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Kamiya T, Hamaoka K, Ono A, Okada Y, Emori M, Teramoto A. Influence of different standing positions on anatomical parameters of coronal whole-leg weight-bearing radiographs in preoperative planning for high tibial osteotomy. J Exp Orthop 2024; 11:e12085. [PMID: 38974048 PMCID: PMC11227596 DOI: 10.1002/jeo2.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose The purpose of this study was to assess the differences in lower limb global alignment and anatomical parameters of coronal whole-leg radiographs, which were generally used in preoperative planning for high tibial osteotomy (HTO), according to different weight-bearing standing positions. Methods Between April 2021 and December 2022, 176 patients (60 males and 116 females) were investigated. Full-weight-bearing coronal whole-leg radiographs were obtained with the patella centred on the femoral condyle. Patients were divided by Kellgren-Lawrence grade (KL-0, KL-I, KL-II and KL-III) and assessed in two standing positions: legs closed and legs spread. Patients with flexion contractures or those unable to stand with full weight bearing were excluded. The mechanical distal femoral angle, medial proximal tibial angle (MPTA), femorotibial angle, joint line convergence angle, percentage weight-bearing line (%WBL) and hip-knee-ankle angle (HKAA) were measured. The Student's t test was used to compare the two standing positions. A p value < 0.05 indicated a statistically significant difference. Results The MPTAs of legs closed standing and legs spread standing were 84.9 ± 2.6° and 85.1 ± 2.4° in KL-0, 84.7 ± 2.0° and 84.9 ± 2.1° in KL-I and 85.0 ± 2.43° and 85.4 ± 2.4° in KL-II, respectively. There were statistically significant differences in the MPTA between the two standing positions in KL-0, KL-I and KL-II. In contrast, the %WBL and HKAA did not change regardless of the standing position. In the KL-III group, no statistical significance was observed for any of the anatomical parameters. Conclusion Several anatomical parameters were changed between the legs closed standing and the legs spread standing positions. It was suggested that the standing position should be taken into consideration in the planning for HTO. Level of Evidence Level IV, Case series with no comparison group.
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Affiliation(s)
- Tomoaki Kamiya
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Kodai Hamaoka
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Akira Ono
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Yohei Okada
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Makoto Emori
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoHokkaidoJapan
| | - Atsushi Teramoto
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoHokkaidoJapan
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Jung SJ, Kang JH, Rhee SJ, Moon SW, Wang L, D’Lima DD. Difference in Correction Power between Hybrid Lateral Closed-Wedge High Tibial Osteotomy and Medial Open-Wedge High Tibial Osteotomy was Associated with Severity of Varus Deformity and Different Hinge Distance from Center of Deformity. Diagnostics (Basel) 2024; 14:1137. [PMID: 38893663 PMCID: PMC11171834 DOI: 10.3390/diagnostics14111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Hybrid lateral closed-wedge high tibial osteotomy (HBHTO) carries certain advantages over medial open-wedge high tibial osteotomy (OWHTO). We investigated the potential difference in the required correction angle between HBHTO and OWHTO to achieve an equal amount of whole lower-extremity alignment correction, retrospectively analyzing the preoperative plain radiographic images of 100 patients. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical lateral distal femoral angle (mLDFA), hip-knee-ankle axis (HKA), length of the tibia, width of the tibial plateau, length of the lower limb (leg length), and location of the center of deformity (CD) were measured. Differences in the required correction angle at the hinge point between the two techniques (CAD) were compared, and correlation analysis was performed to reveal the influential factors. The mean difference in CAD between HBHTO and OWHTO was 0.78 ± 0.22 (0.4~1.5)°, and mean WBL position change per correction angle was 3.9 ± 0.3 (3.0~4.6)% in HBHTO and 4.1 ± 0.3 (3.1~4.7)% in OWHTO. Correlation analysis revealed a strong positive correlation between CAD and HKA. mLDFA, JLCA, MPTA, leg length, OWCD, HBCD, and HCD were also significantly correlated with CAD. HBHTO required a 5.6% larger correction angle at the hinge point to achieve the same amount of alignment correction as OWHTO.
