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Miltenberg B, Puzzitiello RN, Ruelos VCB, Masood R, Pagani NR, Moverman MA, Menendez ME, Ryan SP, Salzler MJ, Drager J. Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review. Am J Sports Med 2024; 52:258-268. [PMID: 36779579 DOI: 10.1177/03635465221142868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. PURPOSE To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. RESULTS A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). CONCLUSION Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
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Affiliation(s)
| | | | | | - Raisa Masood
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nicholas R Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael A Moverman
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Scott P Ryan
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew J Salzler
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Justin Drager
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Chen J, Li J, Zhang H, Feng W, Ye P, Qi X, Li J, Deng P, Li Y, Huang Y, Zeng J, Zeng Y. Bone Healing and Clinical Outcome Following Medial Opening-wedge High Tibial Osteotomy Using Wedge-Shaped Cancellous Allograft. Orthop Surg 2024; 16:86-93. [PMID: 38014470 PMCID: PMC10782265 DOI: 10.1111/os.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge-shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. METHODS All patients who underwent MOWHTO using a novel wedge-shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre-operative and post-operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow-up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow-up. A paired student's t test was conducted for comparison of differences of the relevant data pre-operatively and post-operatively. RESULTS A total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from -6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above-mentioned parameters at last follow-up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow-up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS-Knee score and KSS-Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow-up, respectively. Nevertheless, there was no significant difference in ROM between pre-operation and last follow-up (p > 0.05). CONCLUSION For MOWHTO, the wedge-shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.
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Affiliation(s)
- Jinlun Chen
- The First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jiahao Li
- Department of OrthopaedicsPanyu Hospital of Chinese MedicineGuangzhouChina
| | - Haitao Zhang
- Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Wenjun Feng
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Pengcheng Ye
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xinyu Qi
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jie Li
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Peng Deng
- Department of OrthopaedicsGuangdong Second Traditional Chinese Medicine HospitalGuangzhouChina
| | - Yijin Li
- The First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Yiwei Huang
- The First Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Jianchun Zeng
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yirong Zeng
- Department of OrthopaedicsThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
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Sakai M, Akasaki Y, Akiyama T, Horikawa T, Okazaki K, Hamai S, Tsushima H, Kawahara S, Kurakazu I, Kubota K, Mizu-Uchi H, Nakashima Y. Similar short-term KOOS between open-wedge high tibial osteotomy and total knee arthroplasty in patients over age 60: A propensity score-matched cohort study. Mod Rheumatol 2023; 33:623-628. [PMID: 35652607 DOI: 10.1093/mr/roac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/28/2022] [Accepted: 05/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade. METHODS Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups. RESULTS After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA groups. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score. CONCLUSIONS In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.
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Affiliation(s)
- Mamiko Sakai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Tomohiro Horikawa
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Kumamoto Saishun Medical Center, Koshi, Kumamoto, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Ichiro Kurakazu
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Kenji Kubota
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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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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van Haeringen MH, Kuijer PPFM, Daams JG, van Geenen RCI, Brinkman JM, Kerkhoffs GMMJ, van Heerwaarden RJ, Hoorntje A. Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07229-3. [PMID: 36473985 DOI: 10.1007/s00167-022-07229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to establish the gold standard for surgical technique, fixation, and rehabilitation for HTO in patients with unicompartmental knee osteoarthritis. METHODS Medline, Embase, and SPORTDiscus databases were searched up to April 2022. Included were (1) randomized controlled trials (RCTs) comparing opening-wedge HTO (owHTO) and closing-wedge HTO (cwHTO), (2) biomechanical studies and prospective patient studies comparing biomechanical and clinical results for plate fixators, and (3) RCTs comparing an early versus delayed full-weight-bearing (FWB) protocol. RESULTS The pooled results for the surgical technique showed no significant differences between owHTO and cwHTO for most PROMs on pain, activity, and risk for conversion to TKA. The cwHTO group showed a slightly better improvement in KOOS/WOMAC pain scores (4.51; 95% CI 1.18-7.85), and a significantly lower change in posterior tibial slope (p = 0.03). The pooled results for the fixation method showed the highest force at maximum failure for the Activmotion (Newclip Technics, France), Aescula (B. Braun Korea, Korea), 2nd generation Puddu (Arthrex Inc., USA), and TomoFix plate (Depuy Synthes, Switzerland). The pooled results for the rehabilitation protocol showed no significant differences between the early full-weight-bearing (FWB) group and the delayed FWB group for functional scores, complication rates, and delayed unions. CONCLUSION Both owHTO and cwHTO reduced pain and improved knee function. Locking plate fixation should be used for owHTO. An early FWB protocol has proven to be safe in patients with small corrections, no hinge fractures, and non-smokers. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- M H van Haeringen
