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Kumaki D, Tensho K, Iwaasa T, Maezumi Y, Yoshida K, Koyama S, Shimodaira H, Hiriuchi H, Takahashi J. Postoperative patient-reported outcome measures after medial open-wedge high tibial osteotomy was improved by decreased joint line convergence angle. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38813913 DOI: 10.1002/ksa.12252] [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: 02/15/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To evaluate the relationship between pre- and postoperative joint line convergence angle (JLCA) changes and patient-reported outcome measures related to medial open-wedge high tibial osteotomy (MOWHTO). METHODS Sixty-one patients (71 knees) who underwent MOWHTO were examined. Preoperative and 2-year postoperative radiographic parameters (hip-knee-ankle angle, weight-bearing line ratio, medial proximal tibial angle and JLCA) were measured, and knee injury and osteoarthritis outcome scores (KOOS) were assessed. Patients were divided into two groups: group D (decreased JLCA compared with preoperative status) included 44 knees with a ΔJLCA < 0° and group I (increased JLCA and no-change JLCA compared with preoperative status) included 27 knees with a ΔJLCA ≥ 0°. KOOS sub-scores and the proportion of patients whose improvement exceeded the minimum clinically important difference (MCID) were compared between both groups using Student's t tests, Mann-Whitney U tests and chi-square tests. Multiple regression analysis was performed to determine the factor that had an influential effect on the postoperative KOOS total. RESULTS Significant differences in 2-year postoperative KOOS were observed between the two groups, including total, symptom, pain and activities of daily living scores. Group D had significantly more patients who achieved MCID for both KOOS symptoms and pain scores than group I did. Multivariate analysis indicated that JLCA change and body mass index were significantly associated with the postoperative KOOS total. CONCLUSION Patients with decreased JLCA had better 2-year post-MOWHTO KOOS and better symptom and pain improvements. Therefore, strategies that reduce JLCA are crucial to improving clinical outcomes, and efforts should be made to improve JLCA in surgical techniques. LEVEL OF EVIDENCE Level Ⅳ, Case series.
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Affiliation(s)
- Daiki Kumaki
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yusuke Maezumi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazushige Yoshida
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Hiriuchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Mabrouk A, Fernandes LR, Jacquet C, Kley K, Claes S, Ollivier M. The tipping point in medial opening wedge high tibial osteotomy relates to the shape of the proximal tibia more than to lower limb alignment correction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1008-1015. [PMID: 38469922 DOI: 10.1002/ksa.12121] [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: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The tipping point (TP) of the knee joint is the centre of rotation of the joint in the coronal plane. This study aimed to define the TP in medial opening wedge high tibial osteotomy (MOWHTO). METHODS Data from 154 consecutive patients with varus knee malalignment, who underwent MOWHTO between 2017 and 2021, was retrospectively reviewed. The degree of preoperative osteoarthritis (OA), using the Kellgren-Lawrence (KL) grading system, was recorded. Long-leg standing radiographs were used to record the alignment parameters, including the hip-knee-ankle angle (HKA), the mechanical lateral distal femoral angle (mLDFA), the medial proximal tibial angle (MPTA), the joint line convergence angle (JLCA) and the joint line obliquity (JLO) angle. Postoperative Tegner activity scores, Western Ontario and McMaster University Scores and patients' satisfaction were recorded. To define the TP, the relationship of all variables to Δ JLCA (absolute difference between preoperative to postoperative JLCA values) was analysed. Linear regression was employed for Δ JLCA to preoperative JLCA and postoperative and Δ MPTA (absolute difference between preoperative and postoperative values). K-means clustering was used to partition observations into clusters, in which each observation belongs to the cluster with the nearest mean serving as a prototype of the cluster, and analysed if there was any specific threshold influencing Δ JLCA. After defining the TP, further subanalysis of the TP based on the preoperative KL OA grade and analysis of variance of this TP to the KL OA grade was performed. RESULTS A total of 154 patients (77.9% males and 22.1% females) were included. The mean age was 48.2 ± 11 years, and the mean body mass index was 27.1 ± 4 kg/m2. Preoperatively, 26 (16.9%) patients had KL grade IV OA. The mean preoperative and postoperative JLCA and the significance of their relation to Δ JLCA were 2.6° ± 1.8° (p < 0.0001) and 1.9° ± 1.8° (p = 0.6), respectively. The mean Δ JLCA was 1.4° ± 1.5°. The mean pre- and postoperative MPTA and the significance of their relation to Δ JLCA were 84.6 ± 2.2 (p = 0.005) and 91.8 ± 2.5 (p < 0.0007), respectively. The mean Δ MPTA was 7.2 ± 2.3 (p = 0.3). The mean preoperative and postoperative HKA and the significance of their relation to Δ JLCA were 174.6 ± 2.5 (p = 0.2) and 181.9 ± 2.4 (p = 0.7), respectively. The overall linear regression for Δ JLCA was statistically significant for preoperative JLCA (R2 = 0.3, p < 0.0001) and postoperative MPTA (R2 = 0.09, p = 0.0001) and statistically insignificant for Δ MPTA (R2 = 0.01, p = 0.2) and postoperative HKA (R2 = 0.04, p = 0.7). MPTA > 91.5° was the optimal threshold dividing this series data set between substantial and nonsignificant Δ JLCA. CONCLUSION In this study, the main predictive factors for intra-articular correction (Δ JLCA) after MOWHTO were the preoperative value of JLCA and the postoperative value of MPTA. A value of 92° for postoperative MPTA is potentially the optimal threshold to predict intra-articular correction. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Mid Yorkshire Teaching Hospitals, England
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | | | | | | | | | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
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Nam HS, Pei Yuik Ho J, Park SY, Cho JH, Lee YS. Development of a machine learning model for identifying the optimal situation favoring double-level osteotomy over single-level high tibial osteotomy. Knee 2024; 47:196-207. [PMID: 38417191 DOI: 10.1016/j.knee.2024.02.006] [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: 07/18/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND This study aimed to develop a machine learning (ML) model to identify the optimal situation wherein double-level osteotomy (DLO) is favored for severe varus knees by analyzing unfavorable outcomes. This study hypothesized that there are the most favorable algorithms and contributing factors for identifying the optimal situation favoring DLO over opening-wedge high tibial osteotomy (OWHTO). METHODS Data were retrospectively collected from patients who underwent OWHTO (505 knees). Unfavorable outcome parameters were defined as follows: (1) medial proximal tibial angle (MPTA) > 95°, (2) joint line convergence angle (JLCA) > 4° (insufficient medial release), (3) JLCA < 0° (medial instability), (4) recurrence of varus deformity, and (5) lateral hinge fracture. The input data for the ML model included demographic data and preoperative radiological and intra-operative factors. The ML model was used to evaluate overall and to evaluate each unfavorable outcome. Interpretation by the model was performed by SHapley Additive exPlanations. RESULTS The unfavorable group had a larger JLCA and MPTA preoperatively than the favorable group in the conventional comparison. The light gradient boosting machine (LGBM) demonstrated the highest AUC of 0.66 and F-1 score of 0.72 among the ML algorithms. In the overall assessment, the preoperative weight-bearing line ratio (WBLR) was the factor that contributed the most, followed by the preoperative JLCA and the ΔWBLR. ΔWBLR and the preoperative JLCA were the contributing factors for each outcome. CONCLUSIONS The LGBM model was superior in predicting the optimal situations favoring DLO over OWHTO. Preoperative WBLR, preoperative JLCA, and ΔWBLR significantly contributed to the unfavorable outcomes overall and for each outcome in the ML model.
