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Sheridan GA, Page BJ, Greenstein MD, Reif TJ, Fragomen AT, Rozbruch SR. Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures. Strategies Trauma Limb Reconstr 2024; 19:82-86. [PMID: 39359363 PMCID: PMC11443614 DOI: 10.5005/jp-journals-10080-1620] [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: 05/17/2024] [Accepted: 07/19/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Angular deformities of the tibia and femur lead to mechanical axis deviation (MAD) of the lower limb and malorientation of the joints adjacent to the deformity. The current study analyses the outcomes of using a medial closing wedge high tibial osteotomy (MCWHTO) for the management of genu valgum with high medial proximal tibial angle (MPTA), and combined MCWHTO with lateral opening-wedge distal femoral osteotomy (LOWDFO) in the setting of concomitant genu varum with low lateral distal femoral angle (LDFA). Methods There were 18 high tibial osteotomy (HTO)-only and 13 combined HTO + distal femoral osteotomy (DFO) procedures performed. The primary radiographic outcome variables included postoperative MPTA and MAD (in mm). The accuracy of MAD correction was expressed as a percentage. The postoperative posterior proximal tibial angle (PPTA) and limb length discrepancy (LLD) were also measured as secondary radiographic outcome variables. The clinical outcome variables included intraoperative surgical complications (e.g., hinge fracture), all-causes for revision, union rate, time to union, and postoperative knee range of motion. Functional outcomes used included the LDSRS, PROMIS, and EuroQOL scores. Results The mean preoperative MPTA was 92.9° (SD = 1.81, range: 88-96). After surgical correction, the mean MPTA was 86.0° (SD = 1.80, range: 83-90) (p < 0.0001). The mean preoperative MAD was 32.5 mm (SD = 20.16, range: 10-77) lateral to the centre of the knee joint. The mean postoperative MAD was 2.44 mm medial to the centre of the joint (SD = 7.13, range: 13 medial - 15 lateral) (p < 0.0001). The mean change in MAD achieved through surgical correction was 38.16 mm (SD = 17.94, range: 13-77). The accuracy of MAD correction was 96.1% (SD = 0.06%, range: 81.25-100%). The time to unassisted WB was a mean of 75 days (SD = 44.5, range: 44-242).There was a single stable hinge fracture and one case of chronic regional pain syndrome diagnosed. There were no cases of non-union and no indications for revision surgery in any case. Conclusion Medial closing wedge high tibial osteotomy is an effective surgical procedure for the management of genu valgum deformity. The MPTA, LDFA, and MAD can be accurately corrected without significantly altering PPTA or limb length. It may be combined with open lateral distal femoral osteotomy for cases with femoral and tibial contributions to deformity without significantly impacting clinical outcomes. Functional outcomes, specifically relating to self-image are significantly improved after the MCWHTO has been performed. How to cite this article Sheridan GA, Page BJ, Greenstein MD, et al. Medial Closing Wedge High Tibial Osteotomy Accurately Corrects Genu Valgum without Iatrogenic Deformity or Complications: A Consecutive Series of Thirty-one Procedures. Strategies Trauma Limb Reconstr 2024;19(2):82-86.
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Affiliation(s)
| | - Brian J Page
- Hospital for Special Surgery, Orthopaedic Trauma Service; New York Presbyterian – Weill Cornell Medical Center, Orthopaedic Trauma Service, New York, United States of America
| | - Michael D Greenstein
- Department of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, United States of America
| | - Taylor J Reif
- Department of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, United States of America
| | - Austin T Fragomen
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, United States of America
| | - S Robert Rozbruch
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, United States of America
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Li X, Liu X, Wang Z, Wang G. Clinical efficacy of total knee arthroplasty versus unicondylar arthroplasty in the treatment of unicompartmental osteoarthritis. Minerva Surg 2024; 79:261-263. [PMID: 37851011 DOI: 10.23736/s2724-5691.23.10052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Xiaolin Li
- Department of Orthopedics, Shijiazhuang People's Hospital, Shijiazhuang, China -
| | - Xiaofeng Liu
- Department of Neurology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Zhaojun Wang
- Department of Orthopedics, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Guixian Wang
- Department of Orthopedics, Shijiazhuang People's Hospital, Shijiazhuang, China
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Machado A, Micicoi L, Ernat J, Schippers P, Bernard de Dompsure R, Bronsard N, Gonzalez JF, Micicoi G. Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4276-4284. [PMID: 37326635 DOI: 10.1007/s00167-023-07465-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO. METHODS This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed. RESULTS The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = - 0.15, p = 0.04) and function IKS (R = - 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°. CONCLUSION Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Axel Machado
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Lolita Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Justin Ernat
- University of Utah Health, Salt Lake City, Utah, USA
| | - Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Régis Bernard de Dompsure
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France.