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, The Netherlands
| | - J M Brinkman
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - A Hoorntje
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Suh DW, Nha KW, Han SB, Cheong K, Kyung BS. Biplane Medial Opening-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope more than Uniplane Osteotomy. J Knee Surg 2022; 35:1229-1235. [PMID: 33618401 DOI: 10.1055/s-0040-1722659] [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] [Indexed: 02/07/2023]
Abstract
Few clinical studies have compared uniplane high tibial osteotomy (HTO) with biplane HTO. The study aim was to compare the radiological and clinical results of uniplane HTO and biplane HTO, especially in terms of the increase in the posterior tibial slope (PTS). Medial opening-wedge HTO patients' medical records and radiological results from a single institution were retrospectively reviewed. Pre- and postoperative serial radiographs, including the Rosenberg, lateral view, and standing anteroposterior view of the whole lower extremity, magnetic resonance imaging at postoperative day 2, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at postoperative 2 years were reviewed to evaluate radiological and clinical results, including the change in PTS. A total of 61 knees, including 34 for uniplane and 27 for biplane HTOs, were enrolled. There were no significant differences in the pre- and postoperative mechanical angles or incidences of the lateral hinge fractures, and all patients showed complete union at postoperative 2 years. The PTS was increased more in the biplane group than in the uniplane group (3.1 ± 2.6 in biplane vs. 0.8 ± 1.7 in uniplane, p < 0.05). The WOMAC scores were 72 ± 9.3 in the uniplane and 75 ± 5.8 in the biplane group (not significant). The increase in PTS was lower in uniplane medial opening HTO than in biplane HTO.
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Affiliation(s)
- Dong Won Suh
- Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Kyung Wook Nha
- Department of Orthopaedic Surgery, Ilsanpaik Hospital, Inje University, Ilsan, Gyeonggi-do, Korea
| | - Seung Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kuhoang Cheong
- Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Bong Soo Kyung
- Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, Korea
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The benefits of a percutaneous supplemental screw to reinforce the hinge of a medial open wedge tibial osteotomy. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04573-4. [PMID: 35941314 DOI: 10.1007/s00402-022-04573-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/31/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Our earlier studies reported that an additional lag screw placed from the opposite side increases the stability of the fixation construct in medial open wedge high tibia osteotomy (MOWHTO). The aim of the study was to evaluate the clinical relevance of the use of a supplemental screw with immediate post-operative full weight-bearing and its benefits in terms of functional outcome, radiographic outcome and complications. MATERIALS AND METHODS A retrospective study was performed comparing the historical cohort (MOWHTO without opposite screw) (group A) with the current cohort (MOWHTO with opposite screw) (group B). The patients underwent clinical and radiological assessments. We evaluated the WOMAC (The Western Ontario and McMaster Universities) score, IKDC (International Knee Documentation Committee) scores, and Lysholm knee score. Patients' return to sports and work were also recorded. RESULTS We included 123 knees receiving MOWHTO alone (group A) with 114 knees (group B) receiving MOWHTO with an opposite screw. A shorter bone union time (18.3 ± 2.1 weeks v.s. 11.5 ± 2.6 weeks, p < 0.001), earlier return to sports (6.1 months vs. 4.6 months, p < 0.001) and return to works (3.2 months vs. 2.3 months, p < 0.001) and better 6-month functional outcomes were found in group B (p < 0.001). The complications were similar in both groups. One patient experienced irritation at the site of the screw entrance and the screw was removed after union. CONCLUSION The current study evaluated the clinical efficacy of a supplemental lag screw placed from the opposite side in MOWHTO. Comparing to the plate alone, the additional opposite screw improved the implant and fixation stability under immediate weight-bearing without causing complications. A shorter time for returning to sports and work was noted, and a better functional outcome at 6-month follow-up was registered.
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Ma XL, Hu YC, Wang KZ. Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy. Orthop Surg 2022; 14:789-806. [PMID: 35509153 PMCID: PMC9087466 DOI: 10.1111/os.13281] [Citation(s) in RCA: 5] [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: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1–5 are indications and contraindications for PKO for lower extremity alignment correction, items 6–21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23–25 address the perioperative period, follow‐up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction.
