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Jing L, Zhao X, Wang W, Yu L, Yang J, Wang J. Osseous factors influencing distal tibial rotation in biplane medial opening wedge high tibial osteotomy. INTERNATIONAL ORTHOPAEDICS 2024; 48:465-471. [PMID: 37707599 DOI: 10.1007/s00264-023-05968-7] [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: 07/29/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE There is a lack of studies investigating the distal tibial rotation (DTR) during medial opening wedge high tibial osteotomy (MOWHTO). This study was designed to evaluate osseous factors influencing DTR in patients who underwent biplane MOWHTO. METHODS A total of 106 knee joints in 69 patients who underwent surgery for varus malalignment of knee were reviewed. Based on several software, standard and actual hinge positions were defined in pre-operative and post-operative CT data. Pearson's correlation and Spearman's correlation analysis were performed with DTR change as the dependent variable. Independent variables included angles between standard and actual hinge in the sagittal (ASAHS) and axial (ASAHA) planes, pre-operative and post-operative medial proximal tibial angle, opening width (OW), tuberosity osteotomy angle, flange angle (FA), gap ratio, and hinge fracture. RESULTS The distal tibia rotated approximately 0.35° internally. Pearson's and Spearman's correlation analysis showed that DTR change was associated with ASAHS, OW, and FA. Larger OW and FA resulted in higher external rotation angles. CONCLUSIONS DTR change was significantly associated with ASAHS, followed by OW and FA rather than ASAHA if only considering osseous factors in biplane MOWHTO. The distal tibia tended to rotate externally when the actual hinge was inclined posteriorly to the standard hinge in the sagittal planes, but rotate externally or internally when the actual hinge was inclined anteriorly.
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Affiliation(s)
- Lizhong Jing
- Department of Orthopaedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong Province, China
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Xia Zhao
- Department of Radiology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Weiguo Wang
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Le Yu
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China
| | - Jiushan Yang
- Department of Orthopedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong Province, China.
| | - Jian Wang
- Department of Orthopaedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong Province, China.
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Pang R, Jiang Z, Xu C, Shi W, Zhang X, Wan X, Bahat D, Li H, Senatov F, Bulygina I, Wang H, Zhang H, Li Z. Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis. Orthop Surg 2022; 15:413-422. [PMID: 36585795 PMCID: PMC9891955 DOI: 10.1111/os.13483] [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: 12/07/2021] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 01/01/2023] Open
Abstract
The purpose of this meta-analysis was to identify if patient-specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI-assisted HTO, the weight bearing line ratio (WBL%), hip-knee-ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = -36.41; 95% CI: -42.30 to -30.53; p < 0.00001), HKA (MD = -9.95; 95% CI: -11.65 to -8.25; p < 0.00001), and mMPTA (MD = -8.40; 95% CI:-10.27 to -6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: -0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: -0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI -0.34 to 0.55; p = 0.64). The data show that 3D-based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO.
