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Zhao Y, Wang H, Zhao B, Diao S, Gao Y, Zhou J, Liu Y. The learning curve for minimally invasive Achilles repair using the "lumbar puncture needle and oval forceps" technique. BMC Musculoskelet Disord 2024; 25:373. [PMID: 38730376 PMCID: PMC11088138 DOI: 10.1186/s12891-024-07489-9] [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: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair. METHODS From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes. RESULTS Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly. CONCLUSION Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.
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Affiliation(s)
- Yanrui Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Hanzhou Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Binzhi Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Shuo Diao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Yuling Gao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
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Yadav AK, Parihar M, Mariani I, Giorgino R, Mangiavini L, Ursino N, D'Ambrosi R. High tibial osteotomy with an external fixator or unicompartmental knee arthroplasty for varus knee in young patients? J Orthop 2022; 34:254-259. [PMID: 36148179 PMCID: PMC9486030 DOI: 10.1016/j.jor.2022.09.006] [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] [Received: 07/28/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study compares the functional results and survivorship of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with an external fixator for medial compartment osteoarthritis (OA) of the knee. Methods Two cohorts of patients aged less than 60 years who had undergone either a cemented medial mobile-bearing UKA or an HTO with an external fixator were included in the study. The first cohort included patients undergoing a series of 197 consecutive medial UKA procedures (UKA group). The second cohort consisted of 60 consecutive patients undergoing HTO with an external fixator (HTO group). Each patient was assessed based on the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Subjective International Knee Documentation Committee (IKDC) score/questionnaire. A clinical evaluation was conducted on the day of the surgery (T0) and at the follow-up visit (T1) (minimum follow-up time was 60 months). Complications and failures resulting from the surgery were recorded for each patient. Results Only the age of the patients at the pre-operative time differed significantly between the two groups, with the HTO group being significantly younger (47.7 ± 8.0 versus 55.8 ± 2.2).After the final follow-up visit, all scores improved in both groups (p < 0.05).IKDC and Oxford scores were higher for the UKA group (p < 0.05). In the HTO group, three complications occurred (5%), including two superficial infections and one deep infection. On the other hand, the UKA group reported four complications (2%): three aseptic mobilisations and one infection requiring revision surgery. There was no difference in the complication rate between the two groups (p = 0.208). Conclusions In young patients (<60 years) with an isolated medial knee OA, both HTO and UKA led to good to excellent clinical results with a low rate of complications at mid-term follow-up; both surgical procedures may be considered in this patient population. Level of evidence Level III.
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Affiliation(s)
- Amit Kumar Yadav
- Sir HN Reliance Foundation Hospital and Research Center, Mumbai, India
| | - Mangal Parihar
- Mangal Ananad Hospital, Swastik Park Chembur East, Mumbai, Maharashtra, India
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Riccardo Giorgino
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | | | - Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
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Larrainzar-Garijo R, Molanes-López EM, Cañones-Martín M, Murillo-Vizuete D, Valencia-Santos N, Garcia-Bogalo R, Corella-Montoya F. Computer-Assisted Surgery Enables Beginner Surgeons, Under Expert Guidance, to Achieve Long-Term Clinical Results not Inferior to Those of a Skilled Surgeon in Knee Arthroplasty. Indian J Orthop 2022; 56:1439-1448. [PMID: 35923307 PMCID: PMC9283583 DOI: 10.1007/s43465-022-00666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to determine whether the use of a surgical navigation system in total knee replacement (TKR) enables beginner and intermediate surgeons to achieve clinical PROM outcomes as good as those conducted by expert surgeons in the long term. METHODS We enrolled 100 consecutive patients whose total navigated knee arthroplasty (TKA) was performed in our institution from 2008 to 2010. According to the principal surgeon's surgical experience, the patients were divided into three groups: (1) beginner surgeons, with no more than 30 previous knee replacement performances, (2) intermediate surgeons, with more than 30 but not more than 300, and (3) expert surgeons, with more than 300 knee replacements. Demographic data collected on the cohort included gender, laterality, age, and body mass index (BMI). The outcome measures assessed were Forgotten Joint Score (FJS), implant positioning, limb alignment, and prosthesis survival rate. A margin of equivalence of ± 18.5 points in the FJS scale was prespecified in terms of the minimal clinically important difference (MCID) to compare the FJS results obtained in the long period between the groups of interest. RESULTS The mean follow-up was 11.10 ± 0.78, 10.86 ± 0.66, and 11.30 ± 0.74 years, respectively, for each of the groups. The long-term FJS mean score was 80.86 ± 21.88, 81.36 ± 23.87, and 90.48 ± 14.65 for each group. The statistical analysis proved noninferiority and equivalence in terms of the FJS results reported in the long term by patients in Groups 1 or 2 compared to those in Group 3. More specifically, it has been proved that the mean difference between groups is within the interval of equivalence defined in terms of the MCID. The overall prostheses survival rate was 93.7%. CONCLUSION Navigated assisted TKA, under expert guidance, can be as effective when performed by beginner or intermediate surgeons as performed by senior surgeons regarding the accuracy of implant positioning, limb alignment, and long-term clinical outcome.
