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Mabrouk A, Monda M, Bell L, Broderick J, Dawson M. Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating. J Exp Orthop 2024; 11:e12081. [PMID: 39015342 PMCID: PMC11249844 DOI: 10.1002/jeo2.12081] [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: 05/05/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
Purpose This study aimed to compare two different double-level knee osteotomy (DLO) fixation techniques. The primary outcome reported the radiological coronal plane correction and its accuracy. The secondary outcomes reported the correction outliers, the clinical outcomes, the 5-year postoperative satisfaction and the complications. Methods A retrospective review of a single surgeon osteotomy database identified 52 cases of DLO between 2011 and 2019, of which 24 cases met the inclusion criteria. Patients were categorised into two groups: the nail-plate (NP) group fixed with a magnetic extendable intramedullary tibial nail and femoral conventional plate, and the double-plate (DP) group fixed with conventional plates (tibia and femur). Radiographic parameters were recorded, including the mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and weight-bearing line ratio (Mikulicz %). Surgical accuracy was calculated as the difference between the achieved and the planned correction. Outliers were defined as those with a greater than 10% difference from the planned correction. Simple knee value scores and visual analogue scale for pain were recorded preoperatively and postoperatively at 2 and 5 years. Five-year patient satisfaction was recorded. Results A total of 24 patients were included: the NP group (n = 12) and the DP group (n = 12). Significant coronal plane corrections were achieved in the NP group for the mean mFTA (preoperative 167.9° ± 3.4° to postoperative 182.1° ± 1.4°), the mean MPTA (preoperative 83.5° ± 2.9° to postoperative 91.3° ± 2.8°) and the mean mLDFA (preoperative 89.8° ± 3.4° to postoperative 85.9° ± 4.4°). Similarly, significant coronal plane corrections were achieved in the DP group for the mean mFTA (preoperative 168.6° ± 4.4° to postoperative 182.2° ± 2°), the mean MPTA (preoperative 84.2° ± 2° to postoperative 88.3° ± 4.1°) and the mean mLDFA (preoperative 90.7° ± 2.9° to postoperative 83.9° ± 1.7°) (all p < 0.05). The mean correction accuracy was higher for the NP versus DP group at 3.4 ± 3.4% versus 7.1 ± 3.9% (intergroup p < 0.05). There were no outliers in the NP group versus two outliers (overcorrected) (16.7%) in the DP group. Significant clinical improvement was reported in both groups at 2 and 5 years postoperatively (all p < 0.05). Conclusion Superior correction accuracy and no outliers were achieved in hybrid fixation double-level knee osteotomy compared to the conventional double-plating technique. The magnetic extendable nail offers the advantage of fine-tuning the correction postoperatively and could be a potential research template for future designs of postoperative correction implants. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Trauma & Orthopaedics DepartmentLeeds Teaching HospitalsLeedsUK
| | - Maureen Monda
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
| | - Lucy Bell
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
| | - James Broderick
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
| | - Matthew Dawson
- Trauma & Orthopaedics DepartmentNorth Cumbria NHS TrustNorth CumbriaUK
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Hou W, Xiao F, Peng P, He M, Wei Q. Osteotomy for treating knee osteoarthritis from 2012 to 2023: Bibliometric analysis and global trends. Medicine (Baltimore) 2024; 103:e37036. [PMID: 38363940 PMCID: PMC10869070 DOI: 10.1097/md.0000000000037036] [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: 10/11/2023] [Accepted: 01/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Numerous surgical interventions are available for the treatment of knee osteoarthritis (KOA). In recent years, knee-preserving surgery, specifically osteotomy, has gained significant attention from patients, particularly those who are young and physically active, as it not only effectively alleviates pain but also preserves bone integrity, thereby allowing for potential future joint replacement. This study aims to comprehensively analyze the global application trends of osteotomy for KOA and identify the current research hotspots. METHODS We conducted a literature search encompassing English-language studies on osteotomy for KOA published from 2012 to 2023 in the Web of Science Core Collection (WoSCC) database. Bibliometric analysis tools, including VOSviewer, CiteSpace, and R Studio, were employed to analyze global trends and research hotspots. RESULTS We analyzed 1520 eligible publications, comprising 1350 articles and 170 reviews. The number of articles on osteotomy for KOA has exhibited a consistent upward trend over the past decade. The top 3 contributing countries (South Korea, United States, and China) accounted for 45.98% of all published articles. U.S. scholars exhibited high productivity, prominence, and academic impact in this field. Seoul National University published the most papers on the relationship between osteotomy and KOA, while Sungkyunkwan University had the highest average citation rate. Among authors, Yong Seuk Lee from Korea and Steffen Schroeter from Germany had the highest number of publications and average citation values, respectively. Research interests were clustered into 5 categories: "High tibial osteotomy," "Biomechanics of osteotomy," "Osteotomy combined with cartilage repair techniques," "Postoperative prognosis and outcomes," and "Improvement of surgical techniques." CONCLUSION Recent years have witnessed notable rapid progress in the research on osteotomy for KOA. The field is poised for continued growth in terms of academic literature. The United States has emerged as a global leader in knee osteotomy research, while Korea demonstrates considerable potential in this domain. Future research hotspots may encompass high tibial osteotomies, osteotomies combined with cartilage repair techniques, and advancements in surgical techniques for KOA.
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Affiliation(s)
- Wenyuan Hou
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Xiao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Peng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mincong He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
| | - Qiushi Wei
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, Guangzhou, China
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Jörgens M, Keppler AM, Ahrens P, Prall WC, Bergstraesser M, Bachmeier AT, Zeckey C, Cavalcanti Kußmaul A, Böcker W, Fürmetz J. 3D osteotomies-improved accuracy with patient-specific instruments (PSI). Eur J Trauma Emerg Surg 2024; 50:3-10. [PMID: 35879618 PMCID: PMC10923740 DOI: 10.1007/s00068-022-02060-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Three-dimensional (3D) printed patient-specific instruments (PSI) have been introduced to increase precision and simplify surgical procedures. Initial results in femoral and tibial osteotomies are promising, but validation studies on 3D planning, manufacturing of patient-specific cutting blocks and 3D evaluation of the attained results are lacking. METHODS In this study, patient-specific cutting blocks and spacers were designed, fabricated, and used to perform a high tibial osteotomy (HTO). After segmentation of CT data sets from 13 human tibiae, 3D digital planning of the HTO was performed with a medial opening of 8 mm. These 3D models were used to fabricate patient-specific cutting blocks and spacers. After the surgical procedure, accuracy was evaluated measuring 3D joint angles and surface deviations. RESULTS The lowest mean deviation was found to be 0.57° (SD ± 0.27) for the MPTA. Medial and lateral tibial slope deviated from the 3D planning by an average of 0.98° (SD ± 0.53) and 1.26° (SD ± 0.79), respectively, while tibial torsion deviated by an average of 5.74° (SD ± 3.24). Color analysis of surface deviations showed excellent and good agreement in 7 tibiae. CONCLUSION With 3D cutting blocks and spacers, the 3D planning of the HTO can be translated into reality with small deviations of the resulting joint angles. Within this study, the results of the individual steps are examined for errors and thus a critical evaluation of this new and promising method for performing patient-specific HTOs is presented.
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Affiliation(s)
- Maximilian Jörgens
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
| | - Alexander M Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | | | - Wolf Christian Prall
- FIFA Medical Centre of Excellence, Division of Knee, Hip, Shoulder and Ellbow Surgery, Schoen Clinic Munich, Munich, Germany
| | - Marcel Bergstraesser
- OT Medizintechnik GmbH (Medical Engineering in Orthopedics and Traumatology), Munich, Germany
| | - Andreas T Bachmeier
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christian Zeckey
- Department of Trauma Surgery and Orthopaedics, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Julian Fürmetz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Department of Trauma Surgery, BG Unfallklinikum Murnau, Murnau, Germany
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Mabrouk A, An JS, Glauco L, Jacque C, Kley K, Sharma A, Ollivier M. The joint line convergence angle (JLCA) correlates with intra-articular arthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5673-5680. [PMID: 37884727 DOI: 10.1007/s00167-023-07616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Knees with unicompartmental varus osteoarthritis (OA) usually display a combination of tibiofemoral bony deformity and increased joint line convergence angle (JLCA). The JLCA is a product of intra-articular deformity and lateral soft tissue laxity. This study aims to define the correlation between the JLCA and progression of OA. METHODS A retrospective radiological analysis of 501 patients, who underwent either high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA), was performed. The preoperative OA grade was reported based on the Ahlbäck and the Kellgren-Lawrence (KL). The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the mechanical lateral distal femoral angle (mLDFA) and the joint line convergence angle (JLCA) were recorded. The primary outcome was the relationship between the JLCA values and the OA grade. The secondary outcomes were comparing the JLCA and other alignment parameter values between HTO and UKA groups. RESULTS A total of 501 (59.3% females n = 297) cases were included, comprising 293 cases of HTO and 208 cases of UKA. Patients had a mean age of 57.63 ± 8.97 years, a mean BMI of 28.37 ± 7.39 kg/m2. Patients with Ahlbäck grade 2 represented 49.3% of all patients (n = 247) and patients with KL grade 3 represented 54.7% of all patients (n = 274). A high JLCA was observed in both groups. The reported mean JLCA in the UKA group was 3.69 ± 2.1°, and in the HTO group was 2.93 ± 1.82. There was a significant association between the increase in the JLCA and the progression of OA based on both the Ahlbäck and KL grades (both p values < 0.001). The mean JLCA in patients with Ahlbäck grades 1 and 4 was 1.48 ± 1.32°, and 7 ± 0.93°, respectively. The mean JLCA in patients with KL grades 1 and 4 was 1.77 ± 1.42°, and 4.89 ± 1.73°, respectively. The mean recorded preoperative HKA angle in the UKA group was 175.06 ± 3.08°, and in the HTO group was 173.26 ± 3.02°, whereas the mean MPTA was 88.63 ± 1.72° for the UKA group and 89.31 ± 2.29° for the HTO group. CONCLUSION The JLCA progressively increases with osteoarthritis progression in patients with unicompartmental varus knee osteoarthritis. The JLCA can potentially be used as a grading parameter for osteoarthritis progression akin to Ahlbäck and Kellgren-Lawrence grading systems.