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Affiliation(s)
- Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Seung Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
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Anter Abdelhameed M, Jacquet C, Ollivier M, Argenson JN. The unintentional effect of unicompartmental knee arthroplasty on extraarticular deformity and of high tibial osteotomy on intraarticular deformity for the treatment of anteromedial osteoarthritis. Arch Orthop Trauma Surg 2024:10.1007/s00402-023-05193-2. [PMID: 38300289 DOI: 10.1007/s00402-023-05193-2] [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: 08/30/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Unicompartmental Knee Arthroplasty (UKA) and High Tibial Osteotomy (HTO) are two valid options in the treatment of Anteromedial Osteoarthritis (AMOA) of the knee with UKA being mainly performed in cases of Intraarticular deformity (IA) and HTO in cases of Extraarticular deformity (EA). The exact unintentional effect of UKA on EA deformity and HTO on IA deformity is still not well understood. The aim of this study was to assess this unintentional effect of UKA on EA and HTO on IA deformities respectively. MATERIALS AND METHODS This a single-center retrospective study in which 50 patients who underwent UKA and 50 patients who underwent medial opening wedge HTO (MWOHTO) for the treatment of AMOA were included. Overall, 35 males and 15 females underwent HTO with a mean age of 44.3 ± 11.2 years while the mean age of the UKA group was 71.8 ± 7.9 years in 23 males and 27 females. The radiological effect of UKA and HTO on each of the following angles: Hip-Knee-Ankle angle (HKA), Medial Proximal Tibial Angle (MPTA), mechanical Lateral Distal Femoral Angle (mLDFA) and Joint Line Convergence Angle (JLCA) on long film radiographs both pre- and postoperatively was measured. The postoperative values were compared to the preoperative values to detect the expected and unintended effects of each technique on IA and EA deformities. RESULTS In the HTO group, the MPTA has changed significantly as expected from 83.1 ± 4.5 preoperatively to 88.9 ± 3.9 postoperatively (p value < 0.001) correcting the existing preoperative EA varus without overcorrection. Similarly in the UKA group, the JLCA has also changed significantly as expected to correct the IA varus from 3.8 ± 1.7 preoperatively to 0.9 ± 1 postoperatively (p value < 0.001). On the other hand, the JLCA was unintentionally changed in the HTO group from 2.6 ± 2.1 preoperatively to 1.6 ± 2.4 postoperatively (p value = 0.03) partly correcting the IA varus deformity. Similarly, the MPTA showed a significant change that occurred inadvertently in the UKA group from 84.8 ± 2.1 to 86.3 ± 1.6 postoperatively (p value < 0.001). This unintentional increase in the MPTA also partly corrected the preexisting EA varus deformity. The mLDFA did not show a significant change neither in the HTO group (p value = 0.96) nor in the UKA group (p value = 0.94). CONCLUSION In addition to intraarticular varus correction, UKA can partly correct the extraarticular varus deformity in AMOA even when resurfacing is exclusively attempted. Additionally, intraarticular deformity can be also partially managed by HTO along with the extraarticular varus correction even without performing overcorrection.
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Affiliation(s)
- Mohammed Anter Abdelhameed
- Orthopedic and Traumatology Department, Faculty of Medicine, Assiut University Hospital, Assiut, Arab Republic of Egypt
| | - Christophe Jacquet
- Institute for Locomotion, Hospital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009, Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Matthieu Ollivier
- Institute for Locomotion, Hospital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009, Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Jean-Noel Argenson
- Institute for Locomotion, Hospital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009, Marseille, France.
- Aix Marseille University, APHM, CNRS, ISM, Marseille, France.
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Mabrouk A, An JS, Glauco L, Jacque C, Kley K, Sharma A, Ollivier M. The joint line convergence angle (JLCA) correlates with intra-articular arthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5673-5680. [PMID: 37884727 DOI: 10.1007/s00167-023-07616-4] [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: 07/28/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Knees with unicompartmental varus osteoarthritis (OA) usually display a combination of tibiofemoral bony deformity and increased joint line convergence angle (JLCA). The JLCA is a product of intra-articular deformity and lateral soft tissue laxity. This study aims to define the correlation between the JLCA and progression of OA. METHODS A retrospective radiological analysis of 501 patients, who underwent either high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA), was performed. The preoperative OA grade was reported based on the Ahlbäck and the Kellgren-Lawrence (KL). The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the mechanical lateral distal femoral angle (mLDFA) and the joint line convergence angle (JLCA) were recorded. The primary outcome was the relationship between the JLCA values and the OA grade. The secondary outcomes were comparing the JLCA and other alignment parameter values between HTO and UKA groups. RESULTS A total of 501 (59.3% females n = 297) cases were included, comprising 293 cases of HTO and 208 cases of UKA. Patients had a mean age of 57.63 ± 8.97 years, a mean BMI of 28.37 ± 7.39 kg/m2. Patients with Ahlbäck grade 2 represented 49.3% of all patients (n = 247) and patients with KL grade 3 represented 54.7% of all patients (n = 274). A high JLCA was observed in both groups. The reported mean JLCA in the UKA group was 3.69 ± 2.1°, and in the HTO group was 2.93 ± 1.82. There was a significant association between the increase in the JLCA and the progression of OA based on both the Ahlbäck and KL grades (both p values < 0.001). The mean JLCA in patients with Ahlbäck grades 1 and 4 was 1.48 ± 1.32°, and 7 ± 0.93°, respectively. The mean JLCA in patients with KL grades 1 and 4 was 1.77 ± 1.42°, and 4.89 ± 1.73°, respectively. The mean recorded preoperative HKA angle in the UKA group was 175.06 ± 3.08°, and in the HTO group was 173.26 ± 3.02°, whereas the mean MPTA was 88.63 ± 1.72° for the UKA group and 89.31 ± 2.29° for the HTO group. CONCLUSION The JLCA progressively increases with osteoarthritis progression in patients with unicompartmental varus knee osteoarthritis. The JLCA can potentially be used as a grading parameter for osteoarthritis progression akin to Ahlbäck and Kellgren-Lawrence grading systems.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, UK
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Jae-Sung An
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Loddo Glauco
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Christophe Jacque
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | | | | | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France.
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Rayegan H, Nguyen H, Weinans H, Gielis W, Ahmadi Brooghani S, Custers R, van Egmond N, Lindner C, Arbabi V. Automated Radiographic Measurements of Knee Osteoarthritis. Cartilage 2023; 14:413-423. [PMID: 37265053 PMCID: PMC10807738 DOI: 10.1177/19476035231166126] [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: 08/22/2022] [Revised: 12/27/2022] [Accepted: 03/12/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Herewith, we report the development of Orthopedic Digital Image Analysis (ODIA) software that is developed to obtain quantitative measurements of knee osteoarthritis (OA) radiographs automatically. Manual segmentation and measurement of OA parameters currently hamper large-cohort analyses, and therefore, automated and reproducible methods are a valuable addition in OA research. This study aims to test the automated ODIA measurements and compare them with available manual Knee Imaging Digital Analysis (KIDA) measurements as comparison. DESIGN This study included data from the CHECK (Cohort Hip and Cohort Knee) initiative, a prospective multicentre cohort study in the Netherlands with 1,002 participants. Knee radiographs obtained at baseline of the CHECK cohort were included and mean medial/lateral joint space width (JSW), minimal JSW, joint line convergence angle (JLCA), eminence heights, and subchondral bone intensities were compared between ODIA and KIDA. RESULTS Of the potential 2,004 radiographs, 1,743 were included for analyses. Poor intraclass correlation coefficients (ICCs) were reported for the JLCA (0.422) and minimal JSW (0.299). The mean medial and lateral JSW, eminence height, and subchondral bone intensities reported a moderate to good ICC (0.7 or higher). Discrepancies in JLCA and minimal JSW between the 2 methods were mostly a problem in the lateral tibia plateau. CONCLUSIONS The current ODIA tool provides important measurements of OA parameters in an automated manner from standard radiographs of the knee. Given the automated and computerized methodology that has very high reproducibility, ODIA is suitable for large epidemiological cohorts with various follow-up time points to investigate structural progression, such as CHECK or the Osteoarthritis Initiative (OAI).