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Affiliation(s)
- Ricardo Larrainzar-Garijo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Elisa M. Molanes-López
- Unidad Departamental de BioestadísticaDepartamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Miguel Cañones-Martín
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - David Murillo-Vizuete
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | | | - Raul Garcia-Bogalo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - Fernando Corella-Montoya
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
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Choe JS, Bin SI, Lee BS, Kim JM, Song JH, Cho HK. Learning Curve For Lateral Meniscal Allograft Transplantation: Preventing Meniscal Extrusion. Arthroscopy 2021; 37:3326-3334. [PMID: 33940123 DOI: 10.1016/j.arthro.2021.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study analyzes the large number of lateral meniscal allograft transplantation (LMAT) procedures conducted by a single surgeon over 23 years to determine whether the absolute amount of graft subluxation and the incidence of extrusion are different at the present time compared to the early MAT era. METHODS We reviewed 320 cases of LMAT performed by a single surgeon between 1996 and 2019. This cohort was chronologically divided into 8 groups (of 40 subjects). The absolute amount of subluxation was measured by the coronal sections of magnetic resonance images taken 1 year after operation. Subluxation by more than 3 mm was considered as extrusion. The graft extrusion learning curve was plotted in each series using the learning curve cumulative summation test (LC-CUSUM). RESULTS Extrusion incidence was 41.6%, and the mean absolute amount of graft subluxation was 3.4 ± 2.2 mm for all subjects. There were significant between-group differences in extrusion incidence and absolute amount of graft subluxation (extrusion incidence, P < .001; absolute amount of graft subluxation, P < .001), and the extension incidence and graft subluxation decreased from Group I (72.5%, 4.6 ± 1.7) to Group VIII (27.5%, 2.5 ± 2.1). LC-CUSUM analysis signaled that the surgeon had achieved predefined acceptable outcomes in avoiding extrusion after 128 cases. CONCLUSION The incidence of extrusion and absolute amount of graft subluxation decreased significantly over a period of 23 years, and the surgeon achieved a certain level of proficiency after 128 cases. LEVEL OF EVIDENCE Level IV, Case series.
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Affiliation(s)
- Jung-Su Choe
- Department of Orthopedic Surgery, Cheju Halla Hospital, Jeju
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Kwon Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Azoti W, Aghazade M, Ollivier M, Bahlouli N, Favreau H, Ehlinger M. Orientation and end zone of the osteotomy cut for high tibial osteotomy: Influence on the risk of lateral hinge fracture. A finite element analysis. Orthop Traumatol Surg Res 2021; 107:103031. [PMID: 34343697 DOI: 10.1016/j.otsr.2021.103031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/22/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION the hinge plays a fundamental role in the support and consolidation of a high tibial osteotomy. The objective of this work was to analyse the influence of the end zone of the osteotomy cut and its orientation in relation to the articular joint line (JL) on the risk of hinge fracture. HYPOTHESIS a specific orientation and end zone of the osteotomy cut can be utilised to decrease the risk of hinge fracture. MATERIAL AND METHOD a finite element (FE) model was used to reproduce the proximal portion of the tibia and the proximal tibiofibular joint with transverse isotropic elastic bone properties. A 1.27mm thick, complete, anteroposterior saw cut was made with a U-shaped saw blade. Five proximal and lateral tibial zones were used according to Nakamura et al corresponding to the end zones of the osteotomy cut. Three angulations of the cut relative to the JL were defined: 10°, 15°, 20°. The tests consisted of simulating 15 possible situations (3 angulations for each of the 5 end zones) on this model. These simulations made it possible to identify the existence of a local stress concentration (von Mises, in MPa) at the level of the hinge, corresponding to the main judgment criterion. RESULTS If we consider only the end zones of the osteotomy cut, regardless of its angulation with respect to the JL, the zone which presents, on average, the lowest local stress concentration is the AM zone (40.3MPa). If we consider only the angulation of the osteotomy cut, with respect to the JL, regardless of the end zone of the cut, the angulation that locally concentrates, on average, the least stress is an angulation at 10° (147.7MPa). Finally, it is important to define the best end zone of the osteotomy cut for each angulation value in relation to the JL: for an angulation of 10°, the end