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
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An artificial intelligence based on a convolutional neural network allows a precise analysis of the alignment of the lower limb. INTERNATIONAL ORTHOPAEDICS 2023; 47:511-518. [PMID: 36418444 DOI: 10.1007/s00264-022-05634-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to develop a numeric tool to automate the analysis of deformity from lower limb telemetry and assess its accuracy. Our hypothesis was that artificial intelligence (AI) algorithm would be able to determine mechanical and anatomical angles to within 1°. METHODS After institutional review board approval, 1175 anonymized patient telemetries were extracted from a database of more than ten thousand telemetries. From this selection, 31 packs of telemetries were composed and sent to 11 orthopaedic surgeons for analysis. Each surgeon had to identify on the telemetries fourteen landmarks allowing determination of the following four angles: hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA). An algorithm based on a machine learning process was trained on our database to automatically determine angles. The reliability of the algorithm was evaluated by calculating the difference of determination precision between the surgeons and the algorithm. RESULTS The analysis time for obtaining 28 points and 8 angles per image was 48 ± 12 s for the algorithm. The average difference between the angles measured by the surgeons and the algorithm was around 1.9° for all the angles of interest: 1.3° for HKA, 1.6° for MPTA, 2.1° for LDFA, and 2.4° for JLCA. Intraclass correlation was greater than 95% for all angles. CONCLUSION The algorithm showed high accuracy for automated angle measurement, allowing the estimation of limb frontal alignment to the nearest degree.
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Coakley A, McNicholas M, Biant L, Tawy G. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee 2023; 40:97-110. [PMID: 36413904 DOI: 10.1016/j.knee.2022.11.007] [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: 02/10/2022] [Revised: 05/27/2022] [Accepted: 11/03/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Osteoarthritis is a prolific condition in an increasingly ageing and obese population. Research into treatments of this condition and their efficacy are vital. Outcomes of high tibial osteotomy (HTO) for the varus knee is widely reported. There is less evidence for HTO in the valgus knee. This systematic review aimed to compile all literature reporting the outcomes of HTO to correct the valgus knee, focusing on post-operative clinical outcomes. METHODS Ovid MEDLINE, Embase and Web of Science were searched using key terms: Osteoarthritis [All Fields] AND High tibial osteotomy [All Fields] AND Lateral OR Valgus [All Fields]. Papers were screened for eligibility based on an inclusion and exclusion criteria. Full text screening was completed by two reviewers and data was extracted from the agreed included papers by one reviewer. Quality assessments of the papers were also conducted. PROSPERO ID CRD42021239045. RESULTS Across 17 papers reporting 517 knees, the average pre-operative femorotibial and hip-knee-ankle angles were corrected from 13.6 ± 7.0° and 4.9 ± 1.9° valgus to 2.8 ± 2.9° and 1.2 ± 1.7° varus. Studies show that the procedure is successful at offloading the lateral knee compartment and some evidence it can delay the need for a total knee replacement. However, its impact on overall quality of life remains poorly understood. CONCLUSIONS High tibial osteotomy may be a viable treatment option for valgus knee deformities caused by lateral compartment osteoarthritis. Nevertheless, research into the procedure remains limited. Importantly, our understanding of the relationship between the achieved alignment and outcome remains largely unknown. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alannah Coakley
- Division of Medical Education, School of Medical Sciences, The University of Manchester, Manchester UK
| | - Michael McNicholas
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Orthopaedics, Aintree University Hospital, Liverpool University HOspitals NHS Foundation Trust, Liverpool, UK
| | - Leela Biant
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Orthopaedics, Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Centre of Health Sciences Research, University of Salford, Manchester, UK
| | - Gwenllian Tawy
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Motta DPD, Faria JLRD, Cruz CM, Aguiar DP, Amaral MVG, Kropf LL, Motta GATAD, Cerqueira FDS, Leonetti BD, Cerqueira FDS. Lateral Gradual Opening Osteotomy of the Tibia With Monolateral External Fixator for Correcting the Valgus Deformity of the Tibia. Arthrosc Tech 2022; 11:e2271-e2277. [PMID: 36632387 PMCID: PMC9827065 DOI: 10.1016/j.eats.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022] Open
Abstract
The valgus deformity in the tibia requires correction because it places increased pressure on the lateral compartment of the knee, intensifying the degenerative process. Correction strategies are diverse and depend on patient profile, age, and soft-tissue conditions as well as the orthopaedic surgeon's experience with different surgical materials. Deformity size and location are the primary factors contributing to material and shape choice, whether gradual or acute. The only gradual correction approach involves the use of a monolateral or circular external fixator. This is the only indication for correction in cases of excellent deformity, soft-tissue involvement, and a history of bone infection. This study aimed to present a gradual correction technique for tibial valgus deformity using a monolateral external fixator as well as its postoperative follow-up. This technique has the advantages of greater patient acceptance, lighter assembly, and briefer distraction owing to the use of a single piece as well as the ability of the operated limb to bear a load the day after the surgical procedure and dynamic outpatient follow-up.