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Affiliation(s)
- Ran Pang
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Zhaohui Jiang
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Chunlei Xu
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Wei Shi
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Xinglong Zhang
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Xin Wan
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Daniel Bahat
- Department of OrthopaedicsCleveland ClinicClevelandOhioUSA
| | - Hui Li
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China,Department of OrthopaedicsTianjin Hospital of ITCWM Nankai HospitalTianjinPR China
| | - Fedor Senatov
- Center for Biomedical EngineeringNational University of Science and Technology “MISIS”MoscowRussia
| | - Inna Bulygina
- Center for Biomedical EngineeringNational University of Science and Technology “MISIS”MoscowRussia
| | - Hu Wang
- Department of Physical Health Care and RehabilitationTianjin Vocational College of SportsTianjinPR China
| | - Huafeng Zhang
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
| | - Zhijun Li
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPR China
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Effect of the sagittal osteotomy inclination angle on the posterior tibial slope change in high tibial osteotomy: three-dimensional simulation study. Sci Rep 2022; 12:19254. [PMID: 36357467 PMCID: PMC9649806 DOI: 10.1038/s41598-022-23412-5] [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: 04/13/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
Abstract
In performing medial open-wedge high tibial osteotomy, it is recommended not to alter the posterior tibial slope. However, it remains unclear whether the osteotomy inclination angle affects the posterior tibial slope in the sagittal plane. This study aimed to verify how anterior or posterior osteotomy inclination angle affects the tendency of change in the posterior tibial slope and to conduct quantitative analysis of the extent to which the posterior tibial slope changes according to the degree of the osteotomy inclination angle change in MOWHTO. Computed tomography images of 30 patients who underwent MOWHTO were collected. Three-dimensional models of preoperative original tibia were reconstructed, and virtual osteotomies were performed. The sagittal osteotomy inclination angles formed by the osteotomy line and the medial tibial plateau line were classified as positive in case of anteriorly inclined osteotomy and negative in case of posteriorly inclined osteotomy. Thirteen osteotomies were performed for each tibial model at intervals of 5° from - 30° to 30°. The posterior tibial slope was assessed, and the proportional relationship between the sagittal osteotomy inclination angle and the posterior tibial slope change was analyzed. The posterior tibial slope changed significantly after osteotomy (p < 0.001), except for the cases where the sagittal osteotomy inclination angles were 5°, 0°, and - 5°. Anteriorly and posteriorly inclined osteotomy caused increase and decrease in the posterior tibial slope, respectively. As the inclination angle increased by 1°, the posterior tibial slope increased by 0.079° in anterior inclination osteotomy, while in posterior inclination osteotomy, as the inclination angle decreased by 1°, the posterior tibial slope decreased by 0.067°. The osteotomy inclination angle in the sagittal plane significantly affected the posterior tibial slope. When there was an inclination angle occurred between the osteotomy line and the medial tibial plateau line in the sagittal plane, the posterior tibial slope changed after MOWHTO. The posterior tibial slope tended to increase in anteriorly inclined osteotomy and decrease in posteriorly inclined osteotomy. The change in the posterior tibial slope was proportionally related to the absolute value of the osteotomy inclination angle.
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Patellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slope. Orthop Traumatol Surg Res 2021; 107:103032. [PMID: 34358712 DOI: 10.1016/j.otsr.2021.103032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Open-wedge high tibial osteotomy (OWHTO) corrects coronal deformity and can impact sagittal parameters such as posterior tibial slope and patellar height. The aim of the present study was to analyze change in patellar height after medial OWHTO with respect to tibial and femoral-referenced indices. MATERIAL AND METHOD This single-center retrospective study included 129 patients undergoing isolated posteromedial OWHTO, without change in tibial slope, using patient-specific cutting-guides. Patellar height was assessed on Caton-Deschamps (CD), Insall-Salvati (IS) and Schröter indices. Posterior tibial slope and coronal femoral and tibial angles were also measured. X-rays were taken preoperatively and at 12 months, and analyzed by 2 independent observers. RESULTS OWHTO modified the global lower-limb alignment (Δ=6.3±0.95̊, p<0.0001) and the proximal tibial deformity (Δ=7±0.88̊, p<0.0001). Posterior tibial slope and tibial (CD and IS) and femoral (Schröter) patellar height indices were unchanged. Intra- and inter-observer reproducibility was excellent (ICC 0.79-0.91). There were no correlations between HKA or MPTA angles and change in patellar height. CONCLUSION The present clinical series showed that patellar height was unchanged by isolated posteromedial OWHTO without change in tibial slope, using patient-specific cutting-guides, with whichever femoral or tibial reference index. The Schröter patellar femoral height index was highly reliable and is independent of proximal tibial changes in assessing patellar height, and can thus be recommended in the follow-up of OWHTO. LEVEL OF EVIDENCE III; retrospective cohort study.
