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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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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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Xie T, Huizinga MR, van den Akker-Scheek I, van der Veen HC, Brouwer RW. Joint line obliquity after lateral closing-wedge high tibial osteotomy does not adversely affect clinical and radiological outcome: a 5-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4851-4860. [PMID: 37561185 PMCID: PMC10598188 DOI: 10.1007/s00167-023-07532-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To analyze the association between change in knee joint line obliquity (KJLO) and patient-reported outcome, radiological progression of osteoarthritis, and surgical survival after lateral closing-wedge high tibial osteotomy (HTO). METHODS A cohort of 180 patients treated in one single hospital with lateral closing-wedge HTO was examined. KJLO was defined by the medial proximal tibial angle (MPTA). To assess the association between KJLO and patient-reported outcome, radiological progression of osteoarthritis, and surgical survival, patient groups were defined: I, postoperative MPTA < 95.0°; II, postoperative MPTA ≥ 95.0°; A, MPTA change < 8.0°; B, MPTA change ≥ 8.0°. Propensity score matching was used for between-groups (I and II, A and B) covariates matching, including age, gender, preoperative lower limb alignment, preoperative medial joint space width (mJSW), preoperative Western Ontario and McMaster Universities osteoarthritis Index (WOMAC) score, wedge size, and postoperative follow-up time. Patient-reported outcome was assessed by the WOMAC questionnaire, radiological progression of osteoarthritis by mJSW and Kellgren-Lawrence (KL) grade progression (≥ 1) preoperatively and at follow-ups (> 2 years). Failure was defined as revision HTO or conversion to knee arthroplasty. RESULTS After propensity score matching, groups I and II contained 58 pairs of patients and groups A and B contained 50 pairs. There were no significant differences in postoperative WOMAC score or surgical failure rate between groups I and II or between groups A and B (p > 0.05). However, the postoperative mJSW was significantly lower in group I than group II (3.2 ± 1.6 mm vs 3.9 ± 1.8 mm; p = 0.018) and in group A than group B (3.0 ± 1.7 mm vs 3.7 ± 1.5 mm; p = 0.040). KL grade progression rate was significantly higher in group I than group II (53.4% vs 29.3%; p = 0.008) and in group A than group B (56.0% vs 28.0%; p = 0.005). CONCLUSION Increased KJLO (postoperative MPTA ≥ 95.0°) or MPTA change ≥ 8.0° after lateral closing-wedge HTO does not adversely affect patient-reported outcome, radiological progression of osteoarthritis, or surgical survival at an average 5-year follow-up. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Tianshun Xie
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Maarten R Huizinga
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
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Xie T, Brouwer RW, van den Akker-Scheek I, van der Veen HC. Clinical relevance of joint line obliquity after high tibial osteotomy for medial knee osteoarthritis remains controversial: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:4355-4367. [PMID: 37340220 PMCID: PMC10471655 DOI: 10.1007/s00167-023-07486-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE To systematically review the literature on the association between knee joint line obliquity (KJLO) and clinical outcome after high tibial osteotomy (HTO) for medial knee osteoarthritis and summarize the KJLO cut-off value used when studying this association. METHODS A systematic search was conducted in three databases (PubMed, Embase, and Web of Science) on September 2022, updated on February 2023. Eligible studies describing postoperative KJLO in relation to clinical outcome after HTO for medial knee osteoarthritis were included. Nonpatient studies and conference abstracts without full-text were excluded. Two independent reviewers assessed title, abstract and full-text based on the inclusion and exclusion criteria. The modified Downs and Black checklist was used to assess the methodological quality of each included study. RESULTS Of the seventeen studies included, three had good methodological quality, thirteen fair quality, and one had poor quality. Conflicting findings were shown on the associations between postoperative KJLO and patient-reported outcome, medial knee cartilage regeneration, and 10-year surgical survival in sixteen studies. Three good-quality studies found no significant differences in lateral knee cartilage degeneration between postoperative medial proximal tibial angle > 95° and < 95°. Joint line orientation angles by the tibial plateau of 4° and 6°, joint line orientation angle by the middle knee joint space of 5°, medial proximal tibial angles of 95° and 98°, and Mikulicz joint line angle of 94° were KJLO cut-off values used in the included studies. CONCLUSION Based on current evidence, the actual association between postoperative KJLO and clinical consequences after HTO for medial knee osteoarthritis cannot be ascertained. The clinical relevance of KJLO after HTO remains controversial. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tianshun Xie
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Sakai M, Akasaki Y, Akiyama T, Horikawa T, Okazaki K, Hamai S, Tsushima H, Kawahara S, Kurakazu I, Kubota K, Mizu-Uchi H, Nakashima Y. Similar short-term KOOS between open-wedge high tibial osteotomy and total knee arthroplasty in patients over age 60: A propensity score-matched cohort study. Mod Rheumatol 2023; 33:623-628. [PMID: 35652607 DOI: 10.1093/mr/roac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/28/2022] [Accepted: 05/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade. METHODS Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups. RESULTS After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA groups. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score. CONCLUSIONS In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.