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Affiliation(s)
- Xin-Long Ma
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Kun-Zheng Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Shaanxi, China
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Kim MA, Lee KJ, An KO. Effects of 24 Weeks Combined Rehabilitation Exercise Program on Functional Recovery in Obsess High Tibial Osteotomy Patients. THE ASIAN JOURNAL OF KINESIOLOGY 2022. [DOI: 10.15758/ajk.2022.24.2.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to investigate the effects of a 24 weeks combined rehabilitation exercise program on the subjective questionnaire, isokinetic muscle function test and dynamic balance test of high tibial osteotomy patients with normal weights and obese individuals.METHODS Sixteen tibial osteotomy patients were recruited in the study. They were divided into two groups(normal weight group[n=8] or obesity weight group[n=8]). A pre-test consisting of subjective questionnaire, isokinetic muscle function test and Y balance test. Using the same test in 12 weeks, 24 weeks after the surgery. All groups completed the rehabilitation exercise program for the duration of 24 weeks.RESULTS The significant interaction was observed between group and time on the involve bilateral flexor strength deficits (<i>p</i>=.045) and the posteromedial reach distance (<i>p</i>=.041).CONCLUSIONS These results suggest that a 24 weeks rehabilitation exercise program is needed after high tibial osteotomy in order to restore the same level of activity as before surgery.
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Systematic review of tendon transfers in the foot and ankle using interference screw fixation: Outcomes and safety of early versus standard postoperative rehabilitation. Foot Ankle Surg 2022; 28:166-175. [PMID: 33766498 DOI: 10.1016/j.fas.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/31/2020] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
AIMS To compare the outcomes of early and standard rehabilitation protocols following tendon transfers in the foot and ankle using interference screw fixation (ISF). METHODS A systematic review was performed for relevant articles (1998 to 2020) reporting foot tendon transfer using ISF in adults. The primary outcome was early tendon failure. Secondary outcomes included function and complications. RESULTS In total, 21 studies met the inclusion criteria, totalling 494 patients. Seven studies reported early rehabilitation protocols. The rate of early tendon failure was zero for each protocol and studies consistently reported a significant improvement in function. No differences were found comparing different rehabilitation protocols for tendon transfer for Achilles tendon pathology and foot drop. CONCLUSION Both early and standard rehabilitation protocols are associated with high patient satisfaction and low complication rates, but currently there is a lack of evidence to support early loaded activities or motion. LEVEL OF EVIDENCE IV Systematic review including case series.
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Song M, Li S, Yang S, Dong Q, Lu M. Is Early or Delayed Weightbearing the Better Choice After Microfracture for Osteochondral Lesions of the Talus? A Meta-analysis and Systematic Review. J Foot Ankle Surg 2021; 60:1232-1240. [PMID: 34215515 DOI: 10.1053/j.jfas.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
Osteochondral lesions of the talus (OLT) are common injuries requiring surgery. Arthroscopic microfracture treatment is effective and acceptable. Although the concept of postoperative rehabilitation is continuously being updated, the choice between early weightbearing (EWB) versus delayed weightbearing (DWB) following microfracture is still not settled. A meta-analysis and systematic review was performed to compare the rehabilitation effect of 2 different weightbearing protocols following microfracture. Five databases were searched for relevant studies, and full-text articles comparing EWB and DWB were reviewed. Review Manager 5.3 software was used to summarize the results of the included studies. Two reviewers independently filtered the studies, assessed quality, extracted data, and estimated the risk of bias. The pain score and functional assessment of the ankle were selected as the endpoints. The mean difference was calculated as the summary statistic for continuous data. Then, visual analog scale and American Orthopedic Foot and Ankle Society scale scores were collected and pooled. Five randomized controlled trials including 283 patients were identified for this study, revealing that there was no significant difference in pain scores between EWB and DWB following microfracture 3 months, 6 months, 12 months, and 24 months postoperatively. Function assessment showed similar results. Comprehensive analysis of current evidence still suggests that EWB and DWB after microfracture of OLT produce comparable clinical outcomes in terms of pain and functional activity. Therefore, EWB is recommended to shorten the length of time before returning to work or sports after microfracture of OLT.
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Affiliation(s)
- Mingzhi Song
- Surgeon-in-Charge, Department of Orthopaedics, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China; Department of Orthopaedics, the Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Shipeng Li
- Physician-in-Charge, Department of Medical Insurance, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China; Department of Medical Insurance, the Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Simengge Yang
- Department of Orthopaedics, the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Quanyu Dong
- Surgeon-in-Charge, Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China.
| | - Ming Lu
- Chief Physician, Department of Orthopaedics, Dalian Municipal Central Hospital, Dalian, Liaoning, People's Republic of China.
