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de Paula RE, Pires E Albuquerque RS, de Paula Mozella A, Sobral RD, Valente Maia PA, Prinz RAD, Couto AC, da Palma IM, de Araujo Barros Cobra HA, de Sousa EB, Cordeiro A. Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05410-6. [PMID: 38960933 DOI: 10.1007/s00402-024-05410-6] [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: 12/04/2023] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy. MATERIALS AND METHODS Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05. RESULTS The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p = 0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 min between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 min vs. Autograft: 76.3 ± 15.2 min; p = 0.02). CONCLUSION Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time. TRIAL REGISTRATION NUMBER U1111-1280-0637 1 December 2022, retrospectively registered.
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Affiliation(s)
- Rafael Erthal de Paula
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil.
| | - Rodrigo Sattamini Pires E Albuquerque
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Alan de Paula Mozella
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Ricardo Duran Sobral
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Phelippe Augusto Valente Maia
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Rafael Augusto Dantas Prinz
- Tissue Bank, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Cézar Couto
- Research Division, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro - RJ, Brazil
| | | | - Hugo Alexandre de Araujo Barros Cobra
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Eduardo Branco de Sousa
- Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil
| | - Aline Cordeiro
- Research Division, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro - RJ, Brazil
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Hancock G, Martin R, Bell L, Broderick J, Dawson M. Infection in osteotomy around the knee: Incidence, management and outcomes in a high-volume case series. Knee Surg Sports Traumatol Arthrosc 2024; 32:1000-1007. [PMID: 38469916 DOI: 10.1002/ksa.12119] [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: 12/05/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Current evidence around the management of osteotomy-related infection is insufficient to robustly underpin the expert statements formulated by a recent European consensus statement. We present a review of a large case series in a high-volume osteotomy practice to contribute to the understanding of the incidence, management and outcome of infection in this subspecialty area. METHODS Analyses of two prospectively collected databases for all osteotomy around the knee and infections related to osteotomy were performed, along with a review of hospital readmission data to capture all osteotomy-related infections. Clinical notes were reviewed to assess patient demographics, incidence of infection, how infection was managed and clinical outcome. RESULTS In a series of 822 osteotomies in 755 patients, there were 21 (2.8%) cases of suspected infection. Twelve (1.6%) were contemporaneously deemed 'superficial' and nine confirmed 'deep' infections (1.2%). Deep infections were all successfully managed with wound debridement, with or without plate removal, depending on union and time from initial surgery. One of these infections was noted during a revision procedure, but no revision was carried out as a direct result of infection, no external fixation was required and no infected nonunions were experienced. CONCLUSION All of the cases in this series were managed successfully with debridement ± removal of the plate, without the need for revision or external fixation. Any potential signs of infection around an osteotomy, especially in the case of medial high tibial osteotomy, should raise awareness for deep infection and the need for further surgery due to the limited overlying soft tissue cover. This evidence supports the recent European Society of Sports Traumatology, Knee Surgery and Arthroscopy algorithm. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Graeme Hancock
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Rebecca Martin
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Lucy Bell
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - James Broderick
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - Matt Dawson
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
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Ramos Marques N. Author Reply to "Regarding 'Anterior Slope Correction-Flexion Osteotomy in Traumatic Genu Recurvatum'". Arthroscopy 2023; 39:2258-2259. [PMID: 37866860 DOI: 10.1016/j.arthro.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
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Kim JH, Ryu DJ, Lee SS, Jang SP, Park JS, Kim WJ, Kim IS, Wang JH. Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability? [Formula: see text]. Am J Sports Med 2022; 50:142-151. [PMID: 34850639 DOI: 10.1177/03635465211059162] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon's preference. However, it is still unclear whether transection of sMCL increases valgus laxity. PURPOSE We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. RESULTS All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment (P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, -3.5°± 2.0°; 6 months, -3.2°± 2.3°; 1 year, -3.1°± 2.3°; 2 years, -2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, -0.1°± 2.1°; 3 months, -0.2°± 2.4°; 6 months, -0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). CONCLUSION Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.