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Affiliation(s)
- H. Rayegan
- Orthopaedic-BioMechanics Research Group, University of Birjand, Birjand, Iran
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - H.C. Nguyen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- 3D Lab, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. Weinans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Delft, The Netherlands
| | - W.P. Gielis
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S.Y. Ahmadi Brooghani
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - R.J.H. Custers
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N. van Egmond
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. Lindner
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - V. Arbabi
- Orthopaedic-BioMechanics Research Group, University of Birjand, Birjand, Iran
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Kim YM, Joo YB, Park YC, Lee SH, Song JH. Postoperative change in the joint-line convergence angle is associated with inaccurate correction in open-wedge high tibial osteotomy. J Orthop Surg Res 2023; 18:773. [PMID: 37833793 PMCID: PMC10571238 DOI: 10.1186/s13018-023-04248-9] [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: 07/12/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE Accurate correction is a prerequisite for the favorable outcomes of open-wedge high tibial osteotomy (OWHTO). However, previous studies have reported disappointing results regarding correction accuracy despite the use of intra-operative navigation, which implies that a certain factor other than bony components is involved in the inaccurate correction (mainly overcorrection). The joint-line convergence angle (JLCA) can represent soft tissue effects in OWHTO. This study tried to determine whether the postoperative change in the JLCA (∆JLCA) led to inaccurate correction. METHODS Medical records of 78 OWHTO patients from 2005 to 2021 were retrospectively reviewed. The hip-knee-ankle angle (HKA) was measured with a positive value indicating varus alignment. Inaccurate correction was defined as postoperative HKA < - 3°. The JLCA was measured before and 6 months after surgery on long-standing hip-to-ankle radiographs, and ∆JLCA was defined as the difference between the preoperative and 6-month postoperative JLCAs. ∆JLCA was compared between the accurate correction group and the inaccurate correction group, and a receiver operating characteristic (ROC) curve was used to obtain the cutoff ∆JLCA at which the sensitivity and the specificity for inaccurate correction were maximized. Clinical outcomes were also compared between the groups using the knee injury and osteoarthritis outcome score (KOOS) at final follow-up (60.9 ± 53.3 months postoperatively). RESULTS Of the 78 patients, inaccurate correction was noted in 10 patients. The overall preoperative and postoperative HKAs were 7.0 ± 3.1° and - 0.4 ± 1.5°, respectively. The accurate correction group and the inaccurate correction group had a difference in ∆JLCA (p = 0.010). However, no significant difference was found in the preoperative HKA (p = 0.529). An ROC curve showed that the cutoff ∆JLCA was 1.9°. In the patients having ∆JLCA ≥ 1.9°, the mean JLCA was 4.9 ± 1.6° preoperatively and 1.7 ± 1.2° postoperatively. In the other patients having ∆JLCA < 1.9°, the mean preoperative and postoperative JLCA were 2.5 ± 1.8° and 2.3 ± 1.8°, respectively. The difference in the preoperative JLCA was significant (p < 0.001). The postoperative KOOS subscales did not differ according to correction accuracy. CONCLUSION Inaccurate correction in OWHTO, specifically valgus overcorrection, is associated with large ∆JLCA which represents the postoperative change of soft tissue effects. Overcorrection should be checked in cases of large preoperative JLCAs.
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Affiliation(s)
- Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young Cheol Park
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Seung-Ho Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, 30099, Republic of Korea.
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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: 0] [Impact Index Per Article: 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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Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:3675-3685. [PMID: 34061210 DOI: 10.1007/s00402-021-03974-1] [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: 02/21/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to determine correction error predictors of lower extremitiy alignment after hybrid closed-wedge high tibial osteotomy (HCWHTO). MATERIALS AND METHODS From 2011 to 2015, 102 knees in 75 patients with medial compartment knee osteoarthritis of the knee and varus knee deformities who underwent HCWHTO were evaluated in this retrospective study with a minimum 2-year follow-up. Preoperative radiological parameters including weight-bearing line ratio (WBL ratio), mechanical leg axis angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and JLCA under varus or valgus stress were measured. The knees were divided into the following three groups based on the WBL ratio on average 54 months after procedure: acceptable (WBL crossing the tibial plateau between 50 and 70%), under-correction (< 50%), and overcorrection (> 70%). A multiple regression analysis was performed to evaluate predictors that could influence postoperative WBL ratio and cut-off values of predictive preoperative factors was analysed. RESULTS Significant differences in pre- and postoperative WBL ratios and mechanical leg axis angles were found. Preoperative mLDFA in the under-correction group (89.4° ± 2.1°) was significantly higher than that in the overcorrection group (87.4° ± 2.2°) (p = 0.015), while other preoperative parameters revealed no significant differences. The postoperative MPTA in the under-correction group (92.1° ± 3.7°) was significantly lower than that in the other two groups (p = 0.005 and p = 0.0001, respectively), while there was no significant change between the acceptable (94.6° ± 3.4°) and the overcorrection (96.7° ± 3.2°) groups. Multiple regression analysis revealed that mLDFA (β = - 0.316; p = 0.010) had a significant impact on postoperative WBLR. The cut-off value for under-correction of mLDFA was 89.5°and sensitivity and specificity were 53.6 and 71.6%, respectively (p = 0.014). CONCLUSIONS Preoperative mLDFA is significantly associated with postoperative alignment in HCWHTO. While postoperative MPTA is important, disregarding the preoperative mLDFA may bears a high risk of malcorrection. Varus alignment of the knee with larger mLDFA may be an indication for not only HCWHTO, but also for distal femoral osteotomy.
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Shim SJ, Jeong HW, Kim S, Park YG, Lee YS. Factors Associated With Unfavorable Radiological Outcomes After Opening-Wedge High Tibial Osteotomy for Varus Knees. Orthop J Sports Med 2022; 10:23259671221136501. [PMID: 36452340 PMCID: PMC9703515 DOI: 10.1177/23259671221136501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Corrective osteotomy around the knee is based on deformity profiles of the femoral and tibial sides. Opening-wedge high tibial osteotomy (OWHTO) can be favored if the outcomes are not different, even if there is a certain degree of abnormal parameters after correction. PURPOSE/HYPOTHESIS The purpose of this study was to identify the factors associated with unfavorable radiological outcomes after OWHTO for varus knees. Our hypothesis was that there would be an optimal situation in which double-level osteotomy (DLO) has advantages over isolated OWHTO and an optimal cutoff value of structural parameters for which DLO should be considered in patients with severe varus knees. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The radiological and clinical outcomes of 337 patients who underwent OWHTO were retrospectively evaluated. A subgroup analysis was performed according to the weightbearing line ratio (WBLR) (group 1: <25th percentile; group 2: 25th-75th percentile; and group 3: >75th percentile) and factors associated with unfavorable radiological outcomes. For the assessment of cutoff values of the parameters favoring DLO, unfavorable radiological outcomes were categorized as follows: (1) medial proximal tibial angle (MPTA) >95°, (2) joint-line convergence angle (JLCA) >4° (insufficient medial release), (3) JLCA <0° (medial instability), (4) recurrence of a varus deformity, and (5) lateral hinge fracture. RESULTS The mean follow-up period was 66.2 ± 19.1 months. A low preoperative WBLR was related to a larger preoperative to postoperative change (Δ) in the WBLR, a larger reduction in coronal translation, a larger ΔMPTA, a wide preoperative lateral joint space, and a narrow preoperative medial joint space (P < .001, P < .001, P < .001, P = .016, and P = .003, respectively). However, only an MPTA >95° was significantly related to a low WBLR in the subgroup analysis according to unfavorable radiological outcomes (P = .038). The cutoff value of ΔWBLR causing an MPTA >95° was 46.5%, which showed a good area under the curve of 0.800, with a sensitivity of 74.4% and a specificity of 82.7%. The clinical outcomes significantly improved at the final follow-up compared with those preoperatively, with no significant differences between the WBLR groups. CONCLUSION A ΔWBLR ≥46.5% led to an MPTA >95°. However, clinical outcomes were not affected. DLO should be considered if the surgeon desires a postoperative MPTA ≤95°.