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High Tibial Osteotomy for Varus Deformity of the Knee. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202107000-00006. [PMID: 34242204 PMCID: PMC8274793 DOI: 10.5435/jaaosglobal-d-21-00141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 01/13/2023]
Abstract
High tibial osteotomy is a powerful technique to treat symptomatic varus deformity of the knee and is successful when properly indicated and performed. Indications include varus deformity with medial compartment osteoarthritis, cartilage or meniscus pathology. Several techniques exist to correct symptomatic varus malalignment along with concomitant procedures to restore cartilage or meniscus injuries. Evidence supporting high tibial osteotomy for symptomatic medial compartment pathology exists, which provides a durable solution for joint preservation. This review will discuss the indications, techniques, and outcomes for high tibial osteotomies used in the treatment of symptomatic varus deformity of the knee.
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Neirynck J, van Beek N, Claes T, Claes S, Bartholomeeusen S. Simultaneous bilateral opening-wedge high tibial osteotomy with structural allograft impaction results in excellent early recovery and pain reduction similar unilateral osteotomy. Knee 2021; 30:283-290. [PMID: 33984747 DOI: 10.1016/j.knee.2021.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients suffering from bilateral combined medial osteoarthritis and varus alignment of the knee are eligible for bilateral high tibial osteotomy (HTO) in two-staged surgery. The impact of bilateral HTO surgery on rehabilitation and early outcomes have not yet been reported in the literature, even though these features are decisive in establishing whether a patient is preferably treated in one or two stages. METHODS A total of 29 patients were followed after simultaneous bilateral HTO surgery. Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS) and Lysholm scores were recorded at 3, 6 and 12 months. Results were compared with outcomes of unilateral HTO surgery to asses the additional impact of simultaneous bilateral HTO surgery on the early rehabilitation and recovery of simultaneous bilateral HTO surgery. RESULTS Three months after surgery, NRS pain scores decreased from 60.5 to 40.9 and subsequently to 30.4 and 24.3 after 6 and 12 months, respectively. KOOS-PS scores improved from 50.0 to 44.3 after 3 months, to 33.9 and 29.8 after 6 and 12 months, respectively. Lysholm scores did not improve after 3 months (45.2-44.2), but significantly improved after 6 and 12 months (66.1 and 75.7, respectively). Compared with unilateral HTO surgery, similar improvements were seen after 6 and 12 months. CONCLUSION Simultaneous bilateral HTO surgery generates similar clinical outcomes compared with unilateral HTO surgery and moreover it does not excessively prolong time to achieve these outcomes. It is safe and presumably a more effective approach to treat patients suffering bilateral medial osteoarthritis and varus alignment of the knee compared with two-staged surgery.
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Affiliation(s)
- J Neirynck
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - N van Beek
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - T Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - S Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - S Bartholomeeusen
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.
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Park HJ, Kang SB, Chang MJ, Chang CB, Jung WH, Jin H. Association of Gap Healing With Angle of Correction After Opening-Wedge High Tibial Osteotomy Without Bone Grafting. Orthop J Sports Med 2021; 9:23259671211002289. [PMID: 34026915 PMCID: PMC8120544 DOI: 10.1177/23259671211002289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Studies have reported that opening wedge high tibial osteotomy (OWHTO) without bone grafting has outcomes that are similar to or even better than those of OWHTO with bone grafting, especially after use of a locking plate. However, a consensus on managing the gap after OWHTO has not been established. Purpose: To determine the degree of gap healing achieved without bone grafting, the factors associated with gap healing, and whether additional gap healing would be obtained after plate removal. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 73 patients who underwent OWHTO without bone grafting between 2015 and 2018. Patients in the study were divided into 2 groups based on the correction angle: small correction group (<10°; SC group) and large correction group (≥10°; LC group). The locking plate used in OWHTO was removed at a mean of 13.5 months after surgery in 65 patients. Radiographic indexes were measured: gap filling height, gap vacancy ratio (GVR), and osteotomy filling index. The acceptable gap healing was defined as an osteotomy filling index ≥3. The factors related to gap healing around the osteotomy site were selected after multicollinearity analysis. Results: Although both groups achieved acceptable gap healing regardless of the correction angle, the SC