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Affiliation(s)
- Joo-Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Ryu
- Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea. Department of Orthopedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Republic of Korea
| | - Seung Pil Jang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Sung Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Jae Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Il-Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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Azoti W, Aghazade M, Ollivier M, Bahlouli N, Favreau H, Ehlinger M. Orientation and end zone of the osteotomy cut for high tibial osteotomy: Influence on the risk of lateral hinge fracture. A finite element analysis. Orthop Traumatol Surg Res 2021; 107:103031. [PMID: 34343697 DOI: 10.1016/j.otsr.2021.103031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/22/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION the hinge plays a fundamental role in the support and consolidation of a high tibial osteotomy. The objective of this work was to analyse the influence of the end zone of the osteotomy cut and its orientation in relation to the articular joint line (JL) on the risk of hinge fracture. HYPOTHESIS a specific orientation and end zone of the osteotomy cut can be utilised to decrease the risk of hinge fracture. MATERIAL AND METHOD a finite element (FE) model was used to reproduce the proximal portion of the tibia and the proximal tibiofibular joint with transverse isotropic elastic bone properties. A 1.27mm thick, complete, anteroposterior saw cut was made with a U-shaped saw blade. Five proximal and lateral tibial zones were used according to Nakamura et al corresponding to the end zones of the osteotomy cut. Three angulations of the cut relative to the JL were defined: 10°, 15°, 20°. The tests consisted of simulating 15 possible situations (3 angulations for each of the 5 end zones) on this model. These simulations made it possible to identify the existence of a local stress concentration (von Mises, in MPa) at the level of the hinge, corresponding to the main judgment criterion. RESULTS If we consider only the end zones of the osteotomy cut, regardless of its angulation with respect to the JL, the zone which presents, on average, the lowest local stress concentration is the AM zone (40.3MPa). If we consider only the angulation of the osteotomy cut, with respect to the JL, regardless of the end zone of the cut, the angulation that locally concentrates, on average, the least stress is an angulation at 10° (147.7MPa). Finally, it is important to define the best end zone of the osteotomy cut for each angulation value in relation to the JL: for an angulation of 10°, the end zone must be in AM (38MPa), but also for an angulation of 15° (45MPa), and for an angulation of 20° (38MPa). DISCUSSION-CONCLUSION With the inherent caveats of the experimental conditions, the hypothesis is confirmed. An end zone of the osteotomy cut exists (AM) and an orientation (10°) that induces the lowest local stress concentration and therefore the least likely to induce lateral hinge fracture. However, the orientation of the osteotomy cut is also a matter of surgical habit, especially regarding complementary osteotomy of the tibial tuberosity that some may want to avoid. Thus, it is equally important to know the best end zone associated with a given angulation of the cut in relation to the JL, which according to these results is the AM zone for each angulation. This information helps guide the operator in their surgical practices according to their habits. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Wiyao Azoti
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | | | - Matthieu Ollivier
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital Universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Henri Favreau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Matthieu Ehlinger
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France; Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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刘 军, 杨 莉, 吴 家, 苏 伟, 赵 劲. [Management principle and clinical suggestions of osteotomy gap of opening wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:919-926. [PMID: 32666739 PMCID: PMC8180423 DOI: 10.7507/1002-1892.201909110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO). METHODS The related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed. RESULTS Delayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not. CONCLUSION No matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.