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Affiliation(s)
- Mamiko Sakai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Tomohiro Horikawa
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Kumamoto Saishun Medical Center, Koshi, Kumamoto, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Ichiro Kurakazu
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Kenji Kubota
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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Nakayama H, Kanto R, Onishi S, Amai K, Ukon R, Tachibana T, Yoshiya S, Iseki T, Morimoto S, Iseki T. Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. J Exp Orthop 2023; 10:5. [PMID: 36695905 PMCID: PMC9877267 DOI: 10.1186/s40634-023-00573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the relationship between preoperative Ahlbäck radiographic classification grade and the clinical outcomes of double level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. METHODS The study population comprised a consecutive series of 99 knees (68 patients) for which DLO was performed and follow-up results for a minimum of two years were available. The Ahlbäck radiographic classification system was used to determine the osteoarthritic grade. The following radiological parameters for alignment and bone geometry were measured: mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line convergence angle (JLCA), and mechanical tibiofemoral angle (mTFA). Clinical results were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 2 years after surgery. Difference between preoperative and postoperative measurements as well as relationship between Ahlbäck grade and radiological/clinical results were statistically assessed. RESULTS The average age of the study participants was 60.9 ± 6.2 years and the mean follow-up period was 45.4 ± 15.2 months. Each of the radiological parameters exhibited preoperative abnormal values. Knees with Ahlbäck grade 3 and 4 osteoarthritis exhibited significantly greater JLCA and mTFA than grade 1 knees. Two years post-surgery, all radiological parameter values measured within a normal range. Clinical evaluation showed significant improvement in KOOS after surgery. Analysis of the relationship between Ahlbäck grade and clinical score showed that the 2-year postoperative KOOS scores in grade 3 and 4 osteoarthritic knees were significantly lower than grade 1 knees (with the mean 2-year KOOS scores of 350.0 ± 79.9, 317.9 ± 78.3, and 420.2 ± 42.9, respectively). CONCLUSIONS While DLO may produce significant radiological and clinical improvement in knees with joint space obliteration, Ahlbäck grade 3 and 4 osteoarthritic knees associated with larger JLCA and mTFA showed less satisfactory clinical results compared to grade 1 knees. LEVEL OF EVIDENCE IV case series.
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Affiliation(s)
- Hiroshi Nakayama
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Ryo Kanto
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Shintaro Onishi
- Nishinomiya Kaisei Hospital, Ohama-Cho Nishinomiya City, Hyogo, 662-0957 Japan
| | - Kenta Amai
- grid.510255.60000 0004 0631 9872Osaka Kaisei Hospital, Miyahara Yodogawa Ward, Osaka City, Osaka, 532-0003 Japan
| | - Ryosuke Ukon
- grid.510255.60000 0004 0631 9872Osaka Kaisei Hospital, Miyahara Yodogawa Ward, Osaka City, Osaka, 532-0003 Japan
| | - Toshiya Tachibana
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Shinichi Yoshiya
- Nishinomiya Kaisei Hospital, Ohama-Cho Nishinomiya City, Hyogo, 662-0957 Japan
| | - Takuya Iseki
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Shota Morimoto
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
| | - Tomoya Iseki
- grid.272264.70000 0000 9142 153XDepartment of Orthopaedic Surgery, Hyogo Medical University, Mukogawa-Cho, Nishinomiya City, Hyogo, 653-8501 Japan
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Potential anatomic risk factors resulting oversized postoperative medial proximal tibial angle after double level osteotomy. BMC Musculoskelet Disord 2022; 23:1121. [PMID: 36550449 PMCID: PMC9784003 DOI: 10.1186/s12891-022-06101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Double level osteotomy (DLO) has been introduced to prevent increased postoperative joint line obliquity. However, although DLO is planned, knees with postoperative medial proximal tibial angle (MPTA) > 95° in preoperative surgical planning are present. This retrospective study aimed to evaluate risk factors for an MPTA > 95° in preoperative surgical planning for DLO in patients with varus knee osteoarthritis (OA). METHODS A total of 168 knees that underwent osteotomies around the knee for varus knee OA were enrolled. The hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and mechanical medial proximal tibial angle (mMPTA) were measured on preoperative radiographs. The postoperative WBL ratio was planned to be 62.5%. When the postoperative mMPTA was more than 95° in isolated high tibial osteotomy (HTO), (DLO) was planned so that the postoperative mLDFA was 85°, and residual deformity was corrected by HTO. Knees with postoperative mMPTA ≤ 95° and > 95° were classified into the correctable group and uncorrectable group, respectively. RESULTS DLO was required in 101 knees (60.1%). Among them, 41 knees (40.6%) were classified into the uncorrectable group. Binomial logistic regression analysis showed that preoperative JLCA and mMPTA were independent predictors in the uncorrectable group. CONCLUSIONS Even with DLO, postoperative mMPTA was more than 95° in approximately 40% of cases. Preoperative increased JLCA and decreased mMPTA were risk factors for a postoperative mMPTA of > 95° after DLO.
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Affiliation(s)
- Shuntaro Nejima
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Ken Kumagai
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Shunsuke Yamada
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Masaichi Sotozawa
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Dan Kumagai
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Hironori Yamane
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Yutaka Inaba
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
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Osteotomy around the knee is planned toward an anatomical bone correction in less than half of patients. Orthop Traumatol Surg Res 2021; 107:102897. [PMID: 33753267 DOI: 10.1016/j.otsr.2021.102897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software. METHODS CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/overcorrection at the site of the osteotomy resulting in abnormal bone morphology. A type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology. RESULTS The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2=0.12, p<0.001) for both femoral (R2=0.06, p<0.001) and tibial (R2=0.07, p<0.001) abnormalities. CONCLUSION Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity. LEVEL OF EVIDENCE III; retrospective cohort study.
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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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