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Affiliation(s)
- Ahmed Mabrouk
- Mid Yorkshire Teaching Hospitals, Yorkshire, UK
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Jae-Sung An
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Loddo Glauco
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | - Christophe Jacque
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France
| | | | | | - Matthieu Ollivier
- Institute for Locomotion, Aix-Marseille University, CNRS Sainte-Marguerite Hospital, APHM, Marseille, ISM, France.
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Yang HY, Seon JK. Editorial Commentary: Alignment for Open-Wedge High Tibial Osteotomy Can Be Planned Using the Hip-Knee-Ankle Angle and the Weightbearing Line. Arthroscopy 2023; 39:1232-1234. [PMID: 37019535 DOI: 10.1016/j.arthro.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 04/07/2023]
Abstract
Correct alignment of the limb mechanical axis is a principal goal of open-wedge high tibial osteotomy and determines successful postoperative outcomes. Excessive postoperative joint line obliquity must be avoided. A mechanical medial proximal tibial angle (mMPTA) less than 95° results in poor outcomes. Preoperative planning is commonly performed using a picture archiving and communication system; however, this is time-consuming and sometimes inaccurate because many landmarks and parameters need to be confirmed manually. Hip-knee-ankle (HKA) angle and weightbearing line (WBL) percentage are perfectly correlated to the Miniaci angle when planning open-wedge high tibial osteotomy, and ΔmMPTA and ΔWBL percentage are nearly perfectly correlated with the ΔHKA angle. Surgeons can easily measure the Miniaci angle according to the preoperative HKA and preoperative WBL percentage without digital software, and mMPTA greater than 95° can be avoided. Finally, bony and soft tissue components must be considered during preoperative planning. Medial soft tissue laxity must be specifically avoided.
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Hasegawa M, Naito Y, Tone S, Sudo A. High rates of outliers in computer-assisted high tibial osteotomy with excellent mid-term outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:399-405. [PMID: 34738158 DOI: 10.1007/s00167-021-06788-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The primary aim was to evaluate the accuracy of navigation in opening wedge high tibial osteotomy (HTO). The secondary aim was to examine mid-term outcomes after HTO. METHODS Inclusion criteria were patients with medial compartment knee osteoarthritis who underwent computer-assisted HTOs. Mechanical axis (MA), percentage MA (%MA), and change in posterior tibial slope (ΔPTS) were displayed on the navigation screen. Radiographic examinations included hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and PTS. Preoperative and 5 weeks postoperative standing radiographs of the whole lower extremity and knee were used. Clinical evaluations were performed using American Knee Society knee score and function score both preoperatively and at last follow-up. Radiographic evaluations were performed by orthopedic surgeons. Intraoperative navigation after osteotomy and postoperative standing radiograph were compared. MA (HKA), %MA, and ΔPTS were compared. Outliers were defined as > 3° in MA, > 10% in %MA, and > 10° in ΔPTS. Outlier and non-outlier groups were compared. The rate of conversion to arthroplasty was examined. RESULTS This study involved 38 patients (44 knees) and last follow-up was at a mean of 5 years (range, 1-9 years). Mean American Knee Society knee score and function score improved significantly from 59 to 69 preoperatively to 95 and 85 at last follow-up, respectively. Absolute values of mean errors for MA, %MA, and ΔPTS were 2.1°, 9.3%, 1.2°, respectively. Outlier rates were 18% in MA, 39% in %MA, and 5% in ΔPTS. No significant factors were found in MA and ΔPTS. In %MA, preoperative JLCA was significantly higher in the outlier group compared to the non-outlier group. No knees underwent conversion to total knee arthroplasty. No differences in outcomes were found between outlier and non-outlier groups. CONCLUSION Although rates of outlier values in computer-assisted opening wedge HTO were high, mid-term outcomes were excellent. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Ryu DJ, Park SJ, Lee DH, Kwon KB, Choi GH, Kim IS, Wang JH. Does the anteromedial plate position affect proximal screw length and worsen the clinical outcomes in medial opening wedge high tibial osteotomy? BMC Musculoskelet Disord 2023; 24:14. [PMID: 36611141 PMCID: PMC9824977 DOI: 10.1186/s12891-022-06080-4] [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: 08/10/2022] [Accepted: 12/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During medial opening wedge high tibial osteotomy (MOWHTO), sometimes the plate tends to be positioned anteromedially. The plate position can affect the length of the proximal screw, which significantly affects stability after osteotomy. Therefore, research on the correlation among plate position, screw length, and clinical outcomes is needed. METHODS This retrospective review examines 196 knees in 175 patients who underwent MOWHTO from May 2012 to December 2018, for symptomatic medial compartment osteoarthritis with a varus alignment of > 5°. We evaluated the anteroposterior plate position, length of proximal screw, and postoperative computed tomography (CT). We reviewed patients' clinical outcome scores, presence of lateral hinge fracture, neurovascular complications, and infection. The correlation among proximal plate position, proximal screw length, and clinical outcomes was evaluated using Pearson's correlation analysis. A subgroup analysis by screw angle (> 48 ° or < 48 °) was also performed using chi-square test and Student t-test. RESULTS The mean proximal plate position was 16.28% (range, 5.17-44.74) of the proximal tibia's anterior-to-posterior distance ratio, and the proximal screw length averaged 63.8 mm (range, 44-80 mm). Proximal posteromedial plate position and proximal screw length were significantly correlated (r2 = 0.667, P < .001), as were screw angle and length (r2 = 0.746, P < .001). Medial plating (< 48°) can use a longer proximal screw; nevertheless, no significant difference occurred in clinical outcomes between the two groups. Also, no differences occurred in complication rate, including hinge fracture. CONCLUSION With more medially positioned plating during MOWHTO, we can use longer proximal screws. However, there was no significant difference in clinical outcomes and the incidence of lateral hinge fractures regardless of plate position and screw length.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University school of Medicine, Incheon, South Korea
| | - Sang Jun Park
- Department of Orthopaedic Surgery, Cheongju Micro Hospital, Cheongju-si, Chung-cheong bukdo South Korea
| | - Dae Hee Lee
- grid.264381.a0000 0001 2181 989XDepartment of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 South Korea
| | - Kyeu-Back Kwon
- Department of Orthopaedic Surgery, Samsung Bone Hospital, Osan-si, Gyeonggi-do South Korea
| | - Geun Hong Choi
- Department of Orthopaedic Surgery, Samsung Maditop hospital, Sungnam-si, Gyeonggi-do South Korea
| | - Il Su Kim
- grid.264381.a0000 0001 2181 989XDepartment of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 South Korea
| | - Joon Ho Wang
- grid.264381.a0000 0001 2181 989XDepartment of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
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Ghasemi SA, Murray BC, Buksbaum JR, Shin J, Fragomen A, Rozbruch SR. Opening wedge high tibial osteotomy for medial compartment knee osteoarthritis: Planning and improving outcomes: Case series and literature review. J Clin Orthop Trauma 2023; 36:102085. [PMID: 36654729 PMCID: PMC9840976 DOI: 10.1016/j.jcot.2022.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background Opening wedge high tibial osteotomy (OWHTO) is a safe surgical procedure to treat medial compartmental osteoarthritis caused by a varus deformity. Over-correction of this varus deformity can lead to lateral compartment over-loading. In our study, we planned our correction by using the mechanical axis deviation (MAD). Purpose The purpose of this study is to evaluate the clinical and radiological results of OWHTO based on planning using the MAD measurements. Study Design Retrospective Case Series. Methods 14 patients with Kellgren- Lawrence classification (KL) grade 3 or above underwent OWHTO, with plans to have the mechanical axis pass through 5-15 mm lateral to the center of the tibial plateau. Pre-operative and post-operative radiographic measurements were made and compared using the student t-test. SF-36 scores were obtained for clinical performance. Results Our patients experienced MAD from 25.9 mm medial to the center of the tibial plateau pre-operatively to 12.7 mm lateral to the center of the plateau post-operatively. The mean change in MAD was 38.7 mm (p < 0.0001). The accuracy of our correction compared to the planned MAD was 98.3%. The mechanical axis angle shifted from 7.35° of varus to 3.5° of valgus (p < 0.0001). All patients had post-operative alignments of 1-6° of valgus, with 11 of out the 14 patients with alignments less than 5° of valgus, preventing over-loading of the lateral compartment. Conclusion Using MAD measurements is an accurate planning method for OWHTO that corrects varus deformity without over-loading the lateral compartment, and leads to improved clinical outcomes.