group showed higher and earlier gap healing than did the LC group (gap healing rate 81.4% in the SC group vs 41.7% in the LC group at 3 months postoperatively). The GVR was 8.6% in the SC group and 15.3% in the LC group at 12 months after surgery (P = .005). Both the amount of time that elapsed after surgery and the correction angle were associated with gap healing (P < .05). Additional gap healing was observed after plate removal, as the GVR decreased 2.7% more in the patients with plate removal than in patients who did not have plate removal (P = .012). Conclusion: All patients achieved acceptable gap healing without bone graft. The degree of gap healing was higher in the SC group and increased over time. Gap healing was promoted after plate removal. Considering the results of this study, a bone graft is not necessary in routine OWHTO in terms of gap healing.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woon Hwa Jung
- Department of Orthopedic Surgery, Murup Hospital, Gyeongnam, Republic of Korea
| | - Heejin Jin
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Kanto R, Nakayama H, Iseki T, Onishi S, Ukon R, Kanto M, Kambara S, Yoshiya S, Tachibana T. Return to sports rate after opening wedge high tibial osteotomy in athletes. Knee Surg Sports Traumatol Arthrosc 2021; 29:381-388. [PMID: 32248273 DOI: 10.1007/s00167-020-05967-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 03/24/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE We hypothesized that patient treated with OWHTO who participate in high-impact sports would attain satisfactory outcome. The purpose of this study was to examine the clinical and radiological outcomes in a consecutive series of opening-wedge high tibial osteotomy (OWHTO) in highly active patients. METHODS Seventy-seven consecutive patients who underwent OWHTO with varus osteoarthritic knees were included in the study. The mean age of the study population was 56.1 years. All patients were followed for a minimum of 2 years. Clinical and radiological evaluations were performed at 12 and 24 months after surgery. The clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) Subjective Score. In regards to radiological assessment, the following parameters were measured in full-length weightbearing radiographs both pre- and postoperatively; mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), and weight bearing line (WBL) ratio. RESULTS Fifty-eight patients (75.3%) returned to the same high-impact sports activities as before surgery, with a mean time to return of 8.7 ± 2.7 months (6-14 months). In the clinical assessments, the IKDC subjective score and KOOS both improved from the mean preoperative scores of 38.4 and 217.4 points to the mean postoperative scores of 74.5 and 421.6 points, respectively. The mean pre-symptomatic Tegner activity scale was 5.3 ± 0.6 and significantly decreased to 4.8 ± 1.2 at 2 years postoperative (p < 0.05). In the radiological evaluation, the postoperative mTFA, mMPTA, and WBL ratio values averaged 1.3° ± 2.2° valgus, 90.7° ± 2.9°, and 51.6% ± 8.4°, respectively, at 24 months after surgery. CONCLUSIONS Clinical outcomes based on postoperative patient-reported outcome measures and rate of return to high-impact sports activities were favorable after OWHTO in patients with knee OA who desired to continue sporting activities with the Tegner activity score of ≥ 5 points. LEVEL OF EVIDENCE Retrospective case series, IV.
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Affiliation(s)
- Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ryosuke Ukon
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Makoto Kanto
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Japan
| | - Shunichiro Kambara
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Abstract
Osteoarthritis of the medial compartment, where the lateral compartment and patella-femoral joint are relatively spared, is a common orthopaedic presentation. Most frequently, the treatment of choice would be a total knee replacement, which involves removing healthy joint surfaces in such patients. Arthroscopic debridement in the osteoarthritic knee has fallen out of favour due to poor clinical results. A trend has developed towards less invasive surgery with uni-compartmental knee replacement (UKR) and high tibial osteotomy (HTO) gaining increasing popularity. Surgeons differ in their relative indications and contraindications to performing these procedures. Total knee replacement (TKR) continues to have the lowest overall revision rate of the available options. Growing evidence demonstrates more favourable patient-reported outcome measures in UKR and HTO patients, compared to TKR. Knee joint distraction (KJD) has been demonstrated as an alternative method of treatment in such patients.
Cite this article: EFORT Open Rev 2021;6:113-117. DOI: 10.1302/2058-5241.6.200102
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Affiliation(s)
- Daniel J McCormack
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Darren Puttock
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Steven P Godsiff
