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Kim JG, Lee SS, Lee DH. The Osteotomy Gap Filling Rate of Multiple Time Points After Medial Opening Wedge High Tibial Osteotomy Without Bone Graft. J Arthroplasty 2024:S0883-5403(24)00869-6. [PMID: 39181519 DOI: 10.1016/j.arth.2024.08.025] [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: 04/14/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The purpose of the present study was to analyze osteotomy gap filling of multiple time points until 2 years post-medial opening wedge high tibial osteotomy (MOWHTO). The absolute value of gap filling and postoperative changes relative to the preoperative void osteotomy gap were evaluated using computed tomography (CT) at each time point. METHODS Data of thirty patients who underwent MOWHTO between September 2019 and July 2021 were retrospectively analyzed. Surgical procedures without bone grafts were performed; a standardized rehabilitation protocol was implemented. The osteotomy gap filling rate was measured using CT scans at the immediate postoperative period and at 6, 12, and 24 months after surgery. Statistical analysis was performed to assess changes over time. RESULTS The osteotomy gap filling rate showed a significant continuous increase after MOWHTO, reaching 45.2% at 6 months and 66.7 and 84.4% at 1 and 2 years postoperatively, respectively. The most substantial increase occurred within the initial 6 months, thus indicating a critical period for bone healing. CONCLUSION The osteotomy gap filling rate showed a significant and gradual increase from immediately after surgery to 2 years after MOWTHO without bone grafting, the greatest of which was achieved in the initial 6-month period. Therefore, this study may be helpful for planning postoperative rehabilitation, including the extent of weight-bearing load and the period of crutch use.
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Affiliation(s)
- Joon-Gyom Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, South Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Chen P, Yu J, Guo H, Yuwen P, Zhu Y, Zhang Y. Clinical outcome after open-wedge high tibial osteotomy: comparison of double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). BMC Musculoskelet Disord 2024; 25:609. [PMID: 39085837 PMCID: PMC11292875 DOI: 10.1186/s12891-024-07658-w] [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: 12/03/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The objective of this study was to compare the clinical outcomes of two internal fixation methods for high tibial osteotomy (HTO): double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). METHODS 202 adult patients in our hospital between January 2018 and December 2021 were included and followed up for at least one year: group 1(DT-LCP, 98 patients) and group 2 (T-LCP, 104 patients). Detailed information on demographics, preoperative and postoperative follow-up, surgical procedures, and complications were collected. The information of the International Knee Documentation Committee Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected before surgery and at the last follow-up. RESULTS A total of 202 patients were included in the per-protocol analysis. No significant difference was found in terms of demographic data between groups, except for age and BMI. Clinically relevant improvements in knee pain were reached up to last follow-up after the operation in both groups. The mean pain scores (KOOS, WOMAC) at the final follow-up were significantly higher among group 1 compared to group 2 (P = 0.040 and P = 0.023). Furthermore, the DT-LCP internal fixation exerted more excellent effects on other symptoms, function and quality of life than T-LCP internal fixation. CONCLUSIONS Our study demonstrated that DT-LCP provided better clinical performance due to its implant irritant pain, compared with T-LCP. Thus, DT-LCP is a feasible alternative for the fixation of OW-HTO.
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Affiliation(s)
- Pengzhao Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Jiahao Yu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Haichuan Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Peizhi Yuwen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang 050051, Hebei, People's Republic of China.
- Chinese Academy of Engineering, Beijing 100088, People's Republic of China.
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Guo H, Li C, Wu H, Ma M, Zhu R, Wang M, Yang B, Pan N, Zhu Y, Wang J. Low-density lipoprotein cholesterol-to-lymphocyte count ratio (LLR) is a promising novel predictor of postoperative new-onset deep vein thrombosis following open wedge high tibial osteotomy: a propensity score-matched analysis. Thromb J 2024; 22:64. [PMID: 39014396 PMCID: PMC11250942 DOI: 10.1186/s12959-024-00635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The association of low-density lipoprotein cholesterol (LDL-C) and lymphocyte counts with the development of deep vein thrombosis (DVT) has been demonstrated in many fields but remains lacking in open wedge high tibial osteotomy (OWHTO). This study aimed to assess the predictive value of LDL-C to lymphocyte count ratio (LLR) in screening for postoperative new-onset DVT. METHODS Clinical data were retrospectively collected from patients who underwent OWHTO between June 2018 and May 2023. The limited restricted cubic spline (RCS) was conducted to evaluate the nonlinear relationship between LLR and the risk of postoperative new-onset DVT. The receiver operating characteristic (ROC) curves were plotted and the predictive value of biomarkers was assessed. After adjusting for intergroup confounders by propensity score matching, the univariate logistic regression was applied to assess the association between LLR and DVT. RESULTS 1293 eligible patients were included. RCS analysis showed a linear positive correlation between LLR and the risk of DVT (P for overall = 0.008). We identified LLR had an area under the curve of 0.607, accuracy of 74.3%, sensitivity of 38.5%, and specificity of 80.7%, and LLR > 1.75 was independently associated with a 1.45-fold risk of DVT (95% CI: 1.01-2.08, P = 0.045). Furthermore, significant heterogeneities were observed in the subgroups of age, BMI, diabetes mellitus, hypertension, Kellgren-Lawrence grade, the American Society of Anesthesiologists (ASA) score, and intraoperative osteotomy correction size. CONCLUSION LLR is a valuable biomarker for predicting postoperative new-onset DVT in patients with OWHTO, and routine screening is expected to yield positive benefits.