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Affiliation(s)
- S. Ali Ghasemi
- Orthopaedic Surgery, Albert Einstein Health Network, Philadelphia, PA, 19141, United States
| | - Benjamin C. Murray
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 19131, United States
| | - Joshua R. Buksbaum
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
| | - Jonggu Shin
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
| | - Austin Fragomen
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
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Thürig G, Korthaus A, Frings J, Berninger MT, Frosch KH, Krause M. Influence of Medial Osteotomy Height and Hinge Position in Open Wedge High Tibial Osteotomy: A Simulation Study. Diagnostics (Basel) 2022; 12:diagnostics12102546. [PMID: 36292236 PMCID: PMC9600956 DOI: 10.3390/diagnostics12102546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: In treating medial unicompartmental gonarthrosis, medial open wedge high tibial osteotomy (mOWHTO) reduces pain and is intended to delay a possible indication for joint replacement by relieving the affected compartment. This study aimed to investigate the influence of the osteotomy height with different hinge points in HTO in genu varum on the leg axis. (2) Methods: Fifty-five patients with varus lower leg alignment obtained full-weight bearing long-leg radiographs were analyzed. Different simulations were performed: Osteotomy height was selected at 3 and 4 cm distal to the tibial articular surface, and the hinge points were selected at 0.5 cm, 1 cm, and 1.5 cm medial to the fibular head, respectively. The target of each correction was 55% of the tibial plateau measured from the medial. Then, the width of the opening wedge was measured. Intraobserver and interobserver reliability were calculated. (3) Results: Statistically significant differences in wedge width were seen at an osteotomy height of 3 cm below the tibial plateau when the distance of the hinge from the fibular head was 0.5 cm to 1.5 cm (3 cm and 0.5 cm: 8.9 +/− 3.88 vs. 3 cm and 1.5 cm: 11.6 +/− 4.39 p = 0.012). Statistically significant differences were also found concerning the wedge width between the distances 0.5 to 1.5 cm from the fibular head at the osteotomy height of 4 cm below the tibial plateau. (4 cm and 0.5 cm: 9.0 +/− 3.76 vs. 4 cm and 1.5 cm: 11.4 +/− 4.27 p = 0.026). (4) Conclusion: A change of the lateral hinge position of 1 cm results in a change in wedge width of approximately 2 mm. If hinge positions are chosen differently in preoperative planning and intraoperatively, the result can lead to over- or under-correction.
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Affiliation(s)
- Grégoire Thürig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, 1700 Fribourg, Switzerland
| | - Alexander Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Markus Thomas Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- Correspondence:
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Aman ZS, DePhillipo NN, Peebles LA, Familiari F, LaPrade RF, Dekker TJ. Improved Accuracy of Coronal Alignment Can Be Attained Using 3D-Printed Patient-Specific Instrumentation for Knee Osteotomies: A Systematic Review of Level III and IV Studies. Arthroscopy 2022; 38:2741-2758. [PMID: 35247513 DOI: 10.1016/j.arthro.2022.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the accuracy and precision of postoperative coronal plane alignment using 3D-printed patient-specific instrumentation (PSI) in the setting of proximal tibial or distal femoral osteotomies. METHODS A systematic review evaluating the accuracy of 3D-printed PSI for coronal plane alignment correcting knee osteotomies was performed. The primary outcomes were accuracy of coronal plane limb alignment correction and number of correction outliers. Secondary variables were duration of surgery, number of intraoperative fluoroscopic images, complications, cost, and clinical outcomes (as applicable). RESULTS Ninety-three studies were identified, and 14 were included in the final analysis. Overall, mean postoperative deviation from target correction ranged from 0.3° to 1° for all studies using hip-knee angle measurements and 2.3% to 4.9% for all studies using weight-bearing line measurements. The incidence of correction outliers was assessed in 8 total studies and ranged from 0 to 25% (total n = 10 knees) of patients corrected with 3D-printed PSI. Osteotomies performed with 3D-printed cutting guides or wedges demonstrated significantly shorter operative times (P < .05) and fewer intraoperative fluoroscopic images (P < .05) than control groups in four case control studies. CONCLUSION Patients undergoing distal femoral osteotomy or proximal tibial osteotomy procedures with 3D-printed patient-specific cutting guides and wedges had highly accurate coronal plane alignment with a low rate of outliers. Patients treated with 3D printed PSI also demonstrated significantly shorter operative times and decreased intraoperative fluoroscopy when compared to conventional techniques. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Zachary S Aman
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | | | - Liam A Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Filippo Familiari
- Department of Orthopaedics and Trauma Surgery, Magna Graecia University, Catanzaro, Italy
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11
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Jörgens M, Keppler AM, Degen N, Bachmeier AT, Bergstraesser M, Sass J, Prall WC, Böcker W, Fürmetz J. Reliability of 3D planning and simulations of medial open wedge high tibial osteotomies. J Orthop Surg (Hong Kong) 2022; 30:10225536221101699. [PMID: 35694778 DOI: 10.1177/10225536221101699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: In medial open-wedge high tibial osteotomy (HTO) hinge axis and osteotomy plane influence the resulting anatomy, but accurate angular quantifications using 3D-planning-simulations are lacking. The objectives of this study were developing a standardized and validated 3D-planning method of an HTO and to perform several simulated realignments to explain unintended anatomy changes. Methods: The cutting direction of the main osteotomy was defined parallel to the medial tibial slope and the hinge axis 1.5 cm distal to the lateral plateau. For interobserver testing, this 3D planning was performed on 13 digital models of human tibiae by two observers. In addition, four different hinge axis positions and five differently inclined osteotomy planes each were simulated. The osteotomy direction ranged from medial 0°-30° anteromedial, while the tilt of the osteotomy plane compared to the tibial plateau was -10° to +10°. All anatomic angular changes were calculated using 3D analysis. Results: Multiple HTO plannings by two medical investigators using standardized procedures showed only minimal differences. In the 3D-simulation, each 10° rotation of the hinge axis resulted in a 1.7° significant increase in slope. Tilting the osteotomy plane by 10° resulted in significant torsional changes of 2°, in addition to minor but significant changes in the medial proximal tibial angle (MPTA). Conclusion: Standardized 3D-planning of the HTO can be performed with high reliability using two-observer planning. 3D-simulations suggest that control of the osteotomy plane is highly relevant to avoid unintended changes in the resulting anatomy, but this can be a helpful tool to modify specific angles in different pathologies in the HTO.
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Affiliation(s)
- Maximilian Jörgens
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Alexander M Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Nikolaus Degen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Andreas T Bachmeier
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Marcel Bergstraesser
- OT Medizintechnik GmbH (Medical Engineering in Orthopedics and Traumatology), Munich, Germany
| | - Jan Sass
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Wolf Christian Prall
- FIFA Medical Centre of Excellence, Division of Knee, Hip, Shoulder and Ellbow Surgery, Schoen Clinic Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany
| | - Julian Fürmetz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany.,64365Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Germany
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12
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Kang BY, Lee DK, Kim HS, Wang JH. How to achieve an optimal alignment in medial opening wedge high tibial osteotomy? Knee Surg Relat Res 2022; 34:3. [PMID: 35135631 PMCID: PMC8822774 DOI: 10.1186/s43019-021-00130-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.
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Affiliation(s)
- Byoung Youl Kang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyeon Soo Kim
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Bardot LP, Micicoi G, Favreau H, Zeman P, Khakha R, Ehlinger M, Ollivier M. Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes. Knee Surg Sports Traumatol Arthrosc 2022; 30:715-720. [PMID: 33486561 DOI: 10.1007/s00167-021-06446-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity. MATERIAL AND METHODS This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA). RESULTS From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01). CONCLUSION Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA. LEVEL OF CLINICAL EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Léo-Pôhl Bardot
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
| | - Grégoire Micicoi
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - Henri Favreau
- Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Petr Zeman
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Raghbir Khakha
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
- Guys and St Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, England
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
- Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France.
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14
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Evaluation of the reliability of lower extremity alignment measurements using EOS imaging system while standing in an even weight-bearing posture. Sci Rep 2021; 11:22039. [PMID: 34764394 PMCID: PMC8585885 DOI: 10.1038/s41598-021-01646-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022] Open
Abstract
This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture. Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated. Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. In the inter-observer reliability analysis, all values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not. For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.
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15
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Ryu DJ, Lee SS, Jung EY, Kim JH, Shin TS, Wang JH. Reliability of Preoperative Planning Method That Considers Latent Medial Joint Laxity in Medial Open-Wedge Proximal Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211034151. [PMID: 34631902 PMCID: PMC8495530 DOI: 10.1177/23259671211034151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Soft tissue laxity around the knee joint has been recognized as a crucial factor affecting correction error during medial open-wedge proximal tibial osteotomy (MOWPTO). Medial laxity in particular, which represents the changes in joint-line convergence angle (JLCA), affects soft tissue correction. Purpose: The purpose of this study was to quantify medial laxity and develop a preoperative planning method that considers medial laxity. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed 139 knees in 117 patients who underwent navigation-assisted MOWPTO from January 2014 to July 2019 for symptomatic medial compartment osteoarthritis with varus alignment >5°. We compared the results of 2 preoperative planning methods: conventional Miniaci (n = 47) and latent medial laxity reduction (LMLR) (n = 92). We evaluated the incidence of undercorrection, acceptable correction, and overcorrection. The radiologic parameters were analyzed using multiple linear regression with a stepwise selection model to establish an equation for the optimal preoperative planning method. The intraclass correlation coefficients (ICCs) of intraobserver, interobserver, and intermethod reliability were calculated. Results: The Miniaci method showed a higher incidence of overcorrection (55.3%) than the LMLR method (22.8%) at postoperative 6 months (P = .0006). Multiple linear regression with a stepwise selection model revealed a high correlation coefficient (R2 = 0.888) for the following equation: Adjusted planned correction angle = 0.596 + 0.891 × Target correction angle – 0.255 × ΔJLCAvalgus. Upon simplification, the following equation showed the highest intermethod ICC value (0.991): Target correction angle – ⅓ΔJLCAvalgus, while the Miniaci method showed a relatively low ICC value of 0.875. Conclusion: There was a risk of overcorrection after MOWPTO using the conventional Miniaci method. An equation that considers medial laxity may help during preoperative planning for optimal correction during MOWPTO.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Republic of Korea
| | - Eui Yub Jung
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Joo Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Joon Ho Wang, MD, PhD, Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea ()
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16
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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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Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8813300. [PMID: 33791382 PMCID: PMC7985241 DOI: 10.1155/2021/8813300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02% to a postoperative value of 56.19 ± 0.10% from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08% at the final follow-up (P < 0.01). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values (P > 0.05). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63° to a postoperative week-one valgus of 2.37 ± 0.28°, and it had a valgus of 2.48 ± 0.39° at the final follow-up (P < 0.01). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26° (P > 0.05). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53° and 90.33 ± 1.52°, respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72° and the intraoperative setting value of 90.25 ± 1.67° (P > 0.05). All corrected values were within the acceptable range of preoperative planning. Conclusion Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.