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Affiliation(s)
- Seok Jin Jung
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Jun Ho Kang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
- College of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Sang Won Moon
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Busan 48108, Republic of Korea
| | - Lih Wang
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan 49201, Republic of Korea
| | - Darryl D D’Lima
- Department of Molecular Medicine, Scripps Research, La Jolla, CA 92037, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, La Jolla, CA 92121, USA
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Bechis M, Rosso F, Verocq M, Innocenti B, Rossi R, Bonasia DE. Mathematical explanations for knee osteotomies: "Dear engineer, how would you explain it in a simple way?". Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05366-7. [PMID: 38787456 DOI: 10.1007/s00402-024-05366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Knee osteotomies are effective procedures to treat different deformities and to redistribute the load at the joint level, reducing the risk of wear and, consequently, the need for invasive procedures. Particularly, knee osteotomies are effective in treating early arthritis related to knee deformities in young and active patients with high functional demands, with excellent long-term results. Precise mathematical calculations are imperative during the preoperative phase to achieve tailored and accurate corrections for each patient and avoid complications, but sometimes those formulas are challenging to comprehend and apply. METHODS Four specific questions regarding controversial topics (planning methods, patellar height, tibial slope, and limb length variation) were formulated. An electronic search was performed on PubMed and Cochrane Library to find articles containing detailed mathematical or trigonometrical explanations. A team of orthopedic surgeons and an engineer summarized the available Literature and mathematical rules, with a final clear mathematical explanation given by the engineer. Wherever the explanation was not available in Literature, it was postulated by the same engineer. RESULTS After the exclusion process, five studies were analyzed. For three questions, no studies were found that provided mathematical analyses or explanations. Through independent calculations, it was demonstrated why Dugdale's method underestimates the correction angle compared to Miniaci's method, and it was shown that the variation in patellar height after osteotomy can be predicted using simple formulas. The five included studies examine postoperative variations in limb length and tibial slope, providing formulas applicable in preoperative planning. New formulas were independently computed, using the planned correction angle and preoperatively obtained measurements to predict the studied variations. CONCLUSIONS There is a strict connection among surgery, planning, and mathematics formulas in knee osteotomies. The aim of this study was to analyze the current literature and provide mathematical and trigonometric explanations to important controversial topics in knee osteotomies. Simple and easy applicable formulas are provided to enhance the accuracy and outcomes of this surgical procedure.
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Affiliation(s)
- Marco Bechis
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy.
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy.
| | - Marie Verocq
- Universite Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Avenue F. Roosevelt 50 CP165/56, 1050, Brussels, Belgium
| | - Bernardo Innocenti
- Universite Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Avenue F. Roosevelt 50 CP165/56, 1050, Brussels, Belgium
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Largo Turati 62, 10128, Turin, Italy
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Jung SH, Jung M, Chung K, Kim S, Kang KT, Park J, Sim W, Choi CH, Kim SH. Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2024; 32:64-77. [PMID: 38226764 DOI: 10.1002/ksa.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The aim of this study was to analyse the factors associated with additional postoperative alignment changes after accurate bony correction by selecting only patients with well-performed bony correction as planned and develop a method of incorporating significant factors into preoperative planning. METHODS Among 104 consecutive patients who underwent medial open wedge high tibial osteotomy (MOWHTO) between October 2019 and July 2022, 61 with well-performed bony corrections were retrospectively reviewed. The major criterion for well-performed bony correction was a difference of <1° between the simulated medial proximal tibial angle (MPTA) and the actual postoperative MPTA as measured in three dimensions. Radiographic parameters, such as the joint line convergence angle (JLCA) and joint line obliquity (JLO), were measured preoperatively and postoperatively, utilising standing and supine whole lower extremity anteroposterior, valgus and varus stress radiographs. Multiple linear regression analysis identified the factors affecting alignment changes, and a prediction model was developed. A method for applying this prediction model to preoperative planning was proposed. RESULTS Preoperative JLCA on standing (preJLCAstd ), preoperative JLCA on 0° valgus stress radiograph (vgJLCA0 ), and preoperative JLO (preJLO) were significantly correlated with JLCA change (∆JLCA) (p < 0.001, p < 0.001, p = 0.006). The prediction model was estimated as ∆JLCA = 0.493 × (vgJLCA0 ) - 0.727 × (preJLCAstd ) + 0.189 × (preJLO) - 1.587 in. (R = 0.815, modified R2 = 0.646, p < 0.001). The proposed method resulted in a reduced overcorrection rate (p = 0.003) and an improved proportion of acceptable alignments (p = 0.013). CONCLUSION PreJLCAstd , vgJLCA0 and preJLO can be used to estimate ∆JLCA. PreJLO was recently identified as a significant factor associated with additional alignment changes. Utilising the proposed preoperative planning and a prediction model with these factors shows promise in calibrating postoperative alignment after MOWHTO. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Se-Han Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwangho Chung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
- Skyve R&D LAB, Seoul, Republic of Korea
| | - Jisoo Park
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woongseob Sim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yoon KH, Song SJ, Hwang SH, Kim DH, Park CH. Additional anteromedial staple fixation prevents changes in the posterior tibial slope in retrotuberosity bi-planar open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:3956-3963. [PMID: 37100895 DOI: 10.1007/s00167-023-07427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To compare the changes in posterior tibial slope (PTS) between retrotuberosity biplane open-wedge high tibial osteotomies (RT-OWHTOs) with and without additional anteromedial staple fixation. METHODS Seventy-nine and 77 cases of RT-OWHTOs without (Group N) and with (Group S) additional staple fixation, respectively, were retrospectively reviewed. All procedures were performed using a locking spacer plate. Demographics and preoperative knee condition were similar between the groups. Clinically, the Western Ontario and McMaster Universities Arthritis Index and range of motion were evaluated preoperatively and 2 years postoperatively. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and PTS were evaluated preoperatively and within 2 years postoperatively. Hinge fractures were investigated using computed tomography at 2 weeks postoperatively. PTS loss was defined as the difference between the corresponding values at 2 weeks and 2 years postoperatively. The incidence of PTS failure (PTS loss ≥ ± 3°) was also investigated. RESULTS The clinical results were not significantly different between groups N and S preoperatively and 2 years postoperatively. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively; changes in these variables did not differ significantly between the groups. The incidence of hinge fractures, all of which were categorized as Takeuchi type 1, did not differ significantly. PTS loss within 2 years postoperatively was significantly greater in group N than in group S (1.0° vs. 0.1°; p < 0.01). The incidence of the PTS failure was 16.5% (13/79) and 2.6% (2/77) in groups N and S, respectively (p < 0.01). CONCLUSION Additional anteromedial staple fixation could prevent changes in the PTS in RT-OWHTO. It is a simple method for preventing an increase in the PTS after RT-OWHTO. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Dae Hyeok Kim
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447, Korea.
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Aygün Ü, Bölükbaşı M, Yamak K, Çiçek AC. Comparison of the Miniaci and Dugdale techniques on functional outcomes in medial open wedge high tibial osteotomy. J Exp Orthop 2023; 10:86. [PMID: 37615790 PMCID: PMC10449725 DOI: 10.1186/s40634-023-00653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To compare the correction angles determined by the Miniaci and Dugdale techniques in patients treated with medial open wedge high tibial osteotomy (MOWHTO) and show their impact on clinical outcomes. METHODS Seventy-four patients constituted the study group. The correction angles in Group 1 were measured using the Miniaci technique, and those in Group 2 were measured using the Dugdale technique. The clinical evaluations included the Tinetti Gait and Balance Assessment (TGBA), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and the Visual Analogue Scale (VAS). The effect of the correction angle on the patient's clinical outcomes was evaluated. Measurement techniques were also changed between groups for comparison. RESULTS Seventy-four patients (62 females, 12 males) with a mean age of 53.7 ± 4.9 years were followed up for a mean of 67.4 ± 5.5 months. The TGBA, WOMAC, and VAS scores were improved at the last follow-up compared to the preoperative scores (p < 0.05). The preoperative TGBA and WOMAC scores were not significantly different between the two groups, but the last follow-up TGBA and WOMAC scores in Group 2 were worse than those in Group 1 (p < 0.05). When measuring techniques were changed, the preoperative correction angle (PCA) value and the last follow-up correction angle (LFCA) value were lower in Group 1 measured with the Dugdale technique but higher in Group 2 measured with the Miniaci technique (p < 0.05). CONCLUSION Since the correction angle values measured with the Miniaci technique in MOWHTO are higher than those measured with the Dugdale technique; the functional results are better. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Ümit Aygün
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Ağrı İbrahim Çeçen University, Ağrı, Türkiye.