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Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis. J Clin Med 2021; 10:jcm10184272. [PMID: 34575383 PMCID: PMC8470783 DOI: 10.3390/jcm10184272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
The posterior tibial slope of the tibiofemoral joint changes after medial open wedge high tibial osteotomy (MOWHTO), but little is known about the effect of the sagittal osteotomy inclination angle on the change in the posterior tibial slope of the tibiofemoral joint. The purpose of this study was to investigate the effect of the osteotomy inclination angle in the sagittal plane on changes in the posterior tibial slope after MOWHTO by comparing how anterior and posterior inclination affect the posterior tibial slope of the tibiofemoral joint. The correlation between the osteotomy inclination angle and the postoperative posterior tibial slope angle was also assessed. Between May 2011 and November 2017, 80 patients with medial compartment osteoarthritis who underwent MOWHTO were included. The patients were divided into two groups according to the sagittal osteotomy inclination angle on the 3D reconstructed model. Patients with an osteotomy line inclined anteriorly to the medial tibial plateau line were classified into group A (58 patients). Patients with posteriorly inclined osteotomy line were classified as group P (22 patients). In the 3D reconstructed model, the preoperative and postoperative posterior tibial slope, osteotomy inclination angle relative to medial tibial plateau line in sagittal plane, and gap distance and ratio of the anterior and posterior osteotomy openings were measured. The preoperative and postoperative hip-knee-ankle angle, weight-bearing line ratio, and posterior tibial slope were also measured using plain radiographs. In the 3D reconstructed model, the postoperative posterior tibial slope significantly increased in group A (preoperative value = 9.7 ± 2.9°, postoperative value = 10.7 ± 3.0°, p < 0.001) and decreased in group P (preoperative value = 8.7 ± 2.7°, postoperative value = 7.7 ± 2.7°, p < 0.001). The postoperative posterior tibial slope (group A = 10.7 ± 3.0°, group P = 7.7 ± 2.7°, p < 0.001) and posterior tibial slope change before and after surgery (group A = 1.0 ± 0.8°, group P = −0.9 ± 0.8°, p < 0.001) also differed significantly between the groups. The Pearson correlation coefficient was 0.875 (p < 0.001) for the osteotomy inclination angle, and multivariate regression analysis showed that the only significant factor among the variables was the sagittal osteotomy inclination angle (β coefficient = 0.216, p < 0.001). The posterior tibial slope changed according to the osteotomy inclination angle in the sagittal plane after MOWHTO. The postoperative posterior tibial slope tended to increase when the osteotomy line was inclined anteriorly with respect to the medial tibial plateau line but decreased when the osteotomy line was inclined posteriorly. To avoid inadvertent change of posterior tibial slope, close attention needs to be paid to maintaining the sagittal osteotomy line parallel to the medial joint line during MOWHTO.
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Zheng W, Li H, Hu K, Li L, Bei M. Chondromalacia patellae: current options and emerging cell therapies. Stem Cell Res Ther 2021; 12:412. [PMID: 34275494 PMCID: PMC8287755 DOI: 10.1186/s13287-021-02478-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/22/2021] [Indexed: 01/08/2023] Open
Abstract
Chondromalacia patellae (CMP), also known as runner’s knee, typically occurs in young patients, which is characterized by anterior knee pain (AKP) that is associated with visible changes in patellar cartilage. The initial pathological changes include cartilage softening, swelling, and edema. CMP is caused by several factors, including trauma, increased cartilage vulnerability, patellofemoral instability, bony anatomic variations, abnormal patellar kinematics, and occupation hazards. CMP may be reversible or may progress to develop patellofemoral osteoarthritis. Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications. Additionally, radiological examinations are also necessary for diagnosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic method, which holds a promise in having the unique ability to potentially identify cartilage lesions. Modalities are conventionally proposed to treat cartilage lesions in the PF joint, but none have emerged as a gold standard, neither to alleviated symptoms and function nor to prevent OA degeneration. Recently, researchers have been focused on cartilage-targeted therapy. Various efforts including cell therapy and tissue emerge for cartilage regeneration exhibit as the promising regime, especially in the application of mesenchymal stem cells (MSCs). Intra-articular injections of variously sourced MSC are found safe and beneficial for treating CMP with improved clinical parameters, less invasiveness, symptomatic relief, and reduced inflammation. The mechanism of MSC injection remains further clinical investigation and is tremendously promising for CMP treatment. In this short review, etiology, MRI diagnosis, and treatment in CMP, especially the treatment of the cell-based therapies, are reviewed.