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Ten-year survival rate of 89% after distal femoral osteotomy surgery for lateral compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2021; 29:594-599. [PMID: 32285155 DOI: 10.1007/s00167-020-05988-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the accuracy, safety, and survival of distal femoral osteotomy (DFO) surgery for lateral compartment OA of the knee. METHODS A retrospective cohort study was conducted at a single UK centre, using prospectively collected data over an 8-year period (2009-2017). All patients had pre-operative radiographic analysis and digital planning of their deformity correction in addition to post-operative analysis of the achieved correction and yearly face-to-face follow-up. Complications (defined as an undesirable medical or surgical event as a direct result of the operation), reoperations, and failure (defined as conversion to arthroplasty or revision) were recorded. RESULTS From a total of 83 patients, 81 patients undergoing 86 primary DFOs were included in this study, with a mean follow-up of 99 months (SD 27 months). The mean pre-operative percentage Mikulicz point was 78.7% (SD 19.1%) and post-operative 35.9% (SD 14.8%). The mean accuracy of correction (intended correction - achieved correction) was an 8.2% overcorrection (SD 13.7%). The complication rate was 4.7%. Using Kaplan-Meier analysis, the mean survival was 113 months (95% CI 106-120) with the probability of surviving 10 years 89%. CONCLUSION DFO for valgus alignment and lateral compartment arthritis is associated with low complications, long-term joint preservation, and the prevention of arthroplasty surgery. However, the accuracy of correction still requires improvement in intra-operative technique. LEVEL OF EVIDENCE IV.
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Akasaki Y, Mizu-Uchi H, Hamai S, Tsushima H, Kawahara S, Horikawa T, Nakashima Y. Patient-specific prediction of joint line convergence angle after high tibial osteotomy using a whole-leg radiograph standing on lateral-wedge insole. Knee Surg Sports Traumatol Arthrosc 2020; 28:3200-3206. [PMID: 31828362 DOI: 10.1007/s00167-019-05821-8] [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: 07/11/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the usefulness of a whole-leg radiograph standing on lateral-wedge insole (LWI) for predicting the change in joint line convergence angle (JLCA) before vs. after high tibial osteotomy (HTO). METHODS Forty knees with medial osteoarthritis underwent open-wedge HTO. Pre-operatively, all patients had whole-leg radiographs taken in three different conditions: supine, standing, and standing on LWI inclined at 20°. A standing whole-leg radiograph was also obtained post-operatively. Radiological measurements including JLCA and percentage of mechanical axis (%MA) were compared. Using pre-operative radiographs, correction angles were calculated with the target %MA at 62.5%. Correlations between the difference in calculated correction angle among the three pre-operative conditions and the change in JLCA before vs. after HTO were assessed. RESULTS In the pre-operative standing conditions, the mean JLCA of 3.8° was significantly decreased to 3.2° using LWI, which did not differ from post-operative JLCA of 3.1°. Mean %MA significantly shifted laterally from 20.6 to 24.8% using LWI, and was strongly correlated with the change in JLCA (coefficient, 0.83). Calculated correction angles differed significantly among the three pre-operative conditions. The difference in calculated correction angle between standing with and without LWI was strongly correlated to the change in standing JLCA before vs. after HTO (coefficient, 0.73). CONCLUSION Larger differences in calculated correction angles between pre-operative radiographs standing with and without LWI predicted larger changes in JLCA after HTO. Whole-leg radiograph standing on LWI is a promising modality for correct pre-operative planning considering patient-specific changes in JLCA before vs. after HTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomohiro Horikawa
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, 1-100, Tenryomachi, Omuta, 836-8566, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Managing intra-articular deformity in high Tibial osteotomy: a narrative review. J Exp Orthop 2020; 7:65. [PMID: 32902758 PMCID: PMC7481321 DOI: 10.1186/s40634-020-00283-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.
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Preoperative soft tissue laxity around knee was associated with less accurate alignment correction after hybrid closed-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:3022-3030. [PMID: 31705147 DOI: 10.1007/s00167-019-05762-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to assess the effect of soft tissue correction due to knee joint laxity, which induces alignment error after hybrid closed-wedge high tibial osteotomy (CWHTO). In addition, to verify whether postoperative soft tissue correction can be predicted from preoperative radiographic parameters. METHODS A retrospective evaluation of data from patients treated by CWHTO in 2016-2019 was performed. Standing full-length anteroposterior radiograph measurement was performed pre- and post-surgery, and short anteroposterior radiographs of the knee under maximal manual varus and valgus stress were taken preoperatively. The weight-bearing line, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured, in addition to JLCA under varus or valgus conditions. Soft tissue correction was defined as ΔHKA minus ΔMPTA. Multiple regression analysis was performed to evaluate preoperative factors that could influence soft tissue correction. RESULTS Data from 49 knees were included in the analysis. The mean soft tissue correction was 3.2°, which indicates an over-correction. Multiple regression analysis revealed that JLCA (β = 0.642; p < 0.001) and valgus JLCA (β = - 0.422; p = 0.001) were significantly associated with postoperative soft tissue correction. The final model of the regression formula was described by the following equation: postoperative soft tissue correction = 0.691 × JLCA - 0.411 × valgus JLCA - 0.399. CONCLUSION Preoperative values for JLCA and JLCA under valgus stress are associated with soft tissue correction. Surgeons should, therefore, consider these measurements to achieve postoperative limb alignment.
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Moon HS, Choi CH, Jung M, Lee DY, Kim JH, Kim SH. The effect of knee joint rotation in the sagittal and axial plane on the measurement accuracy of coronal alignment of the lower limb. BMC Musculoskelet Disord 2020; 21:470. [PMID: 32680484 PMCID: PMC7368736 DOI: 10.1186/s12891-020-03487-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although the measurement of coronal alignment of the lower limb on conventional full-length weight-bearing anteroposterior (FLWAP) radiographs was reported to be influenced by the knee joint rotation, no comparative analysis was performed considering the effects of knee joint rotation on the sagittal and axial planes simultaneously using the three-dimensional images while taking into account the actual weight-bearing conditions. The aim of this study was to investigate the effect of knee joint rotation on the measurement accuracy of coronal alignment of the lower limb on the FLWAP radiograph. Methods Radiographic images of 90 consecutive patients (180 lower limbs) who took both the FLWAP radiograph and the EOS image were retrospectively reviewed. The relationship among delta values of mechanical tibiofemoral angle (mTFA) between the FLWAP radiographs and the EOS images (ΔmTFA), knee flexion/extension angle (sagittal plane rotation) on the EOS images, and patellar rotation (axial plane rotation) on the FLWAP radiographs were analyzed. Further, subgroup analysis according to each direction of knee joint rotation was performed. Results There was a significant correlation between ΔmTFA and sagittal plane rotation (r = 0.368, P < 0.001), whereas axial plane rotation was not correlated. In the analysis according to the direction, statistically significant correlation was observed only in the knee flexion group (r = 0.399, P < 0.001). The regression analysis showed a significant linear relationship between ΔmTFA and sagittal plane rotation (r2 = 0.136, P < 0.001). Additional subgroup analysis in patients with the patellar rotation greater than 3% showed a similar result of a linear relationship between ΔmTFA and sagittal plane rotation (r2 = 0.257, P < 0.001), whereas no statistically significant relationship was found in patients with the patellar rotation less than 3%. Conclusion The measurement accuracy of coronal alignment of the lower limb on the FLWAP radiographs would be influenced by knee flexion, specifically when there is any subtle rotation of the knee joint in the axial plane. A strict patellar forward position without axial plane rotation of the knee could provide accurate results of the measurement even if there is a fixed flexion contracture of the knee.
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Affiliation(s)
- Hyun-Soo Moon
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Chong-Hyuk Choi
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae-Young Lee
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Saegil Hospital, Seoul, Republic of Korea
| | - Jung-Hwan Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Noyes FR. Editorial Commentary: Measurements for Successful High Tibial Osteotomy: Understanding Supine Versus Standing and Intraoperative Fluoroscopic Alignment Is Required. Arthroscopy 2020; 36:1665-1669. [PMID: 32503776 DOI: 10.1016/j.arthro.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
A high tibial osteotomy (HTO) that is used to correct varus malalignment, such as with medial arthrosis or before cartilage restoration or posterolateral reconstructions, represents an important and required surgery for clinical success. A major problem that occurs with HTO planning is that the preoperative measurements, with either lower limb supine or standing weight-bearing radiographs, will invariably show abnormal medial or lateral tibiofemoral compartment opening resulting from soft-tissue laxity or injury. It is imperative that this tibiofemoral joint opening be accounted for in the osteotomy correction calculations. There are well-described methods available that affect operative planning, such as the use of preoperative stress radiographs to determine the millimeters of tibiofemoral opening or closure. The use of intraoperative fluoroscopy with application of axial loading to the lower limb and verification of closure of the tibiofemoral joint is recommended. A careful fluoroscopic examination of the tibiofemoral compartments allows a final adjustment of the osteotomy correction and confirms the final weight-bearing line percent measurement and limb alignment. Postoperative radiographs are required to detect outliers resulting from unexpected soft-tissue laxity or inadequate correction.