| | - Murat Bölükbaşı
- Department of Orthopaedics and Traumatology, VM Medical Park Samsun Hospital, Samsun, Türkiye
| | - Kamil Yamak
- Buca Seyfi Demirsoy Training and Research Hospital, Orthopedics and Traumatology Clinic, İzmir, Türkiye
| | - Ali Can Çiçek
- Ağrı Training and Research Hospital, Orthopaedics and Traumatology Clinic, Ağrı, Türkiye
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Przystalski K, Paleczek A, Szustakowski K, Wawryka P, Jungiewicz M, Zalewski M, Kwiatkowski J, Gądek A, Miśkowiec K. Automated correction angle calculation in high tibial osteotomy planning. Sci Rep 2023; 13:12876. [PMID: 37553353 PMCID: PMC10409734 DOI: 10.1038/s41598-023-39967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/02/2023] [Indexed: 08/10/2023] Open
Abstract
High tibial osteotomy correction angle calculation is a process that is usually performed manually or in a semi-automated way. The process, according to the Miniaci method, is divided into several stages to find specific points: the center of the femoral head, the edges of the tibial plateau, the Fujisawa point, the center of the ankle joint, and the Hinge point. In this paper, we proposed an end-to-end approach that consists of different techniques for finding each point. We used YOLOv4 to detect regions of interest. To identify the center of the femoral head, we used the YOLOv4 and the Hough transform. For the other points, we used a combined method of YOLOv4 with the ASM/AAM algorithm and YOLOv4 with image processing algorithms. Our fully-automated method achieved a mean error rate of 0.5[Formula: see text] (0[Formula: see text]-2.76[Formula: see text]) ICC 0.99 (0.98-0.99) 95% CI on our own dataset of standing long-leg Anterior Posterior view X-rays. This might be the first method that automatically calculates the correction angle of high tibial osteotomy.
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Affiliation(s)
- Karol Przystalski
- Medtransfer, Na Zjeździe 11, 31353, Kraków, Poland.
- Department of Information Technologies, Jagiellonian University, Łojasiewicza 11, 30348, Kraków, Poland.
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland.