zone must be in AM (38MPa), but also for an angulation of 15° (45MPa), and for an angulation of 20° (38MPa). DISCUSSION-CONCLUSION With the inherent caveats of the experimental conditions, the hypothesis is confirmed. An end zone of the osteotomy cut exists (AM) and an orientation (10°) that induces the lowest local stress concentration and therefore the least likely to induce lateral hinge fracture. However, the orientation of the osteotomy cut is also a matter of surgical habit, especially regarding complementary osteotomy of the tibial tuberosity that some may want to avoid. Thus, it is equally important to know the best end zone associated with a given angulation of the cut in relation to the JL, which according to these results is the AM zone for each angulation. This information helps guide the operator in their surgical practices according to their habits. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Wiyao Azoti
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | | | - Matthieu Ollivier
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital Universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Henri Favreau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Matthieu Ehlinger
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France; Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Savov P, Hold M, Petri M, Horstmann H, von Falck C, Ettinger M. CT based PSI blocks for osteotomies around the knee provide accurate results when intraoperative imaging is used. J Exp Orthop 2021; 8:47. [PMID: 34176009 PMCID: PMC8236017 DOI: 10.1186/s40634-021-00357-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Correction osteotomies around the knee are common methods for the treatment of varus or valgus malalignment of the lower extremity. In recent years, patient specific instrumentation (PSI) guides were introduced in order to enhance the accuracy of these procedures. The purpose of this study was to determine the accuracy of CT based PSI guides for correction osteotomies around the knee of low volume osteotomy surgeons and to evaluate if CT based PSI blocks deliver a high degree of accuracy without using intraoperative fluoroscopy. Methods Two study arms with CT based PSI cutting blocks for osteotomies around the knee were conducted. Part one: A retrospective analysis of 19 osteotomies was made in order to evaluate the accuracy in the hands of a low volume surgeon on long-leg radiographs. Part two: A cadaveric study with 8 knees was performed for the purpose of analyzing the accuracy without using intraoperative fluoroscopy on pre- and postoperative CT scans. Hip-Knee-Ankle angle (HKA), lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were analyzed. The mean absolute delta (∂) between the planned and postoperative parameters were calculated. The accuracy of both study arms were compared. Results Part one: The mean MPTA ∂, LDFA ∂ and HKA ∂ was 0.9°, 1.9° and 1.5°, respectively. Part two: The mean MPTA ∂ and LDFA ∂ was 3.5° and 2.2°, respectively. The mean ∂ of MPTA is significantly different between clinical patients with fluoroscopic control and cadaveric specimens without fluoroscopic control (P < 0.001). All surgeries were performed without complications such as a hinge fracture. Conclusion The clinical use of PSI guides for osteotomies around the knee in the hands of low volume surgeons is a safe procedure. The PSI guides deliver a reliable accuracy under fluoroscopic control whereas their non-use of intraoperative fluoroscopy leads to a lack of accuracy. The use of fluoroscopic control during PSI guided correction osteotomies is highly recommended. Level of evidence IV – Retrospective and experimental Study
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Affiliation(s)
- Peter Savov
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany.
| | - Mara Hold
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany
| | - Maximilian Petri
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany
| | - Hauke Horstmann
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany
| | - Christian von Falck
- Institute for Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Max Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hanover, Germany
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Kim MS, Koh IJ, Sung YG, Park DC, Han SB, In Y. Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy. BMC Musculoskelet Disord 2021; 22:585. [PMID: 34172033 PMCID: PMC8235825 DOI: 10.1186/s12891-021-04475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Methods Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery. Results The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05). Conclusion Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO. Level of evidence Level III.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Bin Han
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of 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, Republic of Korea.