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Affiliation(s)
- Diego Perez da Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil,Address correspondence to Diego Perez da Motta, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - Av. Brasil, 500, São Cristovão. CEP: 20940-070.
| | - José Leonardo Rocha de Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | | | - Marcus Vinicius Galvão Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Leandro Lemgruber Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Guilherme Augusto Tapado Araújo da Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Fernando dos Santos Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Bruno Domenico Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Flavio dos Santos Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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Rupp MC, Mehl J, Feucht MJ, Imhoff AB. Biomechanical Rationale of Correction Osteotomy and Overcorrection. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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刘 云, 谢 雪, 罗 从. [Research progress of osteotomy around knee in the treatment of valgus knee osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:111-116. [PMID: 35038808 PMCID: PMC8844620 DOI: 10.7507/1002-1892.202108009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To review the research progress of surgical methods of osteotomy around the knee in the treatment of valgus knee osteoarthritis. METHODS The relevant literature on the surgical treatment of valgus knee osteoarthritis at home and abroad in recent years was reviewed, and the advantages, disadvantages, and effectiveness of different surgical methods of osteotomy around the knee were summarized. RESULTS For young and active patients with symptomatic valgus knee osteoarthritis, osteotomy around the knee is a safe and reliable treatment option. At present, the main surgical methods include medial closing wedge distal femoral osteotomy, lateral opening wedge distal femoral osteotomy, medial closing wedge high tibial osteotomy, and lateral opening wedge high tibial osteotomy. The indications, advantages, and disadvantages of different osteotomies are different, and the selection of appropriate surgical method is the key to achieve good effectiveness. CONCLUSION There are many osteotomies in the treatment of valgus knee osteoarthritis. In order to achieve good results, improve survival rate, and reduce postoperative complications, the most reasonable surgical strategy needs to be developed according to different situations.
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Affiliation(s)
- 云飞 刘
- 南京医科大学附属苏州科技城医院骨科(江苏苏州 215000)Department of Orthopedics, the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu, 215000, P. R. China
| | - 雪涛 谢
- 南京医科大学附属苏州科技城医院骨科(江苏苏州 215000)Department of Orthopedics, the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu, 215000, P. R. China
| | - 从风 罗
- 南京医科大学附属苏州科技城医院骨科(江苏苏州 215000)Department of Orthopedics, the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu, 215000, P. R. China
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Choi HG, Kang YS, Kim JS, Lee HS, Lee YS. Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211047904. [PMID: 34881345 PMCID: PMC8647275 DOI: 10.1177/23259671211047904] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 02/01/2023] Open
Abstract
Background: Assessments of the effects of realignment using opening-wedge high tibial osteotomy (OWHTO) on the medial, lateral, and patellofemoral compartments have been limited to cartilage evaluations. Purpose/Hypothesis: The purpose was to evaluate the effects of OWHTO on the meniscus and cartilage of each compartment as a cooperative unit (meniscochondral unit) using serial magnetic resonance imaging (MRI). It was hypothesized that (1) favorable changes in the meniscochondral unit would occur in the medial compartment and (2) that changes in the patellofemoral and lateral compartments would be negligible. Study Design: Case series; Level of evidence, 4. Methods: Included were 36 knees that underwent OWHTO from March 2014 to February 2016 and had postoperative serial MRI. The MRI was performed at 19.9 ± 7.4 and 52.3 ± 8.3 months postoperatively, and the cartilage and meniscal changes were evaluated by highlighting the regions of interest. We evaluated the T2 relaxation times of each cartilage and meniscal area, the cross-sectional area of the menisci, and the extrusion of the medial meniscus (MM). The meniscochondral unit was assessed using subgroup analyses according to the status of the MM. Results: Significant decreases were seen in T2 relaxation times in the medial femoral condyle (MFC) (P < .001) and medial tibial plateau (MTP) (P = .050), and significant increases were seen in the lateral femoral condyle (LFC) (P = .036). The change was more prominent in the MFC compared with the MTP and LFC (P = .003). No significant changes were observed in the lateral tibial plateau, patella, or trochlear groove. The area of the lateral meniscus (body and posterior horn) was decreased compared with preoperative MRI (P < .001 for both). The extent of MM extrusion decreased between the preoperative, first follow-up, and second follow-up MRIs (P < .001). Conclusion: OWHTO affected the medial compartment positively, the lateral compartment negatively, and the patellofemoral compartment negligibly. The effects were more prominent and consistent in the medial than in the lateral compartment.