| | - Anna Paleczek
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Karol Szustakowski
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Piotr Wawryka
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Michał Jungiewicz
- Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Mickiewicza 30, 30059, Kraków, Poland
- Codete R &D, Na Zjeździe 11, 31353, Kraków, Poland
| | - Mateusz Zalewski
- Ortotop, Ludwinowska 11/9, 30331, Kraków, Poland
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
| | - Jakub Kwiatkowski
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
| | - Artur Gądek
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
- Department of Orthopedics and Physiotherapy, Jagiellonian University Medical College, Jakubowskiego 2, 30688, Kraków, Poland
| | - Krzysztof Miśkowiec
- Trauma and Orthopaedics Clinical Department, University Hospital in Cracow, Jakubowskiego 2, 30688, Kraków, Poland
- Department of Orthopedics and Physiotherapy, Jagiellonian University Medical College, Jakubowskiego 2, 30688, Kraków, Poland
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Current clinical practice of knee osteotomy in the Netherlands. Knee 2023; 41:292-301. [PMID: 36801495 DOI: 10.1016/j.knee.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Realignment osteotomies is gaining popularity amongst Dutch orthopaedic surgeons. Exact numbers and used standards in clinical practice concerning osteotomies are unknown due to the absence of a national registry. The aim of this study was to investigate the national statistics of performed osteotomies, utilized clinical workups, surgical techniques, and post-operative rehabilitation standards in the Netherlands. METHOD Dutch orthopaedic surgeons, all members of the Dutch Knee Society, received a web-based survey between January and March 2021. This electronic survey contained 36 questions, subdivided into: general surgeon-related information, number of performed osteotomies, inclusion of patients, clinical workup, surgical techniques, and post-operative management. RESULTS 86 orthopaedic surgeons filled in the questionnaire, of whom 60 perform realignment osteotomies around the knee. All the 60 responders (100%) perform high tibial osteotomies and 63.3% additionally perform distal femoral osteotomies, while 30% perform double level osteotomies. Discrepancies in surgical standards were reported regarding to inclusion criteria, clinical workup, surgical techniques, and post-operative strategies. CONCLUSIONS In conclusion, this study got more insight in knee osteotomy clinical practices as applied by Dutch orthopaedic surgeons. However, there are still important discrepancies which pleads for more standardization based on available evidence. A (inter)national knee osteotomy registry, and even more so, a (inter)national registry for joint preserving surgeries could be helpful to achieve more standardization and treatment insights. Such a registry could improve all aspects of osteotomies and its combinations with other joint-preserving interventions towards evidence for personalised treatments.
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Lu Y, Wang X, Yang B, Xu Z, Zhang B, Jia B, He J, Qi L, Wang M, Qiao F. Application of SolidWorks software in preoperative planning of high tibial osteotomy. Front Surg 2023; 9:951820. [PMID: 36684138 PMCID: PMC9852509 DOI: 10.3389/fsurg.2022.951820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/27/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Open-wedge high tibial osteotomy (HTO) is a common surgical treatment for medial osteoarthritis in young and active patients. The accuracy of osteotomy is closely associated with postoperative efficacy. The accuracy of digital preoperative planning is higher than that of the preoperative manual measurement and several computer software with varying accuracy and convenience are used for digital preoperative planning. This study aimed to use the SolidWorks software for HTO preoperative planning and to determine its accuracy and reliability in HTO preoperative planning. Methods We reviewed the data of 28 patients with 54 with medial compartment knee arthritis who underwent open-wedge HTO preoperative planning using SolidWorks between June 2019 and March 2021. The standard anteroposterior standing whole-leg radiographs were assessed before and 6 weeks after the surgery. The correction angle, weight-bearing line (WBL) ratio, mechanical femorotibial angle (mFTA), and medial proximal tibial angle (MPTA) before and after the surgery were compared. The clinical results were evaluated using the Knee Society score. Results At 6 weeks after the surgery, the WBL ratio was corrected from 16.8% to 50.5%, mFTA was corrected from 6.4° varus to 1.2° valgus, and MPTA was corrected from 83.4° to 89.3°. No significant difference was observed between the predicted correction angle before the surgery and the correction angle measured 6 weeks after the surgery (t = -1.745, p = 0.087). The knee score and function score of Knee Society increased from 76.4 and 80.7 before surgery to 95.0 and 95.7, respectively. Conclusions The SolidWorks software showed high accuracy and reliability in preoperative planning of open-wedge HTO in patients with medial compartment knee arthritis.