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Verhaeghe C, El Hachem H, Inchboard L, Corroenne R, Dreux C, Jeanneteau P, Legendre G, Descamps P, Saulnier P, May-Panloup P, Bouet PE. Assessment of operator performance during oocyte retrievals: residents' learning curve and continuous monitoring of senior physicians. BMC MEDICAL EDUCATION 2021; 21:193. [PMID: 33823830 PMCID: PMC8025573 DOI: 10.1186/s12909-021-02615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. After acquisition of the skills, the cumulative summation test (CUSUM test) allows to monitor the maintenance of the required level over time. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR. METHODS We performed a retrospective study at Angers university hospital between May 2017 and September 2018. Seven Ob/Gyn residents and 5 senior physicians were included, and all OR performed during that time (n = 690) were analyzed. The performance index assessed was the oocyte retrieval rate (ORR), defined as the ratio of oocytes retrieved to follicles aspirated. We used the LC CUSUM test to analyze the learning curves of residents, and the CUSUM test to monitor the performance of senior physicians. An ORR ≥50% in 60% of retrievals was defined as the threshold for clinical proficiency. RESULTS Six hundred seventy-four oocyte retrieval (OR) were included: 315 were performed by residents, 220 by senior physicians, and 139 by both residents and physicians (mixed retrievals). Four residents (57%) reached the threshold after aspirating 82, 67, 53 and 46 ovaries, respectively. The mean number of ovaries aspirated in order to reach clinical proficiency was 62, and the mean number of weeks needed was 21. The duration of the learning period varied between 26 and 80 days. Two senior physicians (40%) remained proficient across the duration of the study, while two physicians (40%) had one statistically "suboptimal" OR, and one physician (20%) had two suboptimal retrievals. CONCLUSION There is a large variability in the duration of the learning period and the number of procedures needed for a resident to master OR. Senior physicians maintain an adequate performance.
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Affiliation(s)
- C Verhaeghe
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France.
| | - H El Hachem
- Department of Reproductive Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - L Inchboard
- Clinical Research Center, Angers University Hospital, Angers, France
| | - R Corroenne
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - C Dreux
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Jeanneteau
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - G Legendre
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Descamps
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P Saulnier
- Clinical Research Center, Angers University Hospital, Angers, France
| | - P May-Panloup
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
| | - P E Bouet
- Department of Reproductive Medicine, Angers University Hospital, 49000, Angers, France
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Kley K, Bin Abd Razak HR, Khakha RS, Wilson AJ, van Heerwaarden R, Ollivier M. Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy. Arthrosc Tech 2021; 10:e419-e422. [PMID: 33680774 PMCID: PMC7917090 DOI: 10.1016/j.eats.2020.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/17/2020] [Indexed: 02/03/2023] Open
Abstract
Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.
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Affiliation(s)
- Kristian Kley
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Orthoprofis, Hannover, Germany
| | - Hamid Rahmatullah Bin Abd Razak
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Singapore
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Raghbir S. Khakha
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Department of Orthopaedics, Guys & St Thomas’s Hospital, London, United Kingdom
| | - Adrian J. Wilson
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Department of Sports and Exercise, University of Winchester, Winchester, United Kingdom
| | - Ronald van Heerwaarden
- London Osteotomy Centre, Harley Street Specialist Hospital, London, United Kingdom
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, Marseille, France
- Address correspondence to Dr. Matthieu Ollivier, M.D., Ph.D., Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
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10
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Minimally Invasive High Tibial Osteotomy Using a Patient-Specific Cutting Guide. Arthrosc Tech 2021; 10:e431-e435. [PMID: 33680776 PMCID: PMC7917192 DOI: 10.1016/j.eats.2020.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
Medial opening wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. This article presents a technique of performing a minimally invasive OW-HTO using a patient-specific cutting guide (PSCG). Preoperative 3-dimensional planning with computed tomography imaging is essential. The correction parameters, the final plate position, as well as the 3-dimensional position of the hinge as well as wedge are verified preoperatively before the PSCG is produced. After exposure with an oblique incision over the posteromedial tibia, the hamstring tendons are released for later re-attachment and the medial collateral ligament is released slightly. The PSCG is then used to perform the OW-HTO with protection of the posterior neurovascular structures by a retractor placed posterior to the medial collateral ligament. The final fixation of the osteotomy is achieved with a low-profile locking plate and a femoral head allograft wedge.