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Affiliation(s)
- 军廷 刘
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 莉平 杨
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 家恒 吴
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 伟 苏
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - 劲民 赵
- 广西医科大学第一附属医院创伤骨科手外科(南宁 530021)Department of Orthopaedic Trauma and Hand Surgery, the 1st Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
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Survival and Risk Factor Analysis of Medial Open Wedge High Tibial Osteotomy for Unicompartment Knee Osteoarthritis. Arthroscopy 2020; 36:535-543. [PMID: 31901391 DOI: 10.1016/j.arthro.2019.08.040] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 08/17/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the survival rates and analyze the factors that affect survival rate after primary treatment with medial open wedge high tibial osteotomy (MOWHTO) for medial unicompartmental knee osteoarthritis. METHODS Clinical evaluation using Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index score and radiographic evaluation, including mechanical axis, were done before and after surgery. The main failure criteria for survival included the conversion to total knee arthroplasty or KSS of <60 points. Furthermore, risk factors that affected the survival after MOWHTO were analyzed. RESULTS Three hundred thirty-nine knees were included after a minimum of 5 years' follow-up. Their mean age was 56 years, and mean follow-up duration was 9.6 years. The mean KSS and Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly improved after surgery (87.3 and 18.5 points at 5 years and 81.7 and 23.6 points at 10 years). The mean hip-knee-ankle (HKA) angle was corrected from 7.2° varus to 3.4° valgus 1 year after surgery, which was maintained until 10 years after surgery (2.9° valgus at 5 years and 2.3° valgus at 10 years, P > .05). Using Kaplan-Meier survival estimates, the probability of survival for MOWHTO was 96.8% at 5 years, 87.1% at 10 years, and 85.3% at 13 years. The multivariate regression analysis revealed that age ≥65 years (hazard ratio [HR] = 2.34, P = .046), medial compartment cartilage damage International Cartilage Repair Society grade ≥4 (HR = 2.46, I = .045), lateral compartment cartilage damage International Cartilage Repair Society grade≥2 (HR = 3.38, P = .006), postoperative HKA angle <0° (HR = 4.69, P < .001) were associated with failure. CONCLUSION MOWHTO seems to be a good treatment option for young and active patients with medial knee osteoarthrosis and varus alignment, with acceptable survival rates and satisfactory outcomes. Age ≥65 years, grade 4 cartilage damage in medial compartment, grade ≥2 cartilage damage in lateral compartment, and undercorrection of HKA angle appear to be significant risk factors associated with failure. LEVEL OF EVIDENCE Level IV: retrospective case series.
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Ehlinger M, Ollivier M, Course S, Guerin A, Lantz É, Zahraa D, Bonnomet F, Bahlouli N. Effect of saw blade geometry on crack initiation and propagation on the lateral cortical hinge for HTO: Finite element analysis. Orthop Traumatol Surg Res 2019; 105:1079-1083. [PMID: 31447398 DOI: 10.1016/j.otsr.2019.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The hinge plays a primary role in the hold and healing of a high tibial osteotomy (HTO). Weakening of the hinge is a risk factor for failure. The aim of our study was to determine whether the geometry of the saw blade's cutting edge impacts crack initiation or propagation on the hinge. HYPOTHESIS A certain cutting edge geometry exists that will reduce this risk. MATERIALS AND METHODS A finite element model with transverse isotropic elastic bone properties was created. A 1.27-mm thick saw cut (full thickness in anteroposterior direction) was made leaving a 1cm lateral cortical hinge. Three different cutting edge geometries were compared: rectangular, U-shaped, V-shaped. Opening of the osteotomy was done over 1mm for 1 s by a load applied distally with the proximal portion fixed. In the first simulation, no crack was initiated at the hinge, while in the second simulation, the beginnings of a 2mm crack angled upward at 15° was added. These two simulations were used to identify whether a local stress riser was present at the hinge. This information was used to calculate the energy release rate to the hinge, which corresponds to the energy needed to initiate and propagate a crack on the hinge. RESULTS In the first simulation (no crack initiation), a rectangular saw blade geometry resulted in the lowest local stress concentration. In the second simulation (with crack initiation), the U-shaped geometry resulted in the lowest local stress concentration. The U-shaped geometry had the lowest energy release rate, meaning that it was the least likely to initiate and propagate a crack on the lateral cortical hinge. DISCUSSION/CONCLUSION Keeping the inherent limitations related to computer modelling in mind, our findings show that a U-shaped cutting edge is least likely to initiate or propagate a crack since it has the lowest energy release rate. This confirms our hypothesis. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France; Laboratoire ICube, équipe MMB, 67400 Illkirch, France.