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Affiliation(s)
- Weitao Zheng
- Hubei Provincial Key Laboratory of Industrial Microbiology, Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Hubei University of Technology, Wuhan, 430068, Hubei Province, China.,Shanxi Yinmei Technology Co., Taiyuan Economic and Technological Development Zone, Room 301, No. 8, East Street, Taiyuan, China
| | - Hanluo Li
- Hubei Provincial Key Laboratory of Industrial Microbiology, Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Hubei University of Technology, Wuhan, 430068, Hubei Province, China
| | - Kanghong Hu
- Hubei Provincial Key Laboratory of Industrial Microbiology, Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Hubei University of Technology, Wuhan, 430068, Hubei Province, China
| | - Liming Li
- Shanxi Yinmei Technology Co., Taiyuan Economic and Technological Development Zone, Room 301, No. 8, East Street, Taiyuan, China
| | - Mingjian Bei
- Department of Orthopedic Surgery, Emergency General Hospital, Xibahenanli29, Chaoyang dis, Beijing, 100028, China.
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Medial joint space width and convergence angle change with time after medial opening-wedge high tibial osteotomy. Knee 2020; 27:1923-1930. [PMID: 33221690 DOI: 10.1016/j.knee.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/02/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although the medial joint space width (MJSW) is commonly used for radiographic evaluation of knee osteoarthritis, the changes in knee joint space width (JSW) during weight bearing after medial opening-wedge high tibial osteotomy (MOWHTO) remain unclear. This study aimed to depict how medial and lateral JSWs and convergence angles change gradually after MOWHTO. METHODS We retrospectively followed up 81 MOWHTO cases for over 45 months on average. Pre- and postoperative mechanical axes were recorded. The JSWs and convergence angles were measured preoperatively, immediately postoperatively, and 3-6, 9-12, and 21-24 months postoperatively. Patient-reported outcomes were measured using a visual analogue scale (VAS). RESULTS The mean mechanical femoral-tibial angle improved from 8.1° varus to 2.4° valgus. At the aforementioned times, the respective mean values of MJSW were 2.6, 3.5, 3.8, 4.0, and 4.2 mm; mean convergence angles were 4.8°, 2.9°, 2.2°, 2.1°, and 1.9°; and the mean VAS scores were 7.2, 7.8, 4.8, 1.4, and 1.3. The MJSW continued to increase significantly in the first year postoperatively and then plateaued for a minimum of 2 years follow up after MOWHTO. The convergence angle decreased significantly in the first 6 months postoperatively and was then maintained. CONCLUSIONS The MJSW, convergence angle, and VAS scores continued to improve through weight bearing during the first year after MOWHTO and were maintained for at least 2 years. Thus, JSW measurement may be an easy and representative way of radiographically monitoring the effect of MOWHTO.