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Affiliation(s)
- Frank R Noyes
- Cincinnati Sportsmedicine Research and Education Foundation
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Tsuji M, Akamatsu Y, Kobayashi H, Mitsugi N, Inaba Y, Saito T. Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2020; 140:707-715. [PMID: 31468134 DOI: 10.1007/s00402-019-03245-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Using a navigation system in open-wedge high tibial osteotomy (OWHTO) has higher accuracy than using the conventional method. However, unintentional over- and under-correction still exist. This study aimed to compare various factors related to over- and under-correction and to assess their predictive factors in the preoperative radiographs. MATERIALS AND METHODS This study involved 96 knees. The difference in the hip-knee-ankle angle (HKA) between the intraoperative navigation system and postoperative radiograph was termed navigation correction loss (NCL). Knees with absolute values of NCL (|NCL|) ≦ 1.5° and |NCL| > 1.5° were categorised into acceptable (n = 46) and outlier (n = 50) groups, respectively. The differences in joint line convergence angle (JLCA) between varus and valgus radiographs, varus JLCA, valgus JLCA, standing JLCA and standing HKA were compared between the two groups. Clinical results were evaluated using the American Knee Society (AKS) scores. RESULTS The mean intraoperative HKA in the navigation system was - 3.8 ± 1.8°, and that in the postoperative standing radiograph was - 4.2 ± 2.5° (p = 0.033). Preoperative varus, valgus and standing JLCA were higher in the outlier group (p = 0.018, p = 0.020 and p = 0.001, respectively). Logistic regression analyses for preoperative factors of |NCL| ≦ 1.5° showed that standing JLCA was a determining factor, with an odds ratio of 1.334 (confidence interval was 1.087-1.637, p = 0.006). AKS score was higher in the acceptable group (p = 0.040) postoperatively. CONCLUSIONS Higher preoperative standing JLCA was the predictive factor of |NCL| > 1.5°. This factor reduced the rates of under- and over-correction and resulted in better AKS score in OWHTO.
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Affiliation(s)
- Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naoto Mitsugi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urahunecho, Minami-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1516-1525. [PMID: 31289915 DOI: 10.1007/s00167-019-05555-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Coronal correction errors after medial opening wedge high tibial osteotomy (MOWHTO) occasionally occur even with the assistance of navigation. The purpose of the present study was to determine the navigation accuracy in MOWHTO and to identify factors that affect the coronal correction error after navigation-assisted MOWHTO. METHODS A total of 114 knees treated with navigation-assisted MOWHTO were reviewed retrospectively. Mechanical axis (MA) on standing radiograph and medial proximal tibial angle (MPTA) were measured preoperatively and at 6 months postoperatively, and the differences (ΔMA and ΔMPTA) were calculated. Joint line convergence angle (JLCA) on supine and standing radiographs was measured preoperatively, and their difference (ΔJLCA) was calculated. To assess the navigation accuracy, ΔMA and ΔMPTA were compared with the coronal correction by navigation (ΔNMA) using intraclass correlation coefficients (ICCs). Univariable and multivariable regression analyses were used to identify factors that affect coronal correction discrepancy (ΔMA - ΔNMA). RESULTS The reliability of navigation was good in terms of bony correction (ICC between ΔNMA and ΔMPTA, 0.844) and fair in terms of MA correction (ICC between ΔNMA and ΔMA, 0.706). The mean coronal correction discrepancy was 2.0° ± 2.4°. In the multivariable analysis, ΔJLCA was shown to be a predictive factor of coronal correction discrepancy (unstandardized coefficient, 1.026; R2, 0.470). CONCLUSION Navigation in MOWHTO provided reliable information about bony correction; however, MA tended to be overcorrected. The difference in JLCA between the supine and standing radiographs was the most important preoperative factor that predicted the coronal correction discrepancy after MOWHTO. In patients with larger ΔJLCA, each degree of ΔJLCA should be subtracted from the planned amount of correction angle when preoperative planning is performed using standing radiographs. LEVEL OF EVIDENCE IV.
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Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, Kim JY. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1411-1418. [PMID: 30980121 DOI: 10.1007/s00167-019-05502-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to determine which preoperative factors affect the postoperative change in the joint line convergence angle (JLCA) by preoperatively quantifying soft tissue laxity. METHODS Thirty-four patients who underwent medial open-wedge high tibial osteotomy (HTO) with a navigation were analysed. The JLCA change after HTO was calculated using standing long-bone anteroposterior radiographs taken preoperatively and 6 months postoperatively. Latent soft tissue laxity was defined as the amount of soft tissue that can be extended to valgus or varus from the weight-bearing position, and calculated by subtracting the JLCA on weight-bearing standing radiographs from that on stress radiographs. Multiple linear regression was performed to determine the preoperative factors that statistically correlated with the postoperative JLCA change. RESULTS In multiple linear regression, JLCA change had a statistically significant correlation with latent medial laxity (R = 0.6) and a statistically borderline significant correlation with correction angle (R = 0.2). These imply that the postoperative JLCA change increased by 0.6° per 1° increase in latent medial laxity, and increased by 0.2° per 1° increase in correction angle. Latent medial laxity was the most crucial factor associated with postoperative JLCA changes. CONCLUSION The JLCA change could be larger in patients with large latent medial laxity or severe varus deformity requiring a large correction, which could lead to unexpected overcorrection in HTO. Postoperative JLCA change should be considered in preoperative surgical planning. Target point shifting within the hypomochlion point could be a strategy to prevent overcorrection, especially in patients with large latent medial laxity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, South Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Yougun Won
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, South Korea
| | - Young Ki Min
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, South Korea
| | - Sagar Jaiswal
- Department of Orthopaedic Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University School of Medicine, Daejeon, South Korea
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Lee SS, So SY, Jung EY, Kim HJ, Lee BH, Wang JH. Predictive Factors for Patellofemoral Degenerative Progression After Opening-Wedge High Tibial Osteotomy. Arthroscopy 2019; 35:1703-1710. [PMID: 31053459 DOI: 10.1016/j.arthro.2019.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify risk factors for patellofemoral degenerative progression after opening-wedge high tibial osteotomy (HTO) and to investigate the effect of patellofemoral degeneration on the patellofemoral specific patient-reported outcomes. METHODS Between March 2010 and June 2016, 94 knees (86 patients) underwent hardware removal with second-look arthroscopy at 21.4 months after opening-wedge HTO with first-look arthroscopy (mean follow-up duration, 49.8 months). Predictive factors for patellofemoral degeneration, including demographics, preoperative and postoperative mechanical axis (MA) of the lower limb (positive and negative MA indicating varus and valgus, respectively), tibial slope, and modified Blackburne-Peel ratio, were evaluated. Patients were divided into the progression and nonprogression groups according to their patellofemoral degenerative progression from first to second arthroscopy. Clinical outcomes, including the Kujala score and Knee Injury and Osteoarthritis Outcome Score, and radiographic outcomes were compared between the 2 groups. RESULTS Postoperative MA (adjusted odd ratio, 0.62; P < .001) was the most significant predictive factor for progressive change in the patellofemoral joint (Rn2 = 0.31). Twenty-eight knees (30%) showed patellofemoral degenerative progression. Mean postoperative Kujala score (progression group 60.5 vs nonprogression group, 72.3; P = .005) and Knee Injury and Osteoarthritis Outcome Score scales (except for the symptom subscale) were lower in the progression group. Postoperative MA was significantly more corrected in the progression group (progression group -5.1° ± 2.7° vs nonprogression group -2.4° ± 2.3°; P < .001). CONCLUSIONS Postoperative MA, which might be related to overcorrection, is correlated with patellofemoral degenerative progression after opening-wedge HTO. Patients with patellofemoral degenerative progression showed inferior patient-reported outcomes. LEVEL OF EVIDENCE Level IV, case series with subgroup analysis.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Korea
| | - Sang-Yeon So
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eui-Yub Jung
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Jun Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Abstract
Osteotomies around the knee for treating osteoarthritis or knee instability are currently well-established procedures. Success of these realignment procedures is based on the accuracy and the reliability of correction angles in the coronal and sagittal alignment. In this context of improving precision and adapting the correction to each patient, navigation is currently being widely used. The rationale for its use is based on understanding the advantages and limitations, technical principles, and potential pitfalls. This article describes these areas and the overall clinical outcomes of this system for knee osteotomies.
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Affiliation(s)
- Thomas Neri
- Sydney Orthopaedic Research Institute (SORI), Level 1, The Gallery 445 Victoria Avenue, Chatswood, New South Wales 2067, Australia.
| | - Darli Myat
- Sydney Orthopaedic Research Institute (SORI), Level 1, The Gallery 445 Victoria Avenue, Chatswood, New South Wales 2067, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute (SORI), Level 1, The Gallery 445 Victoria Avenue, Chatswood, New South Wales 2067, Australia
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Lee DK, Kim KK, Ham CU, Yun ST, Kim BK, Oh KJ. The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method. Knee Surg Relat Res 2018; 30:303-310. [PMID: 29715716 PMCID: PMC6254867 DOI: 10.5792/ksrr.17.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 11/05/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether surgical experience could improve surgical competency in medial open wedge high tibial osteotomy (MOWHTO). Materials and Methods One hundred consecutive cases of MOWHTO were performed with preoperative planning using the Miniaci method. Surgical errors were defined as under- or overcorrection, excessive posterior slope change, or the presence of a lateral hinge fracture. Each of these treatment failures was separately evaluated using the cumulative summation test for learning curve (LC-CUSUM). Results The LC-CUSUM showed competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture after 27, 47, and 42 procedures, respectively. However, the LC-CUSUM did not signal achievement of competency in prevention of overcorrection after 100 procedures. Furthermore, the failure rate for overcorrection showed an increasing tendency as surgical experience increased. Conclusions Surgical experience may improve the surgeon’s competency in prevention of undercorrection, excessive posterior slope change, and lateral hinge fracture. However, it may not help reduce the incidence of overcorrection even after performance of 100 cases of MOWHTO over a period of 6 years.