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Affiliation(s)
- Seung Jae Shim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ho Won Jeong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Saeil Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju City, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Liu Y, Li R, Zhan Y, Xie X, Luo C. Combined Proximal Tibial Osteotomy for Adult Kashin-Beck Disease with Severe Varus Knee Osteoarthritis: Case Report and Literature Review. Orthop Surg 2022; 14:3441-3447. [PMID: 36220786 PMCID: PMC9732621 DOI: 10.1111/os.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Kashin-Beck disease (KBD) is an endemic, chronic osteoarthropathy that seriously affects joint function and can lead to severe knee deformity. Osteotomy is considered to be one of the effective methods for the treatment of this disease. Therefore, we designed a novel type of osteotomy named combined proximal tibial osteotomy (CPTO), which combines the characteristics of opening-wedge high tibial osteotomy and tibial condylar valgus osteotomy. CASE PRESENTATION We report the case of a 48-year-old male with knee pain and varus deformity who was diagnosed with KBD and varus knee osteoarthritis (Kellgren-Lawrence stage IV). Considering the patient's relatively young age, a varus deformity of the right knee of 16.79°, and an intra-articular instability, we performed a CPTO treatment. In this procedure, we performed an L-shaped osteotomy from the medial edge of the proximal tibia to the intercondylar eminence and an osteotomy from the medial side of the proximal tibia to the lateral side through the same incision, to adjust the leg alignment and the congruity of the joint by valgus correction. At 29 months follow-up, this patient achieved satisfactory results, with a varus right knee of 2.87°. There was significant improvement in his right knee function, pain, and joint stability. CONCLUSIONS CPTO may be an acceptable treatment for KBD patients with severe knee varus deformity and intra-articular instability. It can be considered as an alternative treatment, especially for patients with advanced osteoarthritis needing knee preservation.
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Affiliation(s)
- Yunfei Liu
- Department of OrthopaedicsThe Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical UniversitySuzhouChina
| | - Ruiyang Li
- Department of Orthopaedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Yu Zhan
- Department of Orthopaedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Xuetao Xie
- Department of Orthopaedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Congfeng Luo
- Department of Orthopaedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
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Kim MS, Koh IJ, Choi KY, Kim BS, In Y. Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2513-2524. [PMID: 33786646 DOI: 10.1007/s00402-021-03876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the changes in joint space width (JSW) over time after medial opening-wedge high tibial osteotomy (MOWHTO) and identify risk factors for deterioration of JSW using anteroposterior (AP) and Rosenberg views. METHODS We retrospectively analyzed changes in JSW of 104 MOWHTO patients whose preoperative osteoarthritis (OA) grade was K-L grade 3 or less on AP and Rosenberg views. Serial changes in JSW were assessed from preoperatively to at least 3 years postoperatively. Patients were divided into two groups according to JSW change patterns on each of AP and Rosenberg views: non-deterioration group had either unchanged or increased JSW, and deterioration group had decreased JSW. Clinical outcomes were compared using Western Ontario and McMaster Universities OA Index (WOMAC) score between groups. Multivariate logistic regression analysis was performed to identify risk factors for deterioration of JSW. RESULTS JSW on average for all patients increased 0.5 mm and 0.8 mm on AP and Rosenberg views, respectively (p < 0.05). Non-deterioration group showed significant improvement based on patient-reported outcomes (WOMAC) than deterioration group (all p < 0.05). Undercorrection was an independent risk factor for failure to achieve maintained or increased JSW on both AP (OR 6.885, 95% CI 1.976-23.986, p = 0.002) and Rosenberg (OR 12.756, 95% CI 2.952-55.129, p = 0.001) views. CONCLUSION JSW increased gradually and continuously on standing AP and Rosenberg views until postoperative 3 years after MOWHTO. Deterioration of JSW following MOWHTO was closely related to the undercorrection and affected clinical outcomes. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bo Seoung Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Cazor A, Schmidt A, Shatrov J, Alqahtani T, Neyret P, Sappey-Marinier E, Batailler C, Lustig S, Servien E. Less risk of conversion to total knee arthroplasty without significant clinical and survivorship difference for opening-wedge high tibial osteotomies in varus knee deformities at 10-year minimum follow-up compared to closing-wedge high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2022; 31:1603-1613. [PMID: 36038667 DOI: 10.1007/s00167-022-07122-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO). METHODS This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point. RESULTS At the time of HTO, mean age was 55 years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3 years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3 years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate. CONCLUSION At mean follow-up of 13 years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA. LEVEL OF EVIDENCE Retrospective case series, IV.
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Affiliation(s)
- A Cazor
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - A Schmidt
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
| | - J Shatrov
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia Orthopaedic Research Institute, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - T Alqahtani
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - P Neyret
- Infirmerie Protestante, 3 rue Penthod, 69300, Lyon, France
| | - Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - C Batailler
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - S Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, 25 Avenue François Mitterand, Lyon, France
| | - E Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 29 Boulevard du 11 Novembre 1918, Lyon, France
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Preoperative joint line convergence angle correction is a key factor in optimising accuracy in varus knee correction osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 31:1583-1592. [PMID: 35994079 PMCID: PMC10049955 DOI: 10.1007/s00167-022-07092-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This study aimed to identify and prevent preoperative factors that can be influenced in preoperative planning to reduce postoperative malcorrections. METHODS The method used in this study was a retrospective two-centre analysis of 78 pre and postoperative fully weight-bearing radiographs of patients who underwent valgus osteotomy correction due to symptomatic medial compartment osteoarthritis. A computer software (TraumaCad®) was used to aim for an intersection point of the mechanical tibiofemoral axis (mTFA) with the tibia plateau at 55-60% (medial = 0%, lateral = 100%). Postoperative divergence ± 5% of this point was defined as over- and undercorrection. Preoperative joint geometry factors were correlated with postoperative malcorrection. Planning was conducted using the established method described by Miniaci (Group A) and with additional correction of the joint line convergence angle (JLCA) using the formula JLCA-2/2 (Group B). Additionally, in a small clinical case series, planning was conducted with JLCA correction. Statistical analysis was performed using (multiple) linear regression analysis and analysis of variance (ANOVA) with p < 0.05 considered significant. RESULTS In 78 analysed cases, postoperative malcorrection was detected in 37.2% (5.1% undercorrection, 32.1% overcorrection). Linear regression analysis revealed preoperative body mass index (BMI, p = 0.04), JLCA (p = 0.0001), and osteotomy level divergence (p = 0.0005) as factors correlated with overcorrection. In a multiple regression analysis, JLCA and osteotomy level divergence remained significant factors. Preoperative JLCA correction reduced the planned osteotomy gap (A 9.7 ± 2.8 mm vs B 8.3 ± 2.4 mm; p > 0.05) and postoperative medial proximal tibial angle (MPTA: A 94.3 ± 2.1° vs B 92.3 ± 1.5°; p < .05) in patients with preoperative JLCA ≥ 4°. The results were validated using a virtual postoperative correction of cases with overcorrection. A case series (n = 8) with a preoperative JLCA > 4 revealed a postoperative accuracy using the JLCA correction of 3.4 ± 1.9%. CONCLUSION Preoperative JLCA ≥ 4° and tibial osteotomy level divergence were identified as risk factors for postoperative overcorrection. Preoperative JLCA correction using the formula JLCA-2/2 is proposed to better control ideal postoperative correction and reduce MPTA. The intraoperatively realised osteotomy level should be precisely in accordance with preoperative planning. LEVEL OF EVIDENCE III, cross-sectional study.