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Kim MS, Koh IJ, Kim CK, Choi KY, Yang JS, In Y. Patient Expectations and Satisfaction After Medial Opening Wedge High Tibial Osteotomy. J Arthroplasty 2020; 35:3467-3473. [PMID: 32684398 DOI: 10.1016/j.arth.2020.06.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/31/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The objective of this study is to assess preoperative patient expectations of medial opening wedge high tibial osteotomy (MOWHTO) and related postoperative fulfillment, to increase understanding of associated factors of postoperative satisfaction. METHODS One hundred fifteen patients who underwent MOWHTO were enrolled. Patients' expectations were measured using the Hospital for Special Surgery-Knee Replacement Expectations Survey. Fulfillment of expectations and satisfaction was evaluated using the Hospital for Special Surgery Knee Replacement Fulfillment of Expectations Survey and a 5-point Likert scale at 2 years, postoperatively. The discrepancies between preoperative expectation and postoperative fulfillment score were also assessed. Preoperative and postoperative patient-reported outcomes were evaluated using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Univariate and multivariate analyses were performed to model predictions for satisfaction. RESULTS The most expected items were "pain relief," "walking ability," and "perform daily activities." The top 3 items with the biggest discrepancies between expectation and fulfillment scores were "kneeling," "squatting," and "pain relief." Ninety patients (78.3%) were satisfied and 25 (21.7%) were dissatisfied at 2 years postoperative. Multivariate logistic regressions showed that patient expectations did not affect satisfaction. Small discrepancies between expectation and fulfillment scores (odds ratio [OR] 105.304, 95% confidence interval 20.974-528.714, P < .001), high postoperative fulfillment scores (OR 1.198, 95% CI 1.110-1.293, P < .001), and low postoperative Western Ontario and McMaster Universities Arthritis Index total scores (OR 0.932, 95% CI 0.894-0.971, P < .001) were significantly associated with patient satisfaction. CONCLUSION The small discrepancy between preoperative expectations and postoperative fulfillment of expectations was a major contributor to patients' satisfaction following MOWHTO.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Kyu Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Seo Yang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Chung YW, Yang HY, Kang SJ, Song EK, Seon JK. Allogeneic umbilical cord blood-derived mesenchymal stem cells combined with high tibial osteotomy: a retrospective study on safety and early results. INTERNATIONAL ORTHOPAEDICS 2020; 45:481-488. [PMID: 33068146 DOI: 10.1007/s00264-020-04852-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/09/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use. PURPOSE To investigate the short-term outcomes and cartilage regeneration after implantation of allogeneic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in patients who received high tibial osteotomy (HTO) for symptomatic medial knee osteoarthritis. METHODS Patients underwent treatment of full-thickness chondral injury in the osteoarthritic knee with HTO and implantation of hUCB-MSCs and were followed prospectively for a minimum of one year. Ninety-three patients were followed for a mean 1.7 years (range, 1.0-3.5). Median cartilage lesion size was 6.5 cm2 (range, 2.0-12.8). Clinical outcomes were examined with patient-reported scoring instruments that consisted of the International Knee Documentation Committee (IKDC) subjective score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), and Hospital for Special Surgery (HSS) score. Cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) cartilage repair assessment grading (CRA) system and the Koshino regeneration staging system in 49 patients who underwent second look arthroscopic assessment when their HTO plates were removed. RESULTS At final follow-up, the median IKDC subjective score had significantly improved from 39.0 to 71.3; the WOMAC score from 44.5 to 11.0; the KSS pain and function scores from 29.8 to 43.2 and 61.0 to 81.2, respectively; and the HSS from 61.6 to 82.7 (p < 0.05). Pre-operative examination showed ICRS grade IV cartilage injury in all knees, and cartilage regeneration at 2nd look arthroscopy showed improvements (8.2% of patients improved to ICRS grade I, 69.3% to grade II, and 22.5% to grade III). Moreover, Koshino stage was B in 24.5% and C in 75.5% of patients (p < 0.05). CONCLUSION Allogeneic hUCB-MSC implantation combined with HTO for medial knee osteoarthritis was safe and showed signs of cartilage status improvement. Furthermore, randomized controlled studies with a control group are necessary to determine the real effectiveness and indications of this new combined procedure for patients with osteoarthritis.
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Affiliation(s)
- Young-Woo Chung
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Republic of Korea
| | - Hong-Yeol Yang
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, Republic of Korea
| | - Sung-Ju Kang
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, Republic of Korea
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, Republic of Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, Republic of Korea.
