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Valcarenghi J, Vittone G, Mouton C, Coelho Leal A, Ibañez M, Hoffmann A, Pape D, Ollivier M, Seil R. A systematic approach to managing complications after proximal tibial osteotomies of the knee. J Exp Orthop 2023; 10:131. [PMID: 38055158 DOI: 10.1186/s40634-023-00708-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
Proximal tibial osteotomy (PTO) is an effective procedure for active and young adult patients with symptomatic unicompartmental osteoarthritis and malalignment. They were considered technically demanding and prone to various complications related to the surgical technique, biomechanical or biological origin. Among the most important are hinge fractures and delayed or non-healing, neurovascular complications, loss of correction, implant-related problems, patellofemoral complaints, biological complications and changes in limb length. Being aware of these problems can help minimizing their prevalence and improve the results of the procedure.The aim of this narrative review is to discuss the potential complications that may occur during and after proximal tibial osteotomies, their origin and ways to prevent them.
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Affiliation(s)
- Jérôme Valcarenghi
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire d'Ambroise Paré, Mons, Belgium
| | - Giulio Vittone
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
| | - Alexandre Coelho Leal
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Department of Orthopedics and Traumatology, Hospital del Mar, Barcelona, Spain
| | - Maximiliano Ibañez
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Institut Català de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron-Dexeus, Carrer Sabino de Arana, 5-19, 08028, Barcelona, Spain
| | - Alexander Hoffmann
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
| | - Dietrich Pape
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St Marguerite Hospital, Marseille, France
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte- Marguerite Hospital, Aix Marseille University, Marseille, France
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg.
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg.
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Jacquet C, Sharma A, Fabre M, Ehlinger M, Argenson JN, Parratte S, Ollivier M. Patient-specific high-tibial osteotomy's 'cutting-guides' decrease operating time and the number of fluoroscopic images taken after a Brief Learning Curve. Knee Surg Sports Traumatol Arthrosc 2020; 28:2854-2862. [PMID: 31352498 DOI: 10.1007/s00167-019-05637-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient-specific cutting guides (PSCGs) have been advocated to improve the accuracy of deformity correction in opening-wedge high-tibial osteotomies (HTO). It was hypothesized that PSCGs for HTO would have a short learning curve. Therefore, the goals of this study were to determine the surgeons learning curve for PSCGs used for opening-wedge HTO assessing: the operating time, surgeons comfort levels, number of fluoroscopic images, accuracy of post-operative limb alignment and functional outcomes. METHODS This prospective cohort study included 71 consecutive opening-wedge HTO with PSCGs performed by three different surgeons with different experiences. The operating time, the surgeon's anxiety levels evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), the number of fluoroscopic images was systematically and prospectively collected. The accuracy of the postoperative alignment was defined by the difference between the preoperative targeted correction and the final post-operative correction both measured on standardized CT-scans using the same protocol (ΔHKA, ΔMPTA, ΔPPTA). Functional outcomes were evaluated at 1 year using the different sub-scores of the KOOS. Cumulative summation (CUSUM) analyses were used to assess learning curves. RESULTS The use of PSCGs in HTO surgery was associated with a learning curve of 10 cases to optimize operative time (mean operative time 26.3 min ± 8.8), 8 cases to lessen surgeon anxiety levels, and 9 cases to decrease the number of fluoroscopic images to an average of 4.3 ± 1.2. Cumulative PSCGs experience did not affect accuracy of post-operative limb alignment with a mean: ΔHKA = 1.0° ± 1.0°, ΔMPTA = 0.5° ± 0.6° and ΔPPTA = 0.4° ± 0.8°. No significant difference was observed between the three surgeons for these three parameters. There was no statistical correlation between the number of procedures performed and the patient's functional outcomes. CONCLUSION The use of PSCGs requires a short learning curve to optimize operating time, reduce the use of fluoroscopy and lessen surgeon's anxiety levels. Additionally, this learning phase does not affect the accuracy of the postoperative correction and the functional results at 1 year. LEVEL OF EVIDENCE II: prospective observational study.
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Affiliation(s)
- Christophe Jacquet
- 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
| | - Akash Sharma
- 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
| | - Maxime Fabre
- 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
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Jean-Noël Argenson
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274, Marseille, France
| | - Sebastien Parratte
- 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.,International Knee and Joint Centre, Abu Dhabi, UAE
| | - 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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