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Affiliation(s)
- Han Gyeol Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Orthopaedic Surgery, Nalgae Hospital, Seoul, Republic of Korea
| | - Yu Suhn Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Han Sang Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Patient-Specific Instrument Guided Double Chevron-Cut Distal Femur Osteotomy. J Pers Med 2021; 11:jpm11100959. [PMID: 34683100 PMCID: PMC8538705 DOI: 10.3390/jpm11100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
The risk of non-union and prolonged periods of protected weight-bearing still remain unsolved issues after distal femur osteotomy (DFO). To improve the stability, we developed the double chevron-cut technique, which is a modified medial closing-wedge DFO guided by a patient-specific instrument. The purpose of this study was to investigate the feasibility and outcome of this operative approach. Twenty-five knees in twenty-three consecutive patients with genu valgum and lateral compartment osteoarthritis that received double chevron-cut DFO were included. The target of correction was 50% on the weight-bearing line (WBL) ratio. Patient-reported outcomes included the Oxford Knee Score (OKS) and the 2011 Knee Society Score (KSS). The mean of the WBL ratio was corrected from 78.7% ± 12.0% to 48.7% ± 2.9% postoperatively. The mean time to full weight bearing was 3.7 ± 1.4 weeks. Union of the osteotomy was achieved at 11.3 ± 2.8 weeks. At a mean follow-up of 17 months, the OKS improved from a mean of 27.6 ± 11.7 to 39.1 ± 7.5 (p = 0.03), and the KSS from a mean of 92.1 ± 13.0 to 143.9 ± 10.2 (p < 0.001). Three patients developed complications, including one case of peri-implant fracture, one of loss of fixation, and one of non-union. The double chevron-cut DFO followed by immediate weight-bearing as tolerated is effective in treating genu valgum deformity and associated lateral compartment osteoarthritis.
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van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, van Heerwaarden RJ. Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc 2020; 28:2798-2807. [PMID: 30911790 DOI: 10.1007/s00167-019-05480-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A varus-producing medial closing wedge high tibial osteotomy (MCWHTO) is an uncommon procedure. The aim of this retrospective study was to assess the survivorship and prevalence of post-operative subjective knee laxity and satisfaction in a large cohort of patients with a MCWHTO performed without a MCL-reefing procedure. METHODS All patients (n = 176) who underwent a MCWHTO in our clinic between 2008 and 2016 were approached to participate. After review of patient charts, questionnaires were sent to willingly patients. Primary outcome was the survivorship of the MCWHTO; secondary outcome was patient-reported instability and satisfaction. RESULTS One-hundred and thirteen patients participated in the study. The 5-year survival rate of the MCWHTO was almost 80%. A total of 77% of the patients was satisfied with the treatment. With regard to post-operative subjective knee laxity, 26% of the patients experienced instability of the knee post-operation. Instability was significantly correlated with the KOOS domains, the Lysholm score, the IKDC knee function score and the Physical and Mental Health Domains of the SF-36. CONCLUSION Medial closing wedge high tibial osteotomy provides good results regarding survivorship and patient satisfaction for patients with a valgus deformity which is located in the proximal tibia. Clinically relevant is that in the surgical technique without MCL-reefplasty instability is significantly correlated with worse patient-reported outcome measures. The addition of a MCL reefing procedure will improve outcome in selected patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- W A M van Lieshout
- Maartenskliniek Woerden, Woerden, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R J van Heerwaarden
- Maartenskliniek Woerden, Woerden, The Netherlands. .,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands.