| | - Matthieu Ollivier
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Arnaud Guerin
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - Éric Lantz
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - Dany Zahraa
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - François Bonnomet
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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Carranza VA, Reeves J, Getgood A, Burkhart TA. Development and validation of a finite element model to simulate the opening of a medial opening wedge high tibial osteotomy. Comput Methods Biomech Biomed Engin 2019; 22:442-449. [PMID: 30714405 DOI: 10.1080/10255842.2018.1563599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Medial opening wedge high tibial osteotomy (MOWHTO) is a surgical procedure intended to alter the coronal and sagittal plane alignment of the lower limb to primarily relieve the symptoms of osteoarthritis in the medial compartment of the knee. The purpose of this work was to develop and validate a finite element model to simulate the opening of a high tibial osteotomy and determine whether a pilot hole at the cortical hinge reduces the risk of lateral cortical fracture. Fifteen models were reconstructed from CT images of eight cadaveric specimens. The validated models indicated that the addition of the pilot hole increased the stresses and likelihood of a type-I and type-II fractures during the opening of a medial open wedge high tibial osteotomy compared to the no-hole condition.
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Affiliation(s)
- Victor A Carranza
- a School of Biomedical Engineering , Western University , London , ON , Canada
| | - Jacob Reeves
- b Mechanical and Materials Engineering , Western University , London , ON , Canada
| | - Alan Getgood
- c Fowler Kennedy Sport Medicine Clinic, Department of Surgery , Western University , London , ON , Canada
| | - Timothy A Burkhart
- d Lawson Health Research Institute, Department of Mechanical and Materials Engineering , Western University , London , ON , Canada
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Siboni R, Beaufils P, Boisrenoult P, Steltzlen C, Pujol N. Opening-wedge high tibial osteotomy without bone grafting in severe varus osteoarthritic knee. Rate and risk factors of non-union in 41 cases. Orthop Traumatol Surg Res 2018; 104:473-476. [PMID: 29555559 DOI: 10.1016/j.otsr.2018.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/02/2018] [Accepted: 01/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Using locking plates in opening-wedge high tibial osteotomy (OWHTO) via a medial opening theoretically allows early weight-bearing without need for bone or bone-substitute grafting. It incurs a risk of non-consolidation in case of large correction (>10°), although rates and risk factors of non-union are not known. The present retrospective study compared OWHTO with correction <10° versus >10°, with a view to determining: (1) complications rates (non-union) according to degree of correction, and (2) risk factors for such complications. HYPOTHESIS OWHTO with correction greater than 10° without graft shows normal consolidation and allows early weight-bearing. MATERIAL AND METHOD Forty-one patients treated by OWHTO for medial osteoarthritis of the knee between January 2101 and November 2015 were included in a retrospective study. HKA angle was assessed by long-leg axis radiographs, preoperatively and at 3 months. Clinical and radiological follow-up at 6 weeks, 3 months and 6 months assessed consolidation in terms of >40% filling of the osteotomy site. Partial (contact) weight-bearing was allowed from the first postoperative day, with full weight-bearing at 6 weeks. RESULTS Mean patient age was 59±5 years. Mean body-mass index (BMI) was 30.3±5.2; 17 patients (41.5%) had BMI >30. Mean initial HKA angle was 173.5°±3° (range, 167-178°) and mean correction was 10.7°±2.7° (range, 5-15°). There were 27 corrections of 10° or more, and 14 less than 10°. At 3 months, mean HKA was 182.9°±2.5° (range, 178-187°). Twelve cases showed lateral tibial cortex fracture after opening. Thirty-six patients (87.8%) showed consolidation, at a mean 5±3 months. Five patients showed osteotomy site non-union; in all these cases, the lateral cortex was broken initially (P=0.003); all had BMI >30 (mean, 37.2±3.8; P<0.03); none were smokers. On univariate analysis, lateral tibial cortex fracture (OR=10; 95% CI, (1.59-196.30)), BMI >30 (OR=1.18; 95% CI, (1.03-1.41)) and correction ≥10° (OR=10.50; 95% CI, (2.49-53.86)) were associated with delayed consolidation. On multivariate analysis, only degree of osteotomy was significantly associated with delayed consolidation (OR=11.51; 95% CI, (2.13-95.74)). DISCUSSION/CONCLUSION Obesity and initial lateral cortex fracture appeared as risk factors for non-consolidation of OWHTO with large correction. Systematic bone or bone-substitute grafting may therefore be considered in this population in case of >10° correction. LEVEL OF EVIDENCE IV, prospective cohort study.