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Gulagaci F, Jacquet C, Ehlinger M, Sharma A, Kley K, Wilson A, Parratte S, Ollivier M. A protective hinge wire, intersecting the osteotomy plane, can reduce the occurrence of perioperative hinge fractures in medial opening wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:3173-3182. [PMID: 31773202 DOI: 10.1007/s00167-019-05806-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE A recent study reported that positioning a K-wire to intersect the cutting plane at the theoretical lateral hinge location increases the lateral hinge's resistance to fracture during the opening of opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to evaluate the clinical relevance of the use of this K-wire and its benefits in terms of lateral hinge protection during OWHTO in daily practice. METHODS A retrospective comparative study identified 206 patients who underwent OWHTO from January 2014 to December 2017. Among these patients, 71 had an additional K-wire (HK + group), whereas 135 did not (HK- group). The subjects meeting the inclusion criteria were included in a matched pairing process, which identified 60 patients in the HK + group and 60 patients in the HK- group. Mean follow-up time was 2.3 ± 1.0 years (range 2-4.2). Radiographic outcomes were evaluated with intraoperative and postoperative fluoroscopic imaging and with CT imaging at 6 weeks post OWHTO surgery. The knee osteoarthritis outcomes score (KOOS) was used and time needed to return to work and any kind of sports was collected. RESULTS Thirty six patients (30%) were found to have a LHF. Among these patients, 26 (72%) did not have an additional K-wire positioned at their theoretical lateral hinge location (HK- group) during the procedure. LHF rate for patients without additional K-wire group (HK-) was 43.3%, whereas it was 16.7% for the patients with an additional K-wire (HK +) [Odd ratio 3.8 95% CI 1.6-8.3; p = 0.005]. The mean time to return to work, return to any kind of sports, and bone union was significantly shorter for HK + group (p < 0.05). CONCLUSION This study demonstrated that during OWHTO, positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location reduced the number of intraoperative lateral hinge fractures. LEVEL OF EVIDENCE III retrospective case-control study.
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Affiliation(s)
- Firat Gulagaci
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Christophe Jacquet
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Akash Sharma
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Kristian Kley
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Adrian Wilson
- The Wellington Hospital, Wellington Place, St. John's Wood, London, UK
| | - Sebastien Parratte
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France.,The Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France. .,APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Marseille, France. .,The Institute for Locomotion, Aix-Marseille University, Marseille, France.
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Song SJ, Yoon KH, Park CH. Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction. Am J Sports Med 2020; 48:2718-2725. [PMID: 32762564 DOI: 10.1177/0363546520943872] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO). PURPOSE To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO (P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups. RESULTS No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group (P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367). CONCLUSION Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyoung Ho Yoon
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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15
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Jacquet C, Marret A, Myon R, Ehlinger M, Bahlouli N, Wilson A, Kley K, Rossi JM, Parratte S, Ollivier M. Adding a protective screw improves hinge's axial and torsional stability in High Tibial Osteotomy. Clin Biomech (Bristol, Avon) 2020; 74:96-102. [PMID: 32151903 DOI: 10.1016/j.clinbiomech.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS Despite the use of a locking plate a 30% incidence of lateral hinge fracture after Open-Wedge High Tibial Ostetomy was described in the literature. A finite element model was used to analyze if the presence of a hinge-securing screw in the osteotomy area, using Patient Specific Cutting Guides with a locking plate, decreases the stresses within the lateral hinge during compression and torsion. METHODS A 3D model of a tibial sawbone was used to simulate an opening wedge of 10°. To apply loads on the tibial plateau, two supports were modelled on each tibial plateau to simulate the femoral condyles forces. A two second model with a hinge-stabilizing was defined with two different screws (diameter 2 mm and 4 mm). Two cases of static charges were considered 1) compression test (2500 N) 2) Torsion test (along the tibial mechanical axis). FINDINGS During compression simulation, 17% of the total surface of lateral hinge was stressed between 41-50Mpa without hinge-securing screw while the amount of surface under stress between 41 and 50 MPa dropped significantly under screw stabilization (1% for the 2 mm and 3% for the 4 mm). During torsion stress simulation a decrease of the value of the maximal stress in the lateral hinge was also observed with the addition of a hinge-securing screw (37 MPa without screw, 27Mpa with a 2 mm screw and 25 Mpa with a 4 mm screw). INTERPRETATION Positioning a screw intersecting the cutting plane at the theoretical lateral hinge location associated with a locking plate reduces lateral hinge stress in both compression and torsion. Those findings need to be confirmed by further specimens' mechanical testing.