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Affiliation(s)
- Do Kyung Lee
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Kwang Kyoun Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Chang Uk Ham
- Department of Orthopaedic Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok Tae Yun
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Kag Kim
- Department of Orthopaedic Surgery, Joint Center, SungMin Hospital, Incheon, Korea
| | - Kwang Jun Oh
- Department of Orthopaedic Surgery, Joint Center, SungMin Hospital, Incheon, Korea
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Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R. Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc 2018; 26:1859-1866. [PMID: 28417183 DOI: 10.1007/s00167-017-4548-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The primary purpose of the study was to gain insight into geometric changes of the patellar height (PH) and posterior tibial slope (PTS) after a biplanar ascending medial open-wedge high tibial osteotomy (HTO) compared to biplanar descending medial open-wedge HTO in patients with genu varum. METHODS Sixty-four patients (mean age 45.2 ± 8.7 years, females n = 24, males n = 40) with varus malalignment and medial gonarthrosis were retrospectively studied. Patients received either a biplanar ascending or descending medial open-wedge HTO. Radiographic analysis included the assessment of standing total leg axis, PH, and PTS prior to and after surgery. RESULTS In the ascending HTO group, PH decreased significantly by 4.0% (p = 0.037, Caton-Deschamps index) after an average leg axis valgus-producing correction of 7.1° ± 2.8°. In the descending HTO group, with an average leg axis correction of 7.0° ± 3.7°, there were no significant PH changes. There were no significant differences between the ascending and descending HTO groups regarding PTS or leg axis. The mean post-operative leg axis between ascending (1.6° ± 1.9°) and descending HTO (1.9° ± 2.4°) was not significantly different. CONCLUSION Compared to the biplanar ascending medial open-wedge HTO, the descending HTO did not influence patella height or increase the posterior tibial slope. In order to respect patellofemoral and slope-related knee kinematics, a biplanar descending medial open-wedge HTO has proven useful to control patella height and posterior tibial slope. These findings underscore the importance of the preoperative patella height assessment in the osteotomy planning and subsequent choice of the biplanar osteotomy direction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthias Krause
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Tobias Claus Drenck
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Alexander Korthaus
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Achim Preiss
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
| | - Karl-Heinz Frosch
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany.
| | - Ralph Akoto
- Division of Knee and Shoulder Surgery, Sports Traumatology, Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany
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Bae DK, Lee JW, Cho SJ, Song SJ. Comparison of Mechanical Axis and Dynamic Range Assessed with Weight Bearing Radiographs and Navigation System in Closed Wedge High Tibial Osteotomy. Knee Surg Relat Res 2017; 29:225-231. [PMID: 28854769 PMCID: PMC5596404 DOI: 10.5792/ksrr.16.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose To compare navigation and weight bearing radiographic measurements of mechanical axis (MA) before and after closed wedge high tibial osteotomy (HTO) and to evaluate post-osteotomy changes in MA assessed during application of external varus or valgus force. Materials and Methods Data from 30 consecutive patients (30 knees) who underwent computer-assisted closed-wedge HTO were prospectively analyzed. Pre- and postoperative weight bearing radiographic evaluation of MA was performed. Under navigation guidance, pre- and post-osteotomy MA values were measured in an unloaded position. Any change in the post-osteotomy MA in response to external varus or valgus force, which was named as dynamic range, was evaluated with the navigation system. The navigation and weight bearing radiographic measurements were compared. Results Although there was a positive correlation between navigation and radiographic measurements, the reliability of navigation measurements of coronal alignment was reduced after osteotomy and wedge closing. The mean post-osteotomy MA value measured with the navigation was 3.5°±0.8° valgus in an unloaded position. It was 1.3°±0.8° valgus under varus force and 5.8°±1.1° valgus under valgus force. The average dynamic range was >±2°. Conclusions Potential differences between the postoperative MAs assessed by weight bearing radiographs and the navigation system in unloaded position should be considered during computer-assisted closed wedge HTO. Care should be taken to keep the dynamic range within the permissible range of alignment goal in HTO.
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Affiliation(s)
- Dae Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jong Whan Lee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Kim MS, Son JM, Koh IJ, Bahk JH, In Y. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2017; 137:1035-1045. [PMID: 28593581 DOI: 10.1007/s00402-017-2729-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A considerable percentage of outliers with under- or over-correction continue to be reported despite precise preoperative planning and cautious intraoperative correction of lower limb alignment in medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether our novel technique for the intraoperative adjustment of alignment under valgus stress reduces the number of outliers in patients undergoing MOWHTO compared to the conventional technique, which corrects alignment according to the cable method only. MATERIALS AND METHODS One hundred seventeen consecutive knees were enrolled in this case-control study. The first 52 knees (51 patients) were corrected in accordance with preoperative plans using the Dugdale method with modification with an intraoperative cable (group 1). In the other 65 knees (60 patients), the angle was corrected using the Dugdale method and limb alignment was adjusted using the intraoperative cable technique by applying valgus stress to the knee joint (group 2). The postoperative weight bearing line ratios and mechanical axis of the lower limb were compared at postoperative one year. Each knee was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative one year. RESULTS A significant reduction in the number of outliers was seen in group 2 compared to group 1 (group 1 = 48.1%, group 2 = 9.2%, p < 0.001). Nineteen of 52 knees (36.5%) were under-corrected in group 1, whereas 6 of 65 knees (9.2%) were under-corrected in group 2 (p < 0.001). Six of 52 knees (11.6%) were over-corrected in group 1, whereas 0 of 65 knees (0.0%) were over-corrected in group 2 (p = 0.005). At one -year after operation, group 2 showed significantly lower WOMAC score than group 1 (p = 0.014). CONCLUSIONS Intraoperative adjustment of alignment under valgus stress significantly reduced the number of outliers compared to a technique that corrected alignment using the cable method in patients undergoing MOWHTO. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jong Min Son
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hoon Bahk
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea.
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Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy. Knee 2017; 24:362-371. [PMID: 28169100 DOI: 10.1016/j.knee.2016.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/27/2016] [Accepted: 11/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assess the axial rotational change of distal tibia and posterior tibial slope (PTS) change after OWHTO in 3-D planes and to identify the causal relationship on the effect of variation in the posterior slope angle and rotational errors. METHODS A total of 21 patients (23 knees) underwent OWHTO and were evaluated with 3D-CT before and after surgery. Medial proximal tibial angle in the coronal plane, PTS in the sagittal plane, and rotational axis in axial plane were evaluated and compared between pre- and post-operative 3D models constructed by applying reverse-engineering software. As a selective osteotomy parameter, hinge axis and gap ratio were measured in the postoperative 3D models RESULTS: The increasing tendency of internal rotation of the distal tibia after OWHTO was positively related to hinge axis (β=0.730, p=0.001, R2=0.546) and gap ratio (β=-0.283, p=0.001, R2=0.520), which also showed statistically significant linear correlations to PTS changes after multivariate regression analysis that controlled for the rotational change of the distal tibia (hinge axis: β=0.443, p=0.006; gap ratio: β=0.144, p=0.017). CONCLUSION Hinge axis more posterolaterally was related to a greater increase in internal rotation after biplane medial open-wedge HTO, and hinge axis and gap ratio were significant predictors of PTS change after rotational change was controlled for. Hinge axis has to be considered an important independent variable for limiting unintended axial rotation change as well as PTS change as secondary. CLINICAL RELEVANCE The relationship of the hinge axis with the rotational change and its influence to PTS change, acknowledged from by-product of the statistical analysis, might provide a deeper understanding of HTO, and should have constitutional effects on the development of HTO procedures and implants.
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Chang J, Scallon G, Beckert M, Zavala J, Bollier M, Wolf B, Albright J. Comparing the accuracy of high tibial osteotomies between computer navigation and conventional methods. Comput Assist Surg (Abingdon) 2017; 22:1-8. [PMID: 27981853 PMCID: PMC6262829 DOI: 10.1080/24699322.2016.1271909] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The accuracy of correction has been shown to be an important determinant in long-term outcomes of patients who were treated with a medial open-wedge high tibial osteotomy (HTO) who suffer from unicompartmental osteoarthritis (OA). Computer navigation systems have the potential to improve surgical precision. The purpose of this study was to compare radiographic outcomes between patients treated with a navigation system and those treated through conventional methods of assessing alignment intra-operatively. The null hypothesis was that the method of assessing the alignment intra-operatively would make no difference in the accuracy of correction. METHODS In this retrospective study, 107 patients with medial varus OA who were managed by open-wedge HTO were included. Of the 107 patients, 41 were treated using an intraoperative navigation system and 66 were treated using conventional methods. Pre-operative and post-operative single-leg, long-leg standing alignment films were used to determine the extent of pre-operative varus deformity and the post-surgical correction achieved compared to the predetermined target range. RESULTS The navigational system had eight instances of software malfunction (19.5%) intra-operatively and correction was determined using the cable method. These results were analyzed as part of the conventional group. Post-operative radiographic differences were significant between the two groups. In the navigation group, 75.8% of the patients were corrected within the target range compared to 66.2% in the conventional group. More patients were also under corrected (to the point of remaining in varus) using conventional methods compared to a navigation system. There was no statistically significant difference in the degree of correction in the sagittal plane between the two groups. Regardless of the method used for checking alignment intra-operatively, there was a statistically significant difference in post-operative weight-bearing measurements when the surgeon had intra-operative axial loading versus when they did not. CONCLUSION For coronal plane corrections, the navigation system was shown to have greater success in achieving the desired correction value and in having fewer patients who were under corrected. Despite the measurement technique a surgeon chooses to assess the accuracy of correction, axial loading the extremity in order to simulate the weight-bearing film alignment post-operatively is important to maximize the accuracy of correction needed.