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Affiliation(s)
- R Siboni
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - P Beaufils
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - P Boisrenoult
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - C Steltzlen
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - N Pujol
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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Nie Y, Huang Z, Xu B, Shen B, Kraus VB, Pei F. Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis. J Orthop Res 2018; 36:10.1002/jor.23867. [PMID: 29424452 PMCID: PMC7480762 DOI: 10.1002/jor.23867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 02/07/2018] [Indexed: 02/05/2023]
Abstract
To investigate the change in short-term clinical outcomes and biomechanical properties of the knee in response to upper partial fibulectomy and to probe into the biomechanical mechanism underlying the clinical benefits of upper partial fibulectomy for medial compartment knee osteoarthritis (KOA). A total of 29 patients with medial compartment KOA underwent upper partial fibulectomy. Visual analog scale (VAS) pain, the hospital for special surgery knee score (HSS), hip-knee-ankle (HKA) angle (measured in the frontal plane), and flexion/extension range of motion of the knee were assessed before and up to 6 months after surgery. Patients and 20 healthy controls were evaluated by 3D gait analysis and dynamic lower limb musculoskeletal analysis. Both VAS pain and HSS score were significantly improved (p < 0.001) one day after surgery and steadily improved during the subsequent 6 months. HKA angle improved (p = 0.025) immediately and remained stable by 3 months after surgery. The decreased overall peak KAM (decreased by 11.1%) and increased HKA angle (increased by 1.80 degrees from a more varus to more neutral alignment) of affected and operated side by 6 months after surgery were observed. Muscle activity of biceps femoris caput longum of affected and operated side increased immediately and was equivalent to healthy controls by 6 months after surgery (p = 0.007). This pilot study provides biomechanical evidence of benefit from partial upper fibulectomy and indicates a plausible rationale for the improvement in clinical symptoms. Long-term clinical outcomes and precise biomechanical mechanism of partial upper fibulectomy should be further investigated. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-10, 2018.
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Affiliation(s)
- Yong Nie
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People’s Republic of China
| | - ZeYu Huang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People’s Republic of China
- Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Bin Xu
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People’s Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People’s Republic of China
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, Durham, NC, United States
- Department of Medicine, Division of Rheumatology, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - FuXing Pei
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, SiChuan University, ChengDu, SiChuan Province, People’s Republic of China
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Survival of opening versus closing wedge high tibial osteotomy: A meta-analysis. Sci Rep 2017; 7:7296. [PMID: 28779084 PMCID: PMC5544741 DOI: 10.1038/s41598-017-07856-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/04/2017] [Indexed: 11/08/2022] Open
Abstract
This meta-analysis was designed to compare the longevity of the survivorship of opening versus closing wedge high tibial osteotomy (HTO). All studies reporting survival rates in patients who underwent open or closed wedge HTO with more than 5-year follow-up duration were included in the meta-analysis. Survival time was considered as time to conversion to TKA. Twenty three studies were included in meta-analysis, 20 of which were of level IV evidence. The pooled 5-year survival rates were 95.1% (95% CI: 93.1 to 97.1%) in open wedge HTO and 93.9% (95% CI: 93.1 to 94.6%) in closed wedge HTO. Although there was 1.2% greater survival rate in open wedge HTO than in closed wedge HTO, this difference did not reach statistical significance (P = 0.419). Pooled 10-year survival rates were 91.6% (95% CI: 88.5 to 94.8%) in open wedge HTO and 85.4% (95% CI: 84.0 to 86.7%) in closed wedge HTO, indicating that open wedge HTO had 6.2% greater survival rate 10 years after surgery than did closed wedge HTO (P = 0.002). No difference in 5-year survivorship was found between open- and closed-wedge HTO. However, the survival rate was higher in open-wedge HTOs than in closed wedge HTO at 10 years.
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