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Affiliation(s)
- Christophe Jacquet
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Auriane Marret
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Robin Myon
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, CHU Hautepierre, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
| | - Nadia Bahlouli
- Laboratoire ICube, IUT de Haguenau 2 rue Boussingault, FR-67000 Strasbourg, France
| | - Adrian Wilson
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Kristian Kley
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France
| | - Jean-Marie Rossi
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; Centrale Marseille, 13451 Marseille Cedex 20, France
| | - Sebastien Parratte
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
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16
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Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture. Knee Surg Sports Traumatol Arthrosc 2020; 28:751-758. [PMID: 30783689 DOI: 10.1007/s00167-019-05404-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE It was hypothesized in this in-vitro study that positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location would limit the cut depth and help preserve the lateral hinge during the opening of the osteotomy. Objectives were (1) to compare the mechanical resistance of the hinge and the protective effect of leaving the K-wire during the opening procedure (2) to check if the K-wire would limit the depth of the osteotomy. METHODS An ex-vivo mechanical study, testing 5 pairs of fresh-frozen tibias, was designed. CT-scan based Patient-specific cutting guides were obtained to define the cutting plane and the location of the K-wire at the hinge, using standardized 3D planning protocol. In each pair, OWHTO was performed either with or without the K-wire. To evaluate the hinge's resistance to fracture, the specimens were rigidly fixed at the proximal tibia and a direct load was applied on the free tibial diaphysis to open the osteotomy. The maximum load at breakage, maximum permissible displacement and maximal angulation of the osteotomy before hinge failure was measured. To assess the preservation of an unscathed hinge (protected by the K-wire), the distance from the end of the osteotomy cut to the lateral tibial cortical was measured in mm. RESULTS The maximum load to hinge breakage in the K-wires PsCG knees compared to the control group (48.3 N vs 5.5 N, p = 0.004), the maximum permissible displacement (19.8 mm vs 7.5 mm, p = 0.005) and the maximal angulation of the osteotomy before hinge breakage (9.9° vs 2.9°, p = 0.002) were all statistically superior in the K-wires PsCG knees compared to the control group. A mean distance of 10 ± 1 mm between cut-bone (saw-print) and lateral hinge cortical bone was found post-performing the osteotomy and the hinge failing. CONCLUSION The maximum load to breakage and the maximum permissible displacement were, respectively, 880% and 260% higher during the opening of the OWHTO in using K-wires compared to the non-K-wire control group. This confirms the mechanical advantage of using a K-wire for both stabilization and protecting the Hinge during OWHTO. This comparative cadaveric study shows an improvement of the lateral hinges resistance to failing during the opening of the osteotomy. This can be achieved by the placement of a K-wire intersecting the cutting plane at the theoretical location of the lateral hinge.
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Sun M, He R, Guo L, Chen G, Duan X, Zhang Y, Yang L. [Clinical application and research status of open wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:640-643. [PMID: 31090361 PMCID: PMC8337196 DOI: 10.7507/1002-1892.201901014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/06/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research status of open wedge high tibial osteotomy (OWHTO). METHODS Relevant literature at home and abroad was reviewed, and the clinical application, effectiveness and complications, technical comparison, and surgical skills of OWHTO were summarized and analyzed. RESULTS OWHTO is an effective treatment for mild to moderate medial compartment osteoarthritis due to knee varus. This method can delay the injury process of medial compartment of the knee, delay the time of total knee arthroplasty, and even avoid joint replacement surgery by adjusting the axial alignment of the lower extremity to the non-pathological lateral compartment through osteotomy and orthopedic. OWHTO has the advantages of small incision, dynamic adjustment of the axial alignment of the lower extremity, accurate correction of malformation, and rapid postoperative recovery. CONCLUSION With the development of surgical instruments and techniques, OWHTO once again enter the sight of orthopedic surgeons. This technique can solve the pain symptoms of arthritis, correct the tibial varus deformity and reconstruct the axial alignment of the lower extremity, and satisfactory clinical results has been obtained.
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Affiliation(s)
- Maolin Sun
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Rui He
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Lin Guo
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Guangxing Chen
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Xiaojun Duan
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Ying Zhang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Liu Yang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038,
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