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Van Genechten W, Van den Bempt M, Van Tilborg W, Bartholomeeusen S, Van Den Bogaert G, Claes T, Claes S. Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up. Knee Surg Sports Traumatol Arthrosc 2020; 28:3747-3757. [PMID: 31713662 DOI: 10.1007/s00167-019-05765-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Painful and slow recovery are the presumed disadvantages after opening-wedge high tibial osteotomy (HTO) and play a role in favouring arthroplasty as treatment for moderate isolated medial knee arthritis. The primary study objective was to investigate the effect of press-fit structural impacted bone allograft with locking plate fixation on early ambulation, postoperative pain levels, and resumption of daily-life activities in opening-wedge HTO. METHODS A prospective consecutive opening-wedge HTO case series was conducted, including 103 patients with final follow-up at 1 year. Weight-bearing was allowed from the day after surgery "as tolerated" by the patient. Clinical assessment included the Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Additionally, the Knee Society Score (KSS) was assessed during consultation at 1, 3, and 12 months postoperatively with special attention for clinical anchor questions. Required sample size was calculated and a linear mixed-effect model was used for repeated measures over time of the clinical scores. RESULTS The NRS decreased by 1.5 at 1 month (p < 0.01) and 2.1 at 3 months (p < 0.01), while KOOS pain significantly improved with 19.2 (p < 0.01) by this time compared to baseline. Under reduced pain levels, 98% were able to walk > 500 m without support, while all patients were able to climb up and down the stairs 3 months postoperatively. CONCLUSION The study strongly supports the initial hypothesis that applying structural triangular bone allograft in HTO leads to low postoperative pain levels, early ambulation, and excellent short-term clinical outcomes. Study results have the potential to alter the general perception about HTO being a painful procedure with painstakingly slow recovery and consequently encourage the consideration of HTO as a highly valuable joint-preserving option, while treating unicompartmental knee arthritis. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
| | | | | | | | | | - Toon Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - Steven Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.,Department of Orthopaedic Surgery, Leuven University Hospital, Leuven University, Leuven, Belgium
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Tardy N, Steltzlen C, Bouguennec N, Cartier JL, Mertl P, Batailler C, Hanouz JL, Rochcongar G, Fayard JM. Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy? Orthop Traumatol Surg Res 2020; 106:S231-S236. [PMID: 32943382 DOI: 10.1016/j.otsr.2020.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Preoperative planning in high tibial osteotomy (HTO) is a critical step for achieving the desired correction and a clinically satisfactory outcome. Conventional radiography, navigation assistance and patient-specific instrumentation (PSI) are the 3 means of planning, but no prospective studies have compared precision between the 3. The aims of the present study were: (1) to analyze and compare correction precision between the 3 planning approaches at 1 year's follow-up; (2) to compare results to those reported in the literature; and (3) to analyze factors influencing the achievement of planned correction. HYPOTHESIS The study hypothesis was that PSI provides more precise and reproducible planned correction than conventional methods or navigation. MATERIAL AND METHOD Between June 2017 and June 2018, a multicenter non-randomized prospective observational study was conducted in 11 centers. One hundred and twenty-six patients with Ahlbäck grade I, II or III idiopathic medial tibiofemoral osteoarthritis with stable knee were included and allocated to 3 preoperative planning groups: conventional (group 1), navigation (group 2) and PSI (group 3). Mean age at surgery was 51.2 years (range, 19-69 years; median, 53.2 years); 100 male, 26 female. Complete weight-bearing radiographic work-up was performed preoperatively and at 1 year's follow-up. The PSI group also underwent CT as part of guide production. Target angular correction and mechanical Hip-Knee-Ankle (HKA) axis were set preoperatively. The main endpoint was the difference between planned HKA and HKA at a minimum 12 months. RESULTS Mean HKA difference was 1.1±3 in group 1, 2.1±2.6 in group 2 and 0.3±3.1 in group 3. Precision was better with PSI, but not significantly when comparing all 3 groups together. On pairwise intergroup comparison, there was a significant difference only between groups 2 and 3, in favor of PSI (P=0.011). DISCUSSION None of the 3 techniques demonstrated superiority in achieving target correction at 1 year. The study hypothesis was thus not confirmed. All 3 techniques proved reliable and precise in HTO planning. LEVEL OF EVIDENCE III, prospective non-randomized comparative study.
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Affiliation(s)
- Nicolas Tardy
- Centre Ostéo-Articulaire des Cèdres, Clinique des Cèdres, 5, rue des Tropiques, 38130 Echirolles, France.