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Affiliation(s)
- Justin Chang
- a University of Iowa Roy J and Lucille A Carver College of Medicine , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Greg Scallon
- b University of Minnesota Twin Cities , Department of Orthopedic Surgery , Minneapolis , MN , USA
| | - Mitch Beckert
- a University of Iowa Roy J and Lucille A Carver College of Medicine , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Jeff Zavala
- a University of Iowa Roy J and Lucille A Carver College of Medicine , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Matthew Bollier
- c University of Iowa Hospitals and Clinics , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - Brian Wolf
- c University of Iowa Hospitals and Clinics , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
| | - John Albright
- c University of Iowa Hospitals and Clinics , Department of Orthopedics and Rehabilitation , Iowa City , IA , USA
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Kim HJ, Lee HJ, Shin JY, Park KH, Min SG, Kyung HS. Preoperative planning using the picture archiving and communication system technique in high tibial osteotomy. J Orthop Surg (Hong Kong) 2017; 25:2309499016684701. [PMID: 28142346 DOI: 10.1177/2309499016684701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study aimed to evaluate the accuracy of the picture archiving and communication system (PACS) method in order to select the correction angle and gap in open-wedge high tibial osteotomy (HTO) and clinical results of the patients. MATERIAL AND METHODS This retrospective study analyzed 27 consecutive patients (30 knees) underwent open-wedge HTO using the PACS method between April 2013 and March 2015. Full-length lower limb radiographs obtained preoperatively and at the final follow-up were used to the percentages of crossing points of the weight-bearing line and tibial plateau with respect to the medial border and mechanical femur-tibia angle. Preoperatively predicted and postoperatively measured wedge angles and gaps were compared. The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Knee Society score. RESULTS At the 20.5 months (12-26.5) follow-up, the weight-bearing line on the tibial plateau was corrected from 17.3% to 61.3%, and the mechanical femur-tibia angle was corrected from 7.3° varus to 3.1° valgus. No significant difference in preoperative and postoperative measured values was observed ( p = 0.440 and p = 0.505). The mean HSS score increased from 66.7 to 88.8 ( p < 0.001). The knee score and function score of Knee Society increased from 62.0 to 88.7 ( p < 0.001) and from 60.2 to 91.7 ( p < 0.001), respectively. CONCLUSION In open-wedge HTO, correction of angular deformity based on the PACS method could be an accurate correction method and the good clinical results could be obtained.
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Affiliation(s)
- Hee-June Kim
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun-Joo Lee
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ji-Yeon Shin
- 2 Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Kyeong-Hyeon Park
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Gi Min
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Soo Kyung
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy. Knee Surg Relat Res 2016; 28:283-288. [PMID: 27894175 PMCID: PMC5134794 DOI: 10.5792/ksrr.16.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). Materials and Methods This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. Results The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. Conclusions In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.
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Affiliation(s)
- Seong-Dae Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - GuoFeng Zhang
- Department of Orthopedic Surgery, Yantaishan Hospital, Yantai, China
| | - Hee-June Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Byoung-Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Soo Kyung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2016; 24:3704-3712. [PMID: 26154482 DOI: 10.1007/s00167-015-3682-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/18/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE Open-wedge high tibial osteotomy (HTO) cannot always accurately correct limb alignment, resulting in under- or over-correction. This study assessed the relationship between soft tissue laxity of the knee joint and alignment correction in open-wedge HTO. METHODS This prospective study involved 85 patients (86 knees) undergoing open-wedge HTO for primary medial osteoarthritis. The mechanical axis (MA), weight-bearing line (WBL) ratio, and joint line convergence angle (JLCA) were measured on radiographs preoperatively and after 6 months, and the differences between the pre- and post-surgery values were calculated. Post-operative WBL ratios of 57-67 % were classified as acceptable correction. WBL ratios <57 and >67 % were classified as under- and over-corrections, respectively. RESULTS Preoperative JLCA correlated positively with differences in MA (r = 0.358, P = 0.001) and WBL ratio (P = 0.003). Difference in JLCA showed a stronger correlation than preoperative JLCA with differences in MA (P < 0.001) and WBL ratio (P < 0.001). Difference in JLCA was the only predictor of both difference in MA (P < 0.001) and difference in WBL ratio (P < 0.001). The difference between pre- and post-operative JLCA differed significantly between the under-correction, acceptable-correction, and over-correction groups (P = 0.033). Preoperative JLCA, however, did not differ significantly between the three groups. Neither preoperative JLCA nor difference in JLCA correlated with change in posterior slope. CONCLUSIONS Preoperative degree of soft tissue laxity in the knee joint was related to the degree of alignment correction, but not to alignment correction error, in open-wedge HTO. Change in soft tissue laxity around the knee from before to after open-wedge HTO correlated with both correction amount and correction error. Therefore, a too large change in JLCA from before to after open-wedge osteotomy may be due to an overly large reduction in JLCA following osteotomy, suggesting alignment over-correction during surgery. LEVEL OF EVIDENCE II.
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Song SJ, Bae DK. Computer-Assisted Navigation in High Tibial Osteotomy. Clin Orthop Surg 2016; 8:349-357. [PMID: 27904715 PMCID: PMC5114245 DOI: 10.4055/cios.2016.8.4.349] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 11/25/2022] Open
Abstract
Computer-assisted navigation is used to improve the accuracy and precision of correction angles during high tibial osteotomy. Most studies have reported that this technique reduces the outliers of coronal alignment and unintended changes in the tibial posterior slope angle. However, more sophisticated studies are necessary to determine whether the technique will improve the clinical results and long-term survival rates. Knowledge of the navigation technology, surgical techniques and potential pitfalls, the clinical results of previous studies, and understanding of the advantages and limitations of the computer-assisted navigation are crucial to successful application of this new technique in high tibial osteotomy. Herein, we review the evidence concerning this technique from previous studies.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Nha KW, Kim HJ, Ahn HS, Lee DH. Change in Posterior Tibial Slope After Open-Wedge and Closed-Wedge High Tibial Osteotomy: A Meta-analysis. Am J Sports Med 2016; 44:3006-3013. [PMID: 26872893 DOI: 10.1177/0363546515626172] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is unclear whether open- or closed-wedge high tibial osteotomy (HTO) results in significant changes in posterior tibial slope, with no consensus on the magnitude of such changes. Furthermore, methods of measuring posterior tibial slope differ among studies. This meta-analysis was therefore designed to evaluate whether posterior tibial slope increases after open-wedge HTO and decreases after closed-wedge HTO and to quantify the magnitudes of the slope changes after open- and closed-wedge HTO using various methods of measuring posterior tibial slope. HYPOTHESIS Posterior tibial slope increases after open-wedge and decreases after closed-wedge HTO. The magnitude of change is similar for the 2 methods, and the value obtained for posterior tibial slope change is affected by the method of measurement. STUDY DESIGN Meta-analysis. METHODS Multiple comprehensive databases, including MEDLINE, EMBASE, the Cochrane Library, and KoreaMed, were searched for studies that evaluated the posterior slope of the proximal tibia in patients who had undergone open- and/or closed-wedge HTO. Studies were included that compared pre- and postoperative posterior tibial slopes, regardless of measurement method, including anterior and posterior tibial cortex or tibial shaft axis as a reference line, in patients who underwent open- or closed-wedge HTO. The quality of each included study was appraised with the Newcastle-Ottawa Scale. RESULTS Twenty-seven studies were included in the meta-analysis. Pooled data, which included subgroups of 3 methods, showed that posterior tibial slope increased 2.02° (95% CI, 2.66° to 1.38°; P = .005) after open-wedge HTO and decreased 2.35° (95% CI, 1.38° to 3.32°; P < .001) after closed-wedge HTO. CONCLUSION This meta-analysis confirmed that posterior tibial slope increased after open-wedge HTO and decreased after closed-wedge HTO when the results of a variety of measurement methods were pooled. The magnitude of change after open- and closed-wedge HTO was similar and small (approximately 2°), suggesting that both osteotomy techniques may have little effect on the biomechanics of the cruciate ligaments.