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Affiliation(s)
- Haichuan Guo
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Chengsi Li
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Hao Wu
- Department of Information Engineering, Shijiazhuang College of Applied Technology, Hebei, 050086, People's Republic of China
| | - Meixin Ma
- College of Letters & Science, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Ruoxuan Zhu
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Maolin Wang
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Bin Yang
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Naihao Pan
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Juan Wang
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopedic Research Institute of Hebei Province, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Harris C, Nadeem F, Hargreaves M, Campbell C, Momaya A, Casp A. Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:666-677. [PMID: 38410034 DOI: 10.1002/ksa.12084] [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: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty. METHODS Medline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including 'obesity', 'BMI', 'osteotomy' and 'high tibial osteotomy (HTO)' were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient-reported satisfaction scores and postoperative complications. RESULTS Nine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening-wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.). CONCLUSION Obesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chandler Harris
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Fahad Nadeem
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Mathew Hargreaves
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Collier Campbell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amit Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aaron Casp
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ahrend MD, Petzold D, Schuster P, Herbst M, Ihle C, Mayer P, Schröter S. Higher conversion rate to knee arthroplasty in female patients following medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38415780 DOI: 10.1002/ksa.12083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Most studies about medial open-wedge high tibial osteotomy (HTO) reported outcomes without focusing on gender differences. Therefore, the study compared the long-term survival rate and postoperative subjective knee function after HTO in female versus male patients with symptomatic medial compartment knee osteoarthritis. METHODS The data of three cohorts with long-term outcomes were analysed (n = 245; 32% females; age: 49 ± 7 years; Kellgren Lawrence Grade I 6.1%, II 32.7%, III 42.4%; IV 18.8%). The minimum follow-up was at least 6 years or an earlier conversion to total knee arthroplasty (TKA). The gender-specific survival rate after HTO was calculated after 5 and 10 years and compared using Kaplan-Meier analysis and the logrank test. Baseline characteristics and subjective knee function (International Knee Documentation Committee [IKDC]/Lysholm) were analysed between both genders. RESULTS Forty of 78 (51.3%) women and 41 of 167 men (24.5%) underwent TKA. HTO survival in females was significantly lower (p = 0.0010). The 5- and 10-year survival rates were 85.9% and 62.6% for females and 93.4% and 77.7% for males. In females and males, from preoperative to the last follow-up, the IKDC (43 ± 15 to 58 ± 17; 47 ± 14 to 67 ± 18) and the Lysholm (42 ± 18 to 72 ± 18; 55 ± 22 to 77 ± 23) improved significantly (all p < 0.0001). Females had significantly lower preoperative and postoperative IKDC (p = 0.0438; p = 0.0035) and Lysholm scores (p = 0.0002; p = 0.0323). But the absolute improvements of the IKDC and Lysholm were not significantly different between genders. CONCLUSIONS Females had higher conversion rates to TKA and lower knee function at the last follow-up. However, preoperative knee function was lower in females and the absolute improvement following HTO was similar for both genders. In general, females benefit from HTO to treat medial knee arthritis, and TKA could be postponed for half of female patients for more than 10 years. However, surgeons must be aware of the described inferior outcomes in females for realistic patient expectation management. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
- Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany
| | - Daniel Petzold
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Philipp Schuster
- Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Christoph Ihle
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Philipp Mayer
- Osteotomie Komitee der Deutschen Kniegesellschaft, München, Germany
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
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Kim SE, Lee MH, Cho CH, Lee JI, Han HS, Lee MC, Ro DH. Risk Factors and Clinical Outcomes of Osteotomy Plane Violation by D-Hole Screws in Medial Open Wedge High Tibial Osteotomy: A Simulation and Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2104. [PMID: 38138208 PMCID: PMC10745056 DOI: 10.3390/medicina59122104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Stable fixation is essential for successful healing after medial open wedge high tibial osteotomy (MOWHTO) to minimize the risk of non-union and correction loss. In Asians, potential complications such as D-hole screw osteotomy plane violation (D-hole violation) and inadequate plate fitting arise due to improper plate size. This study aimed to evaluate the risk factors for D-hole violation and compare the conventional anatomic (CA) plate with an individualized anatomic (IA) plate in MOWHTO procedures. Materials and Methods: A simulation study on D-hole violation using the CA plate was conducted, involving preoperative radiographs and CT scans of 64 lower extremities from 47 MOWHTO patients. Additionally, a randomized controlled study compared CA and IA plates in MOWHTO procedures with 34 patients (17 in the CA plate group; 18 in the IA plate group). Patient demographics, patient-reported outcome measures (PROMs), and radiological measures were analyzed. Results: In the simulation study, the rates of D-hole violation ranged from 20.3% to 59.4%, with an increase observed as the plate was distalized from 5 mm to 10 mm away from the joint line. Short stature was identified as an independent risk factor for D-hole violation (p < 0.001), with a cutoff value of 155.3 cm. In the randomized controlled study, no significant difference in PROMs and D-hole violation was observed between the CA plate and IA plate groups. However, the IA plate group showed better plate fitting compared to the CA plate group (p = 0.041). Conclusions: This study identified a high risk of D-hole screw osteotomy plane violations in MOWHTO procedures, particularly when the plate is positioned more distally and in individuals with a stature below 155.3 cm. It also revealed that individualized plates provide better tibial fitting compared to conventional anatomic plates, particularly in Asian populations where tibial morphology tends to be shorter than in Western populations. Therefore, evaluating patient stature and selecting tailored plates are essential to optimize plate positioning and minimize plate-related complications in MOWHTO procedures.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Myung Ho Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
| | - Chan Hee Cho
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
| | - Jung-In Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul 03080, Republic of Korea; (S.E.K.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- CONNECTEVE Co., Ltd., Seoul 06249, Republic of Korea
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