| | - Camille Steltzlen
- Service de Chirurgie Orthopédique, Hôpital Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges-Nègrevergne, 33700 Mérignac, France
| | - Jean-Loup Cartier
- Clinique Des Alpes Du Sud, 3, rue Antonin Coronat, 05000 Gap, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique, CHU Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France
| | - Cécile Batailler
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, 103, grande rue de la Croix Rousse, 69317 cedex 04 Lyon, France
| | - Jean-Luc Hanouz
- Service d'Anesthésie Réanimation, CHU de Caen, avenue Côte De Nacre, 14033 Caen, France
| | - Goulven Rochcongar
- Département de Chirurgie Orthopédique et Traumatologique, Niveau 11, Inserm U1075 COMETE "Mobilité: Attention, Orientation & Chronobiologie", Université de Caen, Basse-Normandie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Jean-Marie Fayard
- Ramsay Générale de Santé, Hôpital Privé Jean-Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
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- 15 rue Ampère, 92500 Rueil Malmaison, France
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Simple Medial Meniscus Posterior Horn Root Repair Using an All-Inside Meniscal Repair Device Combined with High Tibial Osteotomy to Maintain Joint-Space Width in a Patient with a Repairable Tear. Indian J Orthop 2020; 55:397-404. [PMID: 33927818 PMCID: PMC8046862 DOI: 10.1007/s43465-020-00234-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare the radiological and clinical outcomes using simple medial meniscus posterior horn (MMPH) root repair using an all-inside meniscal repair device combined with high tibial osteotomy (HTO) and HTO alone. METHODS Between November 2013 and December 2016, patients treated for MMPH root tear along with HTO were enrolled. Based on the tear gap, the participants were divided into repairable (< 2 mm) and unrepairable (> 2 mm) categories. The participants in each group were divided into those amenable to simple MMPH root repair using an all-inside meniscal repair device and those that required no procedure for meniscus. Radiological parameters including mechanical femorotibial alignment (MA), posterior tibial slope (PTS) and medial joint-space width (JSW) were evaluated preoperatively and postoperatively at 2 years. For clinical evaluation, the WOMAC score was determined at the 2-year visit postoperatively. RESULTS A total of 81 knees including 48 repairable (group R) and 33 unrepairable (group I) knees were enrolled. A total of 43 knees underwent simple MMPH root repair using an all-inside meniscal repair device (subgroup r), whereas the other 38 knees did not (subgroup n). The MA, PTS, and their postoperative changes as well as the WOMAC scores showed no differences. However, the JSW in group Rr increased from 3.1 to 3.6 mm, but decreased from 3.7 to 3.4 in group Rn, which was a statistically significant difference. CONCLUSION Simple MMPH root repair using an all-inside meniscal repair device combined with HTO was more effective for the maintenance of JSW compared with HTO without a meniscal procedure in patients with repairable MMPH root tear and varus alignment. However, other options are needed for unrepairable MMPH root tear.
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Jonker L, Fallahi F, Saraswathy JJ, Edge J, Dawson M. OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method. J Orthop Surg (Hong Kong) 2020; 27:2309499019864721. [PMID: 31379259 DOI: 10.1177/2309499019864721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The objective was to evaluate the clinical and patient-related short- to medium-term performance of the OPTY-LINE nail device for high tibial osteotomy (HTO), comparing a case series of the said device to the established Tomofix fixed-plate device. PATIENTS AND METHODS Males with symptomatic medial compartmental osteoarthritis and no serious (co-morbid) knee pathology were followed up, five Tomofix and six OPTY-LINE patients. Patients underwent computed tomography assessment and completed Knee Injury and Osteoarthritis Outcome score (KOOS) and osteotomy surgery patient satisfaction questionnaires, 3 and 6 months post-surgery. A radiologist impression score and a quantitative digital bone density analysis were performed by two independent radiologists. Mann-Whitney U test was applied for inferential statistical tests. RESULTS At 6 months post-surgery, for Tomofix, the median radiologists' healing impression score was 'progressive healing' versus 'union virtually complete' for the OPTY-LINE nail; bone healing quotient was 1.30 (standard deviation (SD) 1.74) versus 1.78 (SD 1.58), p = 0.18. The post-operative absolute surgical accuracy was a mean 12 (7.5) for Tomofix versus 4.1 (2.3) for OPTY-LINE, p = 0.052. At baseline, however, Tomofix patients had more knee symptoms, as determined by KOOS symptom sub-score, when compared to the OPTY-LINE cohort (p = 0.009). CONCLUSION This initial, non-randomized, comparative evaluation of the OPTY-LINE device for HTO has produced similar outcomes to patients treated with the established Tomofix device. In particular, the rate of post-surgical bone regeneration and surgical accuracy achieved with the OPTY-LINE device are encouraging. Large-scale randomized controlled studies with longer follow-up are indicated to further evaluate the clinical and patient-related outcome performance for OPTY-LINE.