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Kim DH, Kim SC, Yoon JS, Lee YS. Are There Harmful Effects of Preoperative Mild Lateral or Patellofemoral Degeneration on the Outcomes of Open Wedge High Tibial Osteotomy for Medial Compartmental Osteoarthritis? Orthop J Sports Med 2020; 8:2325967120927481. [PMID: 32637430 PMCID: PMC7313345 DOI: 10.1177/2325967120927481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background Early osteoarthritis of the knee joint mostly affects the medial compartment, making osteotomy a rational approach to slow the progression of the disease. However, some patients show asymptomatic mild degeneration in the lateral or patellofemoral compartment. Purpose To evaluate the effect of asymptomatic mild lateral or patellofemoral degeneration on the outcomes of medial open wedge high tibial osteotomy (OWHTO) by assessing the outcomes according to the preoperative status of the lateral or patellofemoral degenerative changes. Study Design Cohort study; Level of evidence, 3. Methods A total of 114 patients (121 knees) who underwent biplanar OWHTO with second-look arthroscopic surgery and postoperative magnetic resonance imaging (MRI) were retrospectively enrolled. Patients were categorized into 4 groups according to the Osteoarthritis Research Society International (OARSI) and MRI Osteoarthritis Knee Score (MOAKS) classification systems. The International Cartilage Repair Society (ICRS) grade was used to evaluate the preoperative and postoperative cartilage status. Clinical outcomes were assessed by the American Knee Society (AKS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-item Short Form Health Survey (SF-36). Results No degenerative changes in the lateral and patellofemoral compartments of knees (group I) were identified in 51.2% of cases (62 knees). Asymptomatic degenerative changes only in the lateral compartment (group II: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 15.7% of cases (19 knees), changes only in the patellofemoral compartment (group III: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 10.7% of cases (13 knees), and changes in both the lateral and the patellofemoral compartments (group IV) were identified in 22.3% of cases (27 knees). In the medial compartment, there was no significant difference in the improvement of MOAKS and ICRS grades among all groups (P = .813 and .985, respectively). In the lateral and patellofemoral compartments, there was no significant difference in the decline of MOAKS (P = .649 and .421, respectively) and ICRS grades (P = .927 and .676, respectively) among all groups. Conclusion The presence of mild lateral or patellofemoral degenerative changes did not affect the MRI, arthroscopic, and clinical outcomes of OWHTO. However, long-term observations are necessary to draw definitive conclusions as to whether OWHTO can be indicated in such patients without harmful effects.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seong Chan Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji Soo Yoon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, 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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Jacquet C, Chan-Yu-Kin J, Sharma A, Argenson JN, Parratte S, Ollivier M. "More accurate correction using "patient-specific" cutting guides in opening wedge distal femur varization osteotomies. INTERNATIONAL ORTHOPAEDICS 2018; 43:2285-2291. [PMID: 30413851 DOI: 10.1007/s00264-018-4207-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The distal femoral varization osteotomy (DFVO) by a lateral opening wedge osteotomy is an established intervention for patients suffering from lateral femoro-tibial osteoarthritis on a genu valgum deformity. In order to improve the accuracy of this correction, the use of a customized cutting guide (PSI) has been proposed as an alternative to conventional technique. The objective of our study was to compare the accuracy of post-operative alignment following DFVO in the coronal and sagittal plane using either a conventional abacus technique or PSI guide. METHOD Twenty-one patients that underwent lateral opening wedge osteotomy from a technique using PSI based on 3D CT-scans were matched 1:1 to 21 patients operated on using a conventional technique (pre-operative planning performed on standard radiographs). The accuracy of the correction was analyzed, comparing coronal and sagittal mechanical post-operative angles with pre-operative planning. RESULTS With regard to alignment in the coronal plane (HKA correction), our study demonstrated a significant improvement in the accuracy of the correction obtained in the PSI group compared to the conventional group (0.43 ± 0.50 vs 3.95 ± 1.64 p < 0.001). In the sagittal plane (PDFA correction), we also found a significant improvement in correction accuracy in the PSI group (0.52 ± 0.60 vs 3.10 ± 1.83 p < 0.001). There was a significant decrease in operating time (delta 7.7 ± 3.07 (1.5-13.9) (p = 0.0.161) and fluoroscopic images taken (6.9 ± 0.54 (5.8-8) p < 0.001). CONCLUSION Our results suggest that the use of PSI in DFVO improves the accuracy of correction in both the coronal and sagittal planes compared to conventional techniques.
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Affiliation(s)
- Christophe Jacquet
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France
| | - Johanna Chan-Yu-Kin
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France
| | - Akash Sharma
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France
| | - Jean-Noël Argenson
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France
| | - Sébastien Parratte
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France.,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France. .,Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite BP 29, 13274, Marseille, France.
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