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Huang L, Xu Y, Wei L, Yuan G, Chen W, Gao S, Liu W, Tan Z, Zhao J. Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29576. [PMID: 35905249 PMCID: PMC9333480 DOI: 10.1097/md.0000000000029576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are widely used for the treatment of medial unicompartmental knee osteoarthritis (OA). However, the best approach remains controversial. This study aimed to present a systematic review and a meta-analysis to directly compare the clinical outcomes between HTO and UKA. We hypothesized that the clinical outcomes after UKA and HTO would be similar. METHODS Electronic databases (Web of Science, PubMed, Embase, CENTRAL, and Biosis Preview) were searched for related studies published before November 30, 2021. Retrospective and prospective studies that directly compared the postoperative outcomes between UKA and HTO were included. Odds ratio (ORs) and 95% confidence interval (CIs) for complications, revision to total knee arthroplasty (TKA), and weighted mean difference (MD) and 95% CIs in range of motion (ROM), pain, walking speed and function score were evaluated. Two reviewers independently assessed the quality of the studies. Subgroup and sensitivity analyses were performed to explore the heterogeneity. RESULTS Twenty-three retrospective and 6 prospective studies were included. A total of 3004 patients (3084 knees) were evaluated for comparison. Complications (OR, 4.88, 95% CI: 2.92-6.86) were significantly greater in the HTO group than in the UKA group. Postoperative function scores including Lysholm score (MD, -2.78, 95% CI: -5.37 to -0.18) and Hospital for Special Surgery (HSS) score (MD, -2.80, 95% CI: -5.39 to -0.20) were significantly lower in the HTO group than the UKA group. The postoperative ROM was similar between HTO and mobile-bearing UKA (MD, -3.78, 95% CI: -15.78 to 8.22). However, no significant differences were observed between the HTO and UKA group in terms of postoperative pain, walking speed, and revision to TKA. CONCLUSIONS UKA is superior to HTO in minimizing complications and enhancing postoperative function scores. Mobile-bearing UKA has a similar ROM compared with HTO. Both HTO and UKA provide satisfactory clinical outcomes in terms of walking speed, relieving pain, and revision to TKA. UKA appears to be more suitable for the elderly, and both mobile-bearing UKA and HTO are viable surgical options for younger active individuals.
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Affiliation(s)
- Linke Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Yinglong Xu
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Linhua Wei
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- The Affiliated Nanning Infectious Disease Hospital of Guangxi Medical University, The Fourth People’s Hospital of Nanning, Nanning, GuangxiChina
| | - Guangzhi Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Weiwei Chen
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, GuangxiChina
| | - Shiyao Gao
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Wei Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Zhen Tan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Jinmin Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- * Correspondence: Jinmin Zhao MD, Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi, China (e-mail: )
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Zhao G, Li D, Ji W, Luo C. Biomechanical evaluation of combined proximal tibial osteotomy for varus knee osteoarthritis implanted novel designed plate system: Finite element analysis. Injury 2022; 53:2416-2423. [PMID: 35618538 DOI: 10.1016/j.injury.2022.05.012] [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: 10/19/2021] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Combined proximal tibial osteotomy (CPTO) is an innovative and effective procedure for correcting varus knee osteoarthritis (VKOA) with intra- and extra-articular deformity. Here, we designed a novel internal fixation plate system for CPTO and assessed the biomechanical strength of the bone-implant. METHODS Our newly designed CPTO internal fixation plate system included a specialized plate shape, combination holes, locking screw holes, screw position, and size of fixation. The biomechanical performance of this plate system in CPTO treatment was compared via finite element analysis (FEA) to traditional Tomofix devices implanted in the opening-wedge high tibial osteotomy (OWHTO), tibial condylar valgus osteotomy (TCVO), and CPTO. RESULTS The tibial wedge stiffness and displacement after CPTO implantation of the novel internal plate fixation increased by 9.6%, which was -65% higher than the CPTO with the Tomofix system. The average stress of the bone, plate, and screws in the CPTO implanted the novel designed plate system compared to the Tomofix system decreased by 12.7%, 1.9%, and 20.3 %, respectively. The device maximum stress and wedge stiffness after CPTO with the novel plate system versus traditional OWHTO and TCVO with the Tomofix system were 255.7 MPa, 204 MPa, 130.4 MPa, and 678.9 N/mm, 660.3 N/mm, 1626.0 N/mm, respectively. CONCLUSIONS The novel internal fixation plate system usage during CPTO exhibited similar bone-implant biomechanical strength, compared to OWHTO, but with enhanced construct stability.
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Affiliation(s)
- Gaiping Zhao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.
| | - Dongyan Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Weiping Ji
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Congfeng Luo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Suardi C, Stimolo D, Zanna L, Carulli C, Fabrizio M, Civinini R, Innocenti M. Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty. J Orthop Surg Res 2022; 17:299. [PMID: 35659012 PMCID: PMC9166439 DOI: 10.1186/s13018-022-03184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial-femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty. METHODS We retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip-knee-ankle, anatomical-mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. RESULTS The greatest contributor to arthritic varus (R = 0.444) was MPTA. Minor contributors were mLDFA (R = 0.076), JLCA (R = 0.1554), LDTA (R = 0.065), and femoral bowing (R = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment. CONCLUSIONS The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut.
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Affiliation(s)
- Chiara Suardi
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Davide Stimolo
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Luigi Zanna
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Matassi Fabrizio
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy.
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Undercorrection: the undesired effect of compression on the osteotomy gap of the medial opening wedge high tibial osteotomy and its clinical significance. Arch Orthop Trauma Surg 2022; 142:937-946. [PMID: 33417032 DOI: 10.1007/s00402-020-03717-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Undercorrection is a common problem in opening wedge high tibial osteotomy (OWHTO). We investigated the compression effect of cortex screw on the osteotomy gap and its clinical significance. MATERIALS AND METHODS A standard OWHTO using the TomoFix plate was conducted on 20 bone models in two groups to get a 10-mm medial osteotomy gap. A cortex screw was used temporarily in a neutral (at the center) and an eccentric position (near the inclined plane) of the dynamic hole in group 1 and group 2, respectively. The mean of undercorrection observed in the two groups was compared using an independent t test. Also, the effect of compression on the gap between the plate and medial tibial cortex, and the osteotomy gap was evaluated using a Sine rule. Besides, the mean undercorrection observed was assessed for clinical significance based on the effect on the weight-bearing axis (WBA) using a Cosine Rule. RESULTS The mean undercorrection was 1.3 ± 0.6 mm and 2.6 ± 0.6 mm in group 1 and group 2, respectively. A significantly greater undercorrection was observed in group 2 (p < 0.001). The correction loss in group 2 has resulted from combinations of the sliding effect of the dynamic hole and oblique compression effect over the gap between the plate and medial tibial cortex whereas in group 1 it has only resulted from the oblique compression effect. The observed undercorrection in group 2 has resulted in clinically significant WBA shift (10%) over the width of the tibial plateau. CONCLUSIONS In OWHTO, compression is important for the stability and healing of osteotomy, but it can also cause loss of correction. In patients requiring large correction, the surgeon should control the amount of compression required and consider making extra osteotomy gap to avoid undercorrection. Furthermore, the placement of cortex screws in neutral is essential to lower the risk of undercorrection.