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Affiliation(s)
- Leon Jonker
- 1 Cumbria Partnership NHS Foundation Trust, Research & Development Department, Carlisle, UK
| | - Farshid Fallahi
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
| | - Jayadeep J Saraswathy
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
| | - John Edge
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
| | - Matt Dawson
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
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Petersen W, Bierke S, Häner M. Kniegelenknahe Osteotomie bei unikompartimenteller Gonarthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tian X, Han C, Wang J, Tan Y, Zhu G, Lei M, Ma S, Hu Y, Li S, Chen H, Huang Y. Distal tibial tuberosity high tibial osteotomy using an image enhancement technique for orthopedic scans in the treatment of medial compartment knee osteoarthritis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105349. [PMID: 32146210 DOI: 10.1016/j.cmpb.2020.105349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To observe the efficacy of distal tibial tuberosity high tibial osteotomy in treating medial compartment osteoarthritis of the knee. In the experiment, a medical image enhancement algorithm based on shear wave domain improved Gamma correction was implemented to process medical images in order to diagnose patients more effectively. METHODS Sixty-five patients (13 males and 52 females) were included in the study who were treated with distal tibial tuberosity high tibial osteotomy, and the mean age of the patients was 63±6 years (range 49-73). All patients received X-Ray and MRI before surgery. We carefully studied and analyzed the findings, MRI findings and medical characteristics after using the shearlet domain to improve the Gamma correction method in order to enhance diagnostic accuracy. The improved image help us to judge the damage of the medial and lateral compartment more accurately. Weight bearing line (WBL) and femora-tibial Angle (FTA) were measured to evaluate the lower limb alignment before and 12 months after surgery. Visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, the Westrn Ontario and Mcmaster Universities (WOMAC) scores were recorded to evaluate knee pain and function before surgery, 3 months and 6 months after surgery. RESULTS The X-Ray and MRI scans of the patients were analyzed. After the shear wave shearlet domain is implemented, the image effect is significantly improved. 12 months after surgery, WBL was improved from 16.34±2.18% to 60.32±2.89% (p<0.05), FTA was improved from 171.17±1.87° to 179.83±2.14° (p<0.05). At 3 months and 12 months after surgery, VAS, HSS and WOMAC scores were significantly improved compared with baseline (p<0.05). CONCLUSION Distal tibial tuberosity high tibial osteotomy is able to correct varus deformity, relieve knee pain and the functional dysfunction, indicating which had a significant short-term efficacy. The shear wave shearlet domain incorporates the Gamma correction method to effectively preserve the image details, which to achieve a more accurate diagnosis, and help us to judge the damage of the medial and lateral compartment more accurately.
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Affiliation(s)
- Xiangdong Tian
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China.
| | - Changxiao Han
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
| | - Jian Wang
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Yetong Tan
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Guangyu Zhu
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Ming Lei
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Sheng Ma
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Yuanyi Hu
- Minimal Invasive Joint Department, The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguan Street, Chaoyang District, Beijing, 100029, China
| | - Shuwen Li
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
| | - Handong Chen
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
| | - Ye Huang
- Graduate school of Beijing University of Chinese Medicine, Beijing, China
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Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture. Knee Surg Sports Traumatol Arthrosc 2020; 28:1436-1444. [PMID: 31069445 DOI: 10.1007/s00167-019-05522-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE With surgical modifications reflecting plate design differences of the specific rigid locking plate adding a metal wedge, uniplane high tibial osteotomy (HTO) has fewer lateral-hinge fractures and fewer plate irritations than biplane HTO. METHODS Uniplane HTO with a rigid locking plate adding a metal wedge was compared with biplane HTO with a rigid locking plate including a proximal D-hole. For comparison, the HTO patients' medical records and radiological results in a single institution were retrospectively reviewed. The Oxford knee score 2 years post-operation, CT scan at post-operative day 2 and serial standing long-bone scanography were reviewed to evaluate clinical outcome and radiological results, including the incidence of lateral-hinge fracture, plate irritation and correction loss to varus alignment. RESULTS A total of 103 knees, including 59 uniplane HTO and 44 biplane HTO, were enrolled. The Oxford scores were 38.1 ± 7.8 in the uniplane group and 35.9 ± 8.3 in the biplane group (ns). On CT scans, more lateral-hinge fractures developed in the biplane group, and seven knees (12%) of the uniplane group and 12 knees (27%) of the biplane group had Takeuchi type I stable hinge fracture (p < 0.05); unstable fracture was not noted in either group. Plate irritation occurred in nine knees (19%) of the uniplane group and in 14 knees (32%) of the biplane group, and the difference was statistically significant (p < 0.05). CONCLUSION In clinical situations including the use of surgical modifications reflecting plate design differences, fewer lateral-hinge fractures developed after uniplane medial opening-wedge HTO compared with biplane HTO. Uniplane HTO potentially represents a better option than biplane HTO for the prevention of lateral-hinge fracture. LEVEL OF EVIDENCE IV.
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Hoorntje A, Kuijer PPFM, van Ginneken BT, Koenraadt KLM, van Geenen RCI, Kerkhoffs GMMJ, van Heerwaarden RJ. Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner. Orthop J Sports Med 2020; 7:2325967119890056. [PMID: 31909053 PMCID: PMC6935877 DOI: 10.1177/2325967119890056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Limited evidence exists on patient-relevant outcomes after high tibial osteotomy (HTO), including return to work (RTW). Furthermore, prognostic factors for RTW have never been described. Purpose To investigate the extent and timing of RTW in the largest HTO cohort investigated for RTW to date and to identify prognostic factors for RTW after HTO. Study Design Cohort study; Level of evidence, 3. Methods Consecutive patients who underwent HTO between 2012 and 2015 were included. Patients received a questionnaire