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Affiliation(s)
- Yufeng Lu
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xue Wang
- Department of Emergency Medicine, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Bo Yang
- Graduate School, Xi'an Medical University, Xi'an, China
| | - Zhaochen Xu
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Baogang Zhang
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Bin Jia
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jinlong He
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liang Qi
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Min Wang
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Feng Qiao
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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Thürig G, Korthaus A, Frings J, Berninger MT, Frosch KH, Krause M. Influence of Medial Osteotomy Height and Hinge Position in Open Wedge High Tibial Osteotomy: A Simulation Study. Diagnostics (Basel) 2022; 12:diagnostics12102546. [PMID: 36292236 PMCID: PMC9600956 DOI: 10.3390/diagnostics12102546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: In treating medial unicompartmental gonarthrosis, medial open wedge high tibial osteotomy (mOWHTO) reduces pain and is intended to delay a possible indication for joint replacement by relieving the affected compartment. This study aimed to investigate the influence of the osteotomy height with different hinge points in HTO in genu varum on the leg axis. (2) Methods: Fifty-five patients with varus lower leg alignment obtained full-weight bearing long-leg radiographs were analyzed. Different simulations were performed: Osteotomy height was selected at 3 and 4 cm distal to the tibial articular surface, and the hinge points were selected at 0.5 cm, 1 cm, and 1.5 cm medial to the fibular head, respectively. The target of each correction was 55% of the tibial plateau measured from the medial. Then, the width of the opening wedge was measured. Intraobserver and interobserver reliability were calculated. (3) Results: Statistically significant differences in wedge width were seen at an osteotomy height of 3 cm below the tibial plateau when the distance of the hinge from the fibular head was 0.5 cm to 1.5 cm (3 cm and 0.5 cm: 8.9 +/− 3.88 vs. 3 cm and 1.5 cm: 11.6 +/− 4.39 p = 0.012). Statistically significant differences were also found concerning the wedge width between the distances 0.5 to 1.5 cm from the fibular head at the osteotomy height of 4 cm below the tibial plateau. (4 cm and 0.5 cm: 9.0 +/− 3.76 vs. 4 cm and 1.5 cm: 11.4 +/− 4.27 p = 0.026). (4) Conclusion: A change of the lateral hinge position of 1 cm results in a change in wedge width of approximately 2 mm. If hinge positions are chosen differently in preoperative planning and intraoperatively, the result can lead to over- or under-correction.
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Affiliation(s)
- Grégoire Thürig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, 1700 Fribourg, Switzerland
| | - Alexander Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Markus Thomas Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Correspondence:
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11
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Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients. Knee Surg Sports Traumatol Arthrosc 2022; 31:1563-1570. [PMID: 35635568 DOI: 10.1007/s00167-022-07006-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the incidence of correction loss and survival rate between closed-wedge and open-wedge high tibial osteotomies (CWHTO and OWHTO, respectively) in patients with osteopenic and normal bone. METHODS Retrospective review was conducted for 115 CWHTOs and 119 OWHTOs performed in osteopenic patients [- 2.5 < Bone mineral density (BMD) T scores ≤ - 1] and 136 CWHTOs and 138 OWHTOs performed in normal patients (BMD T score > - 1) from 2012 to 2019. Demographics were not different between CW- and OWHTOs in osteopenic and normal patients (n.s., respectively). Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated pre- and postoperatively (2 weeks after HTO). The occurrence of hinge fractures was investigated using radiographs taken on the operation day. The correction change was calculated as the last follow-up value minus postoperative MPTA. Correction loss was defined when the correction change was ≥ 3°. The survival rate (failure: correction loss) was investigated. RESULTS There were no significant differences in the pre and postoperative MA, MPTA, PTS, and value changes between CW- and OWHTOs in osteopenic and normal patients (n.s., respectively); the incidence of unstable hinge fractures also did not differ significantly (CWHTO vs. OWHTO = 7 vs. 7.6% in osteopenic patients; 2.9 vs. 3.6% in normal patients; n.s., respectively). The average correction change (CWHTO = - 0.6°, OWHTO = - 1.3°, p = 0.007), incidence of correction loss (CWHTO = 1.7%, OWHTO = 9.2%, p = 0.019), and 5-year survival rates (CWHTO = 98.3%, OWHTO = 90.8%, p = 0.013) differed significantly in osteopenic patients; there were no significant differences in these results in normal patients (n.s., respectively). CONCLUSION CWHTO was more advantageous than OWHTO regarding the correction loss in osteopenic patients. Intra- and postoperative care that consider poor bone quality will be required when performing OWHTOs in osteopenic patients. LEVEL OF EVIDENCE III.
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