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How accurately can surgeons perform angle manipulation? Quantitative assessment of the accuracy of manual angle manipulation of orthopedic surgery: a cadaver study. Arch Orthop Trauma Surg 2022; 142:905-911. [PMID: 33417029 DOI: 10.1007/s00402-020-03702-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To date, only few studies have been performed on the accuracy of manual angle manipulation during orthopedic surgery. This cadaver study was aimed at quantitatively assessing the accuracy of manual angle manipulation performed by orthopedic surgeons according to their surgical experience and comparing it with manipulation performed with the assistance of a digital goniometer. MATERIALS AND METHODS Six lower-leg specimens of fresh-frozen human cadavers were subjected to angle manipulation performed via Kirschner wire (K-wire) insertion. K-wires were inserted manually and with the assistance of a digital goniometer at target angles of 0°, 30°, and 60° by three operators who had different levels of experience in orthopedic surgery. The accuracy of the insertion angles at the target angles was evaluated using computed tomography. RESULTS The mean angle error in the manual angle manipulation was 8.8° (standard deviation [SD] 6.0). When the target angles were set to 0°, 30°, and 60°, the identified angle errors were 6.1° (SD 4.3), 8.8° (SD 6.6), and 11.7° (SD 5.6), respectively, and each value did not show any significant difference among the operators. With the assistance of a digital goniometer, the mean (SD) angle error was significantly improved to 2.1° (1.1°) (p < 0.001). The amount of improvement in accuracy significantly increased as the target angle increased (p = 0.01). CONCLUSION This cadaver study quantified the inaccuracy of manual angle manipulation in orthopedic surgery and showed that these inaccuracies can be improved using an assistive device. These results support the need to develop a device that can compensate manual angle manipulation in orthopedic surgery.
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Chua CXK, Tan SHS, Lim AKS, Hui JH. Accuracy of biplanar linear radiography versus conventional radiographs when used for lower limb and implant measurements. Arch Orthop Trauma Surg 2022; 142:735-745. [PMID: 33386975 DOI: 10.1007/s00402-020-03700-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The current standard of care for measuring lower extremity length and angular discrepancies is using a full-length standing anteroposterior radiograph. However, there has been increasing interest to use biplanar linear EOS imaging as an alternative. This study aims to compare lower extremity length and implant measurements between biplanar linear and conventional radiographs. MATERIALS AND METHODS In this 5-year retrospective study, all patients who had a standing full-length anteroposterior and biplanar linear radiographs (EOS®) that include the lower extremities done within one year of each other were included. Patients who underwent surgery in between the imaging, underwent surgeries that could result in graduated length or angulated corrections and inadequate exposure of the lower extremity were excluded. Four radiographic segments were measured to assess lower limb alignment and length measurements. Height and width measurements of implants were performed for patients who had implants in both imaging. RESULTS When comparing imaging and actual implant dimensions, biplanar linear radiographs were accurate in measuring actual implant height (median difference = - 0.14 cm, p = 0.66), and width (median difference = - 0.13 cm, p = 0.71). However, conventional radiographs were inaccurate in measuring actual implant height (median difference = 0.19 cm, p = 0.01) and width (median difference = 0.61 cm, p < 0.01). When comparing conventional and biplanar linear radiographs, there was statistically significant difference in all measurements. This includes anatomical femoral length (median difference = 3.53 cm, p < 0.01), mechanical femoral length (median difference = 3.89 cm, p < 0.01), anatomical tibial length (median difference = 2.34 cm, p < 0.01) and mechanical tibial length (median difference = 2.20 cm, p < 0.01). CONCLUSION First, there is a significant difference in the lower extremity length when comparing conventional and biplanar linear radiographs. Second, biplanar linear radiographs are found to be accurate while conventional radiographs are not as accurate in implant measurements of length and width in the lower extremity.
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Affiliation(s)
- Chen Xi Kasia Chua
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore.
| | - Andrew Kean Seng Lim
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore
| | - James Hoipo Hui
- Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore
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Sohn S, Koh IJ, Kim MS, In Y. Risk factors and preventive strategy for excessive coronal inclination of tibial plateau following medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:561-569. [PMID: 33130934 DOI: 10.1007/s00402-020-03660-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate risk factors and suggest preventive strategy for excessive coronal inclination of tibial plateau following medial opening-wedge high tibial osteotomy (MOWHTO). METHODS A total of 133 consecutive patients who underwent MOWHTO were retrospectively enrolled. Patients were divided into two groups based on postoperative medial proximal tibial angle (post-MPTA) of 95°: control group (n = 111, 83.5%) with post-MPTA less than 95° and excessive MPTA group (n = 22, 16.5%) with post-MPTA 95° or more. Demographics, radiographic parameters [mechanical lateral distal femoral angle (mLDFA), MPTA, posterior tibial slope, joint line obliquity (JLO), hip-knee-ankle angle, joint line convergence angle (JLCA), weight bearing line ratio, and correction angle], and clinical outcomes of patients were compared. Multiple logistic regression analysis was performed to determine risk factors for post-MPTA 95° or more. RESULTS Multiple logistic regression analysis showed that preoperative JLO ≥ 3° [odds ratio (OR) 6.940, 95% confidence interval (CI) 2.373-20.296, p < 0.001] and preoperative JLCA ≥ 5° (OR 5.723, 95% CI 1.833-17.865, p = 0.008) were statistically significant risk factors for post-MPTA ≥ 95°. Incidences of excessive MPTA following MOWHTO in patients with none, one, and two risk factors preoperatively were 3.7%, 26.7%, and 77.8%, respectively. CONCLUSION Preoperative JLO ≥ 3° and JLCA ≥ 5° were two significant risk factors for excessive MPTA following MOWHTO. Thus, surgeon should consider other types of osteotomy if these two risk factors are present together preoperatively in MOWHTO candidates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Elbardesy H, McLeod A, Ghaith HS, Hakeem S, Housden P. Outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. A systematic review. SICOT J 2022; 8:7. [PMID: 35363133 PMCID: PMC8973300 DOI: 10.1051/sicotj/2022009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background: When correcting severe genu varus deformity, knee surgeons must choose between performing a single or double-level osteotomy. This systematic review aims to provide this equipoise with some clarity. Patients and methods: We conducted this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies evaluating the effect of the double level osteotomy (DLO) or those comparing it to high tibial osteotomy (HTO) from all regions and written in any language were included. Results: Six studies were included in this systematic review. They were prepared and analysed using Review Manager V5.0 [Computer Program] (RevMan5). Performing DLO resulted in restoring patellar height, joint-line convergence angle (JLCA), and mMPTA to normal values. DLO was also more successful at avoiding joint line obliquity (JLO) in severe varus deformity when compared to HTO (P < 0.001). No significant difference was reported between the two cohorts regarding the mLPTA. DLO resulted in satisfactory short term KOOS and IKDC scores. The complication rate after DLO was 2.28%. Conclusions: DLO showed a low complication rate and satisfactory short term KOOS and IKDAC scores. Randomised control trials with long term follow-up comparing the DLO and HTO are recommended.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedics, East Kent University Hospital Kent TN240LY UK
- Corresponding author:
| | - André McLeod
- Orthopaedic Senior House Officer, Department of Trauma and Orthopaedic Surgery, Cork University Hospital Wilton, Cork T12DC4A Ireland
| | | | - Samir Hakeem
- Orthopaedic Registrar, Department of Trauma and Orthopaedic, Galway University Hospital Galway H91 YR71 Ireland
| | - Philip Housden
- Department of Trauma and Orthopaedics, East Kent University Hospital Kent TN240LY UK
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Bardot LP, Micicoi G, Favreau H, Zeman P, Khakha R, Ehlinger M, Ollivier M. Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes. Knee Surg Sports Traumatol Arthrosc 2022; 30:715-720. [PMID: 33486561 DOI: 10.1007/s00167-021-06446-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity. MATERIAL AND METHODS This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA). RESULTS From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01). CONCLUSION Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA. LEVEL OF CLINICAL EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Léo-Pôhl Bardot
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
| | - Grégoire Micicoi
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - Henri Favreau
- Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Petr Zeman
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Raghbir Khakha
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
- Guys and St Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, England
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France.
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Wang X, Shi L, Zhang R, Wang W, Kong L, Zhao H, Xu J, Kang Q. Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy. J Orthop Surg Res 2021; 16:451. [PMID: 34261504 PMCID: PMC8278751 DOI: 10.1186/s13018-021-02597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results. MATERIALS AND METHODS Sixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy. RESULTS During the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and - 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05). CONCLUSION Compared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.