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Affiliation(s)
- Kyung-Wook Nha
- Department of Orthopaedic Surgery, Ilsanpaik Hospital, Inje University College of Medicine, Goyangsi, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyeong-Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3529-3555. [PMID: 27665094 DOI: 10.1007/s00167-016-4327-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates radiographic and clinical outcome reporting following navigated high tibial osteotomy (HTO). Conventional HTO was used as a control to compare outcomes and furthermore investigate the quality of evidence in studies reporting outcomes for navigated HTO. It was hypothesized that navigated HTO will show superior clinical and radiographic outcomes compared to conventional HTO. METHODS Two independent reviewers searched PubMed, Ovid (MEDLINE), EMBASE, and Cochrane databases for studies reporting outcomes following navigated HTO. Titles, abstracts, and full-text were screened in duplicate using an a priori inclusion and exclusion criteria. Descriptive statistics were calculated using Minitab ® statistical software. Methodological Index for Nonrandomized Studies (MINORS) and Cochrane Risk of Bias Scores were used to evaluate methodological quality. RESULTS Thirty-four studies which involved 2216 HTOs were analysed in this review, 1608 (72.6 %) navigated HTOs and 608 (27.4 %) conventional HTOs. The majority of studies were of level IV evidence (16). Clinical outcomes were reported in knee and function scores or range of motion comparisons. Postoperative clinical and functional scores were improved by navigated HTO although it is not demonstrated if there is significant improvement compared to conventional HTO. Most common clinical outcome score reported was Lysholm scores (6) which report postoperative scores of 87.8 (standard deviation 5.9) and 88.8 (standard deviation 5.9) for conventional and navigation-assisted HTO, respectively. Radiographic outcomes reported commonly were weight-bearing mechanical axis, coronal plane angle, and posterior tibial slope angle in the sagittal plane. Studies have shown HTO gives significant correction of mechanical alignment and navigated HTO produces significantly less change in posterior tibial slope postoperatively compared to conventional. The mean MINORS for the 17 non-comparative studies was 9/16, and 15/24 for the 14 non-randomized comparative studies. CONCLUSION Navigation HTO results in improved mechanical axis alignment and demonstrates significantly better control over the tibial slope angle change postoperatively compared to conventional methods; however, these improvements have not yet been reflected in clinical outcome scores. Overall the studies report HTO does create significantly improved knee scores and functions compared to patients' preoperative ratings regardless of technique. Future studies on HTO outcomes need to focus on consistency of outcome reporting. LEVEL OF EVIDENCE IV.
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Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 2016; 24:3410-3417. [PMID: 26801783 DOI: 10.1007/s00167-016-3983-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 01/05/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE Medial opening wedge high tibial osteotomy (MOW HTO) is now a successful operation with a range of indications, requiring an individualised approach to the choice of intended correction. This manuscript introduces the concept of surgical accuracy as the absolute deviation of the achieved correction from the intended correction, where small values represent greater accuracy. Surgical accuracy is compared in a randomised controlled trial (RCT) between gap measurement and computer navigation groups. METHODS This was a prospective RCT conducted over 3 years of 120 consecutive patients with varus malalignment and medial compartment osteoarthritis, who underwent MOW HTO. All procedures were planned with digital software. Patients were randomly assigned into gap measurement or computer navigation groups. Coronal plane alignment was judged using the mechanical tibiofemoral angle (mTFA), before and after surgery. Absolute (positive) values were calculated for surgical accuracy in each individual case. RESULTS There was no significant difference in the mean intended correction between groups. The achieved mTFA revealed a small under-correction in both groups. This was attributed to a failure to account for saw blade thickness (gap measurement) and over-compensation for weight bearing (computer navigation). Surgical accuracy was 1.7° ± 1.2° (gap measurement) compared to 2.1° ± 1.4° (computer navigation) without statistical significance. The difference in tibial slope increases of 2.7° ± 3.9° (gap measurement) and 2.1° ± 3.9° (computer navigation) had statistical significance (P < 0.001) but magnitude (0.6°) without clinical relevance. CONCLUSION Surgical accuracy as described here is a new way to judge achieved alignment following knee osteotomy for individual cases. This work is clinically relevant because coronal surgical accuracy was not superior in either group. Therefore, the increased expense and surgical time associated with navigated MOW HTO is not supported, because meticulously conducted gap measurement yields equivalent surgical accuracy. LEVEL OF EVIDENCE I.
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Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T. Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography-Based and Image-Free Navigation System. Arthroscopy 2016; 32:2072-2081. [PMID: 27160461 DOI: 10.1016/j.arthro.2016.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether a combined computed tomography (CT)-based and image-free navigation system results in better coronal and sagittal alignment than the conventional method for performing opening-wedge high tibial osteotomy (OWHTO) and whether CT-based navigation results in acquisition of an accurate osteotomy plane. METHODS Sixty-two consecutive knees were randomly divided into navigated and conventional groups. The intraoperative correction angle was determined by the change in hip-knee-ankle angle in the navigated group and by the predicted medial opening width in the conventional group. Outliers of femorotibial angle (FTA) and tibial posterior slope (TPS) were defined as angles of >175° or <165° and angles of >2.5° or <-2.5°, respectively. Radiographic and clinical data were compared between the 2 groups at 2 years postoperatively. RESULTS Mean postoperative FTAs were 168.5° in the navigated group and 168.1° in the conventional group. Mean change in TPS of -0.2° in the navigated group was significantly lower than that of 1.6° in the conventional group (P = .005). On postoperative CT, mean angle between the tibial plateau and osteotomy planes in the sagittal plane showed a significantly higher anterior opening of 12° in the conventional than in the navigated group (P < .001). There was a significantly greater proportion of TPS outliers in the conventional (51.6%) than in the navigated group (12.9%) (P = .001), and a significantly greater proportion within the normal range in both planes in the navigated (74.2%) than in the conventional group (48.4%) (P = .037). CONCLUSIONS Combined CT-based and image-free navigation in OWHTO better preserves the original TPS and more frequently restores normal coronal and sagittal plane knee joint alignment. CT-based navigation also enabled acquisition of our target osteotomy plane in the sagittal plan. The navigation system in OWHTO was helpful for simultaneous control of the alignment in 2 planes. LEVEL OF EVIDENCE Level II, lesser-quality prospective randomized trial.
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Affiliation(s)
- Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoshihiro Kusayama
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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Wang JH, Shin JM, Kim HH, Kang SH, Lee BH. Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy. INTERNATIONAL ORTHOPAEDICS 2016; 41:85-92. [DOI: 10.1007/s00264-016-3279-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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Holme TJ, Henckel J, Hartshorn K, Cobb JP, Hart AJ. Computed tomography scanogram compared to long leg radiograph for determining axial knee alignment. Acta Orthop 2015; 86:440-3. [PMID: 25582134 PMCID: PMC4513598 DOI: 10.3109/17453674.2014.1003488] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Supine computed tomography scanogram (CTS) is a commonly used alternative to weight bearing long leg plain radiograph (LLR) in measuring knee alignment. No published studies have validated its use in the native knee and the post-unicompartmental replacement knee (UKR). We quantified the difference in measurements obtained from CTS and LLR for knee alignment. PATIENTS AND METHODS Supine CT scanograms and weight bearing long leg plain anteroposterior radiographs were obtained for 40 knees (in 25 patients), 17 of which were native, and 23 of which were post-UKR. The mechanical and anatomical axes of the tibio-femoral joint were measured. Bland-Altman plots were used to calculate the 1.96 standard deviation limits of agreement between CTS and LLR. Intraclass correlation was used to assess intra-rater and inter-rater reliability (where values > 0.81 indicate very good reliability). RESULTS CTS and LLR were equally reliable in measurement of the mechanical and anatomical axes of the tibio-femoral joint (intraclass correlation coefficient (ICC) > 0.9 for all parameters). Statistically significant and clinically relevant differences were found between CTS and LLR in measurement of the mechanical axis (limits of agreement: UKR -3.2° to 6.3°; native -3.2° to 5.6°) and the anatomical axis (limits of agreement: UKR -3.7° to 8.7°; native -2.0° to 8.8°). INTERPRETATION Although it is a reliable tool, CTS is not necessarily an accurate one for measurement of knee alignment when compared to LLR. We recommend that CTS should not be used as a substitute for LLR in measurement of the mechanical or anatomical axes of the knee.
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Affiliation(s)
- Thomas J Holme
- Department of Trauma & Orthopaedics, University College London
| | - Johann Henckel
- Department of Trauma & Orthopaedics, University College London
| | - Kai Hartshorn
- Department of Trauma & Orthopaedics, University College London
| | - Justin P Cobb
- Department of Trauma & Orthopaedics, Imperial College London, UK
| | - Alister J Hart
- Department of Trauma & Orthopaedics, University College London
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Complex Osteotomies of Tibial Plateau Malunions Using Computer-Assisted Planning and Patient-Specific Surgical Guides. J Orthop Trauma 2015; 29:e270-6. [PMID: 25932528 DOI: 10.1097/bot.0000000000000301] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The accurate reduction of tibial plateau malunions can be challenging without guidance. In this work, we report on a novel technique that combines 3-dimensional computer-assisted planning with patient-specific surgical guides for improving reliability and accuracy of complex intraarticular corrective osteotomies. Preoperative planning based on 3-dimensional bone models was performed to simulate fragment mobilization and reduction in 3 cases. Surgical implementation of the preoperative plan using patient-specific cutting and reduction guides was evaluated; benefits and limitations of the approach were identified and discussed. The preliminary results are encouraging and show that complex, intraarticular corrective osteotomies can be accurately performed with this technique. For selective patients with complex malunions around the tibia plateau, this method might be an attractive option, with the potential to facilitate achieving the most accurate correction possible.
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Abstract
Successful outcomes after orthopedic surgical procedures are believed to be highly dependent on reproducible anatomic accuracy. Immediate intraoperative feedback helps surgeons to achieve this accuracy as has been demonstrated with the use of fluoroscopy. Non-image-based computer navigation has been used in joint arthroplasty, anterior cruciate ligament reconstruction, high tibial osteotomy, and cartilage procedures along with applications in hip and shoulder arthroscopy. Most short-term studies have demonstrated superior accuracy when compared with conventional techniques; however, very few studies have shown better clinical outcomes. Robotic-assisted surgery has been most popular in total and unicompartmental arthroplasty, which again has greater accuracy but similar clinical outcomes when compared with conventional techniques. Economic analyses indicate that these high-cost technologies may only be cost-effective in high-volume centers. Other studies have shown that computer navigation improves the accuracy of lower volume surgeons to a greater degree than higher volume surgeons allowing the former to have results similar to the latter.
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