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Otsuki S, Ikeda K, Wakama H, Okuno N, Okamoto Y, Okayoshi T, Miyamoto Y, Neo M. Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy. Knee Surg Relat Res 2020; 32:55. [PMID: 33050942 PMCID: PMC7556938 DOI: 10.1186/s43019-020-00063-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yuki Miyamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
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张 伟, 万 春, 张 涛, 王 明, 刘 钊, 赵 远. [Clinical application of Taylor spatial frame in adjustment of lower extremity force line of knee medial compartmental osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:452-456. [PMID: 32291980 PMCID: PMC8171503 DOI: 10.7507/1002-1892.201905106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/13/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the safety and effectiveness of Taylor spatial frame (TSF) in the treatment of medial compartmental osteoarthritis (MCOA) of the knee and the adjustment of the lower extremity force line at the same time. METHODS The clinical data of 30 patients with MCOA who underwent high tibial osteotomy (HTO) between October 2016 and April 2017 were retrospectively analyzed. According to the different fixation methods, they were divided into external fixation group (TSF external fixation, 16 cases) and internal fixation group (locking steel plate internal fixation, 14 cases). There was no significant difference between the two groups in gender, age, side, disease duration, mechanical femur tibia angle (MFTA), and other general data ( P>0.05). The operation time and intraoperative blood loss of the two groups were recorded and compared; MFTA was used to evaluate the recovery of the lower extremity force line at last follow-up; Hospital for Special Surgery (HSS) score was used to evaluate the clinical effecacy before operation and at 2 weeks, 1 month, and 3 months after operation. RESULTS The operation time and intraoperative blood loss of external fixation group were significantly less than those of internal fixation group ( P<0.05). All patients were followed up 9-16 months, with an average of 12 months. There were 2 cases of delayed healing in the internal fixation group and 1 case of delayed healing in the external fixation group, and all healed after symptomatic treatment. All patients in the two groups had no complication such as needle infection, nonunion at osteotomy, osteomyelitis, and so on. At last follow-up, MFTA standard was used to evaluate the recovery of force line. The results of external fixation group were all excellent, while the results of internal fixation group were excellent in 10 cases and good in 4 cases. The difference between the two groups was significant ( Z=-2.258, P=0.024). The HSS scores in the two groups were significantly improved at each time point after operation, and gradually improved with time after operation ( P<0.05). The HSS score of the external fixation group was significantly higher than that of the internal fixation group ( t=2.425, P=0.022) at 3 months after operation; and there was no significant difference between the two groups at other time points ( P>0.05). CONCLUSION TSF has unique advantages in HTO treatment of MCOA patients and correction of lower extremity force line, such as shorter operation time, less bleeding, firm fixation, and less complications. It can accurately adjust the lower extremity force line after operation and has good effectiveness. It is an effective and safe fixation method.
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Affiliation(s)
- 伟业 张
- 天津中医药大学研究生院(天津 300193)Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - 春友 万
- 天津中医药大学研究生院(天津 300193)Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - 涛 张
- 天津中医药大学研究生院(天津 300193)Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - 明杰 王
- 天津中医药大学研究生院(天津 300193)Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - 钊 刘
- 天津中医药大学研究生院(天津 300193)Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - 远航 赵
- 天津中医药大学研究生院(天津 300193)Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
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Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. INTERNATIONAL ORTHOPAEDICS 2019; 43:2757-2765. [DOI: 10.1007/s00264-019-04372-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022]
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Sun M, He R, Guo L, Chen G, Duan X, Zhang Y, Yang L. [Clinical application and research status of open wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:640-643. [PMID: 31090361 DOI: 10.7507/1002-1892.201901014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the clinical application and research status of open wedge high tibial osteotomy (OWHTO). Methods Relevant literature at home and abroad was reviewed, and the clinical application, effectiveness and complications, technical comparison, and surgical skills of OWHTO were summarized and analyzed. Results OWHTO is an effective treatment for mild to moderate medial compartment osteoarthritis due to knee varus. This method can delay the injury process of medial compartment of the knee, delay the time of total knee arthroplasty, and even avoid joint replacement surgery by adjusting the axial alignment of the lower extremity to the non-pathological lateral compartment through osteotomy and orthopedic. OWHTO has the advantages of small incision, dynamic adjustment of the axial alignment of the lower extremity, accurate correction of malformation, and rapid postoperative recovery. Conclusion With the development of surgical instruments and techniques, OWHTO once again enter the sight of orthopedic surgeons. This technique can solve the pain symptoms of arthritis, correct the tibial varus deformity and reconstruct the axial alignment of the lower extremity, and satisfactory clinical results has been obtained.
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Affiliation(s)
- Maolin Sun
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Rui He
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Lin Guo
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Guangxing Chen
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Xiaojun Duan
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Ying Zhang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Liu Yang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038,
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