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Affiliation(s)
- Xiaoyu Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Li Shi
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Rui Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Wenbo Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Lingchi Kong
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Haoyu Zhao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jia Xu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Qinglin Kang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Akamatsu Y, Nejima S, Tsuji M, Kobayashi H, Muramatsu S. Open-wedge high tibial osteotomy using intraoperative control of joint line convergence angle with reference to preoperative supine radiograph. Arch Orthop Trauma Surg 2021; 141:645-653. [PMID: 33417031 DOI: 10.1007/s00402-020-03738-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Preoperative supine joint line convergence angle (JLCA) correlates with postoperative standing JLCA. Here, we compared the radiographic and clinical outcomes of knees with preoperative JLCAs of ≥ 4° and < 4° in open-wedge high tibial osteotomy (OWHTO). We hypothesized that the postoperative coronal alignment in both groups would not be affected by a change in JLCA if this change could predict before surgery. MATERIALS AND METHODS Eighty-four patients with medial knee osteoarthritis who underwent OWHTO were enrolled retrospectively. A weight-bearing line (WBL) ratio of 62% and a JCLA equivalent to the preoperative supine JLCA were anticipated in preoperative planning. These were intraoperatively set using an alignment rod and a radiolucent protractor under fluoroscopy. Soft tissue correction was defined as correction angle minus bone correction. The participants with preoperative JLCAs of < 4° (low-JLCA group) and ≥ 4° (high-JLCA group) were compared. RESULTS No significant difference in the coronal alignment was found between the groups after OWHTO. No significant differences in correction angle or bone correction were found between the groups, but the soft tissue correction in the high-JLCA group was higher than that in the low-JLCA group after OWHTO (p = 0.013). CONCLUSIONS When we controlled intraoperative JLCA, the postoperative coronal alignment was not affected by the change in JLCA and the differences in soft tissue correction between the low-JLCA and high-JLCA groups. However, overcorrection compared with the target coronal alignment remained in both groups. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yasushi Akamatsu
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan. .,Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan.
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Hideo Kobayashi
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan.,Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Shuntaro Muramatsu
- Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan
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Saito H, Yonekura A, Saito K, Shimada Y, Yamamura T, Sato T, Nozaka K, Kijima H, Fujii M, Kawano T, Murata S, Miyakoshi N. A new double level osteotomy procedure to restore a joint line and joint angles in severe varus osteoarthritis. - Double level osteotomy associated with tibial condylar valgus osteotomy (DLOTO). ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 24:9-13. [PMID: 33457209 PMCID: PMC7787959 DOI: 10.1016/j.asmart.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022]
Abstract
High tibial valgus osteotomy (HTO) is a well-established surgical procedure to correct a varus malalignment and treat medial compartment osteoarthritis. Recently, double level osteotomy (DLO) was recommended for extensive varus knees as a single level osteotomy (SLO) approach may create an excessive joint line obliquity and eventually result in a new bony deformity. However, a severe varus knee in cases of advanced osteoarthritis involves not only a bony deformity (extra-articular deformity) but also a medial joint space narrowing with a widened lateral joint space (intra-articular deformity). A DLO alone cannot reduce this intra-articular deformity. However, tibial condylar valgus osteotomy (TCVO) can complement DLO as to reduce this intra-articular deformity. This technical note describes a novel modified DLO procedure associated with TCVO which can restore a normal alignment and a joint line and achieve joint preservation even in cases of extensive varus osteoarthritis.
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Affiliation(s)
- Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
- Akita Sports Arthroscopy and Knee Group (ASAKG), Japan
- Corresponding author. Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
- Akita Sports Arthroscopy and Knee Group (ASAKG), Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
| | - Toshiaki Yamamura
- Sapporo Sports Clinic, Chuo-ku Kita-1-jo, Nishi-2-Tyome, 060-0001, Sapporo, Japan
| | - Takahiro Sato
- Sapporo Sports Clinic, Chuo-ku Kita-1-jo, Nishi-2-Tyome, 060-0001, Sapporo, Japan
| | - Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
- Akita Sports Arthroscopy and Knee Group (ASAKG), Japan
| | - Masashi Fujii
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
- Akita Sports Arthroscopy and Knee Group (ASAKG), Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
- Akita Sports Arthroscopy and Knee Group (ASAKG), Japan
| | - Shohei Murata
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
- Akita Sports Arthroscopy and Knee Group (ASAKG), Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, 010-8543, Akita, Japan
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Managing intra-articular deformity in high Tibial osteotomy: a narrative review. J Exp Orthop 2020; 7:65. [PMID: 32902758 PMCID: PMC7481321 DOI: 10.1186/s40634-020-00283-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.
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Ziqi Z, Yufeng M, Lei Z, Chunsheng W, Pei Y, Kunzheng W. Therapeutic Effects Comparison and Revision Case Analysis of Unicompartmental Knee Arthroplasty and Open Wedge High Tibial Osteotomy in Treating Medial Knee Osteoarthritis in Patients Under 60 years: A 2-6-year Follow-up Study. Orthop Surg 2020; 12:1635-1643. [PMID: 32893481 PMCID: PMC7767766 DOI: 10.1111/os.12761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the therapeutic effects and revision cases of unicompartmental knee arthroplasty (UKA) and open wedge high tibial osteotomy (OWHTO) in treating medial knee osteoarthritis (MKOA) in patients under 60 years. Methods The present retrospective study included a total of 192 patients who were diagnosed with MKOA and treated by UKA or OWHTO in the Second Affiliated hospital of Xi'an Jiaotong University and Xi'an Honghui Hospital between December 2012 and December 2016. Among these patients, 83 were treated by UKA (17 men and 66 women, aged 53.7 ± 5.2 years) and 109 were treated by OWHTO (23 men and 86 women, aged 51.8 ± 6.9 years). Patients were followed up at 1, 3, 6, and 12 months for the first year postoperation, and every 6 months from the second year postoperation. Basic data, perioperative data, hospital for special surgery (HSS) score, visual analogue pain score (VAS), low‐impact recovery, and revision cases of the patients were evaluated. Results The average follow‐up periods of the UKA group and the OWHTO group were 39.3 ± 11.2 months and 40.2 ± 13.5 months, respectively. No significant difference was found in the basic data of the two groups (P ≥ 0.05). The operative time, incision length, and dominant blood loss of the UKA group was less than those of OWHTO group by 19.6%, 10.7%, and 35.1%, respectively, and the differences were significant (P < 0.05), while no significant difference was found in postoperative in‐bed time (P ≥ 0.05). The HSS scores of the UKA group at 1 and 3 months postoperation were higher than those of the OWHTO group by 5.1% and 3.9% (P < 0.05), while no differences were found from 6 months postoperation (P ≥ 0.05). The VAS score of the UKA group 1 month postoperation was lower than that of the OWHTO group by 12.2% (P < 0.05), while no differences were found from 3 months postoperation (P ≥ 0.05). One year after the operation, most patients in both groups could not achieve ideal recovery in low‐impact sports, and no significant differences were found (P < 0.05). The sport in which most patients could not achieve ideal recovery was mountain climbing. No revision cases occurred in the OWHTO group, while two revisions occurred in the UKA group. Conclusion Candidates for UKA should be chosen carefully and the current indications and contraindications raised by Goodfellow should be modified.
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Affiliation(s)
- Zhang Ziqi
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Mei Yufeng
- Department of Rheumatology and Immune Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhang Lei
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Wang Chunsheng
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Yang Pei
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Wang Kunzheng
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
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Tsuji M, Akamatsu Y, Kobayashi H, Mitsugi N, Inaba Y, Saito T. Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2020; 140:707-715. [PMID: 31468134 DOI: 10.1007/s00402-019-03245-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Using a navigation system in open-wedge high tibial osteotomy (OWHTO) has higher accuracy than using the conventional method. However, unintentional over- and under-correction still exist. This study aimed to compare various factors related to over- and under-correction and to assess their predictive factors in the preoperative radiographs. MATERIALS AND METHODS This study involved 96 knees. The difference in the hip-knee-ankle angle (HKA) between the intraoperative navigation system and postoperative radiograph was termed navigation correction loss (NCL). Knees with absolute values of NCL (|NCL|) ≦ 1.5° and |NCL| > 1.5° were categorised into acceptable (n = 46) and outlier (n = 50) groups, respectively. The differences in joint line convergence angle (JLCA) between varus and valgus radiographs, varus JLCA, valgus JLCA, standing JLCA and standing HKA were compared between the two groups. Clinical results were evaluated using the American Knee Society (AKS) scores. RESULTS The mean intraoperative HKA in the navigation system was - 3.8 ± 1.8°, and that in the postoperative standing radiograph was - 4.2 ± 2.5° (p = 0.033). Preoperative varus, valgus and standing JLCA were higher in the outlier group (p = 0.018, p = 0.020 and p = 0.001, respectively). Logistic regression analyses for preoperative factors of |NCL| ≦ 1.5° showed that standing JLCA was a determining factor, with an odds ratio of 1.334 (confidence interval was 1.087-1.637, p = 0.006). AKS score was higher in the acceptable group (p = 0.040) postoperatively. CONCLUSIONS Higher preoperative standing JLCA was the predictive factor of |NCL| > 1.5°. This factor reduced the rates of under- and over-correction and resulted in better AKS score in OWHTO.
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Affiliation(s)
- Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naoto Mitsugi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urahunecho, Minami-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Ji W, Luo C, Zhan S, Zhan Y, Xie X, Zhang B. Combined proximal tibial osteotomy for varus osteoarthritis of the knee: Biomechanical tests and finite-element analyses. Knee 2020; 27:863-870. [PMID: 32046900 DOI: 10.1016/j.knee.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/28/2019] [Accepted: 01/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A special combined proximal tibial osteotomy (CPTO) was designed to correct varus osteoarthritis of the knee with severe intra-articular pathologies, which could not be fully corrected by opening-wedge high tibial osteotomy (OWHTO). The biomechanical strength of the CPTO bone-implant construct was evaluated and compared with those of existing osteotomy methods. METHODS Three variations of osteotomy including OWHTO, tibial condylar valgus osteotomy (TCVO), and CPTO were performed on synthetic bones with locking plate and screws. Wedge stiffness, wedge displacement, and load failure were measured by biomechanical tests. Three types of numerical tibial models were also constructed by three-dimensional model reconstruction software. The stability parameters of the three variations including wedge stiffness, wedge displacement, and stress distribution were further measured by finite-element analyses. RESULTS The biomechanical testing results revealed that the wedge stiffness, wedge displacement, and failure load of the CPTO construct were very close to those of the OWHTO construct. The numerical results of wedge stiffness and displacement showed good conformity to the previous biomechanical results. The stress distribution at the lateral hinge, the plate corner, and the holes of the CPTO construct were close to those of the OWHTO counterpart, while the stress distribution at the inter-condylar eminence of the tibia and at the middle region of the screws was close to those of the TCVO counterpart. CONCLUSIONS The CPTO construct can provide comparable strength for early mobilization and rehabilitation to that of the OWHTO construct.
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Affiliation(s)
- Weiping Ji
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Congfeng Luo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu Zhan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xuetao Xie
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Binbin Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Goto N, Akasaki Y, Okazaki K, Kuwashima U, Iwasaki K, Kawamura H, Mizu-Uchi H, Hamai S, Tsushima H, Kawahara S, Nakashima Y. The influence of post-operative knee coronal alignment parameters on long-term patient-reported outcomes after closed-wedge high tibial osteotomy. J Orthop 2020; 20:177-180. [PMID: 32025144 DOI: 10.1016/j.jor.2020.01.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/26/2020] [Indexed: 01/07/2023] Open
Abstract
Background Both intra-articular and extra-articular knee alignment pathologies can affect clinical outcomes after high tibial osteotomy. The purpose of this study was to investigate post-operative knee coronal alignment parameters that affect long-term patient-reported outcomes after closed-wedge high tibial osteotomy (CW-HTO). Methods This study included 105 osteoarthritic knees that underwent CW-HTO. Long-term patient-reported outcomes were defined by the 2011 Knee Society Score (KSS) and were collected at an average follow-up of 10.2 years. Post-operative knee coronal alignment parameters, consisting of the femoral tibial angle (FTA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), tibial plateau inclination (TPI), and joint line convergence angle (JLCA), were measured using standing radiographs of the knee at an average follow-up of 11.0 months. The correlations between these parameters and KSS were then assessed by Spearman's correlation analysis. Comparisons of groups classified by MPTA and TPI cutoff values were performed by the Wilcoxon rank-sum test. Results Post-operative JLCA showed a significant negative correlation with two KSS sub-scores: satisfaction (R = -0.2232, P = 0.022) and total function (R = -0.2059, P = 0.035). There was no significant difference in any KSS sub-score between the "low" groups (MPTA and TPI less than 95 and 5°, respectively) and the "high" groups (MPTA and TPI greater than 98 and 7°, respectively). Conclusions Among knee coronal alignment parameters, a large post-operative residual JLCA, which is an intra-articular varus deformity, was independently associated with worsened long-term clinical outcomes after CW-HTO. Level of evidence Level Ⅳ, Retrospective cohort study.
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Affiliation(s)
- Norio Goto
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kenyu Iwasaki
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka, 806-8501, Japan
| | - Hideya Kawamura
- Masuda Orthopaedic Hospital, 1-1-1 Korimoto, Kagoshima City, Kagoshima, 890-0065, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Decision making for concomitant high tibial osteotomy (HTO) in cartilage repair patients based on a nationwide cohort study of 4968 patients. Arch Orthop Trauma Surg 2020; 140:1437-1444. [PMID: 32447445 PMCID: PMC8277607 DOI: 10.1007/s00402-020-03476-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND High tibial osteotomy (HTO) for varus deformities is a common concomitant treatment in cartilage surgery. Aim of the present study was to analyze factors influencing the decision towards accompanying HTO in patients with cartilage defects of the medial femoral condyle, such as the amount of varus deformity. METHODS Data from 4986 patients treated for cartilage defects of the knee from the German Cartilage Registry (KnorpelRegister DGOU) were used for the current analysis. Seven hundred and thirty-six patients fulfilled the inclusion criteria. Their data were analyzed for factors influencing the decision towards performing a concomitant HTO using t test, univariate and multivariate binary logistic regression models. RESULTS The break point at which the majority of patients receive a concomitant HTO is 3° of varus deformity. Several factors apart from the amount of varus deformity (5.61 ± 2.73° vs. 1.72 ± 2.38°, p < 0.00) differed significantly between the group of patients with HTO and those without. These included defect size (441.6 ± 225.3 mm2 vs. 386.5 ± 204.2 mm2, p = 0.001), symptom duration (29.53 ± 44.58 months vs. 21.85 ± 34.17 months, p = 0.021), defect grade (62.5% IVa/IVb vs. 57.3% IVa/IVb, p = 0.014), integrity of corresponding joint surface (10.8% grade III-IV vs. 0.2% grade III-IV, p < 0.001), meniscus status (15.5% > 1/3 resected vs. 4.4% > 1/3 resected, p < 0.001) and number of previous surgeries (1.01 ± 1.06 vs. 0.75 ± 1.00, p = 0.001). In the stepwise multivariate binary logistic regression test, only the amount of varus deformity, symptom duration and quality of the corresponding joint surface remained significant predictors associated with performing a concomitant HTO. CONCLUSION Based upon data from a nationwide cohort, additional HTO in context with cartilage repair procedures of the medial femoral condyle is frequently performed even in mild varus deformities less than 5°. Other factors also seem to influence decision for HTO.
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