULTS In two low hinge position specimens, the tibial lateral cortex hinge fracture occurred. Osteotomy through the low hinge position resulted in significantly greater posterior tibial slope compared to the standard hinge position (mean ± standard deviation) (11.2 ± 3.0° and 5.6 ± 2.5°, respectively; p < 0.001). Medial proximal tibial angle was also significantly greater for low compared to standard hinge position (95.4 ± 3.5° and 88.0 ± 3.5°, respectively; p < 0.001). Gap ratio was not significantly different between the two groups. CONCLUSION Hinge position significantly affects the posterior tibial slope and medial proximal tibial angle following medial open-wedge HTO. Accurate hinge position is crucial to prevent complications from changes in posterior tibial slope and medial proximal tibial angle after surgery.
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Lee OS, Lee YS. Diagnostic Value of Computed Tomography and Risk Factors for Lateral Hinge Fracture in the Open Wedge High Tibial Osteotomy. Arthroscopy 2018; 34:1032-1043. [PMID: 29229417 DOI: 10.1016/j.arthro.2017.08.310] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were to evaluate (1) the disparity of detection of lateral hinge fracture (LHF) between postoperative simple radiography and high-resolution computed tomography (CT) and affecting factors of LHF and (2) whether generally recommended postoperative rehabilitation protocols are appropriate according to the type of LHF. METHODS From 2014 to 2015, patients who underwent primary open wedge high tibial osteotomy (OWHTO) for isolated medial compartment osteoarthritis of the knee joint were retrospectively enrolled. The patients with minimum 1-year follow-up were included. The incidence of LHF after OWHTO based on simple radiographs was compared with its incidence based on CT scans. In the stable type of LHF and the non-LHF group, early weight bearing was encouraged immediately after OWHTO. In unstable LHF (types II and III), weight bearing was delayed until 2 weeks postoperatively. RESULTS Twenty-three cases (24.5%) of LHF after 94 OWHTOs were detected (15 cases on simple radiographs, 8 cases on CT scan). The coronal osteotomy slope and the osteotomy gap were significantly larger in the LHF group than in the non-LHF group (coronal osteotomy slope, 20.3° ± 5.1° vs 16.7° ± 4.2°, P = .001; anterior osteotomy gap, 7.9 mm ± 2.1 mm vs 6.7 mm ± 1.8 mm, P = .008; posterior osteotomy gap, 12.7 mm ± 3.7 mm vs 11.2 mm ± 3.2 mm, P = .048). The correction loss of the hip-knee-ankle angle and the medial proximal tibial angle in the LHF group was significantly larger than those in the non-LHF group (1.3° ± 1.8° vs 0.4° ± 1.4°, P < .001; 1.3° ± 1.1° vs 0.7° ± 0.9°, P = .009, respectively). CONCLUSIONS Further evaluation with CT scanning is highly valuable immediately after all OWHTO because of its higher detection rate (24.5%) of LHF compared with simple radiographs (16%). In addition, the coronal osteotomy slope was steeper and the opening gap was larger in the LHF group than in the non-LHF group. Finally, the LHF should be managed conservatively in order to prevent postoperative correction loss. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
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Vaishya R, Bijukchhe AR, Agarwal AK, Vijay V. A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis. J Clin Orthop Trauma 2018; 9:300-306. [PMID: 30449975 PMCID: PMC6224694 DOI: 10.1016/j.jcot.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/08/2018] [Accepted: 02/08/2018] [Indexed: 12/27/2022] Open
Abstract
A medial open wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure to correct varus deformity related to Knee Osteoarthritis. It consistently provides relief in knee pain and improves knee function. This technique is recommended for active, middle and old aged individuals with an isolated medial compartment knee OA. The MOWHTO scores several advantages over lateral closed wedge osteotomy and hence is now a preferred choice of HTO.
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Affiliation(s)
| | | | - Amit Kumar Agarwal
- Corresponding author at: Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi-110076, India.
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Dean CS, Chahla J, Matheny LM, Cram TR, Moulton SG, Dornan GJ, Mitchell JJ, LaPrade RF. Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:3687-3694. [PMID: 27613538 DOI: 10.1007/s00167-016-4311-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy. METHODS All patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively. Indications for decreasing tibial slope included medial compartment osteoarthritis with at least one of the following: ACL deficiency, posterior meniscus deficiency, or flexion contracture. Preoperative, immediate postoperative, and 6-month postoperative radiographs were reviewed. RESULTS Twenty-one patients (14 males and 7 females) were included in the study with a mean age of 36.5 years. Intrarater and interrater reliability of slope measurements were excellent at all time points (ICC ≥ 0.94, ICC ≥ 0.85). The osteotomy resulted in an average tibial slope decrease of 0.8 from preoperative (n.s.). At 6-month postoperative, average slope was not significantly different from time-zero postoperative slope (mean = +0.2°). CONCLUSIONS The most important finding of this study was that posteromedial placement of an anteriorly angled osteotomy plate augmented with an anterior staple during a biplanar medial opening-wedge proximal tibial osteotomy did not decrease sagittal plane tibial slope. Whether a staple was effective in maintaining tibial slope from time zero to 6 months postoperatively was unable to be assessed due to no significant change in tibial slope from the preoperative postoperative states. The results of this study note that current osteotomy plate designs and surgical techniques are not effective in decreasing sagittal plane tibial slope. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Chase S Dean
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Lauren M Matheny
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Tyler R Cram
- The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.,Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Samuel G Moulton
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Justin J Mitchell
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Robert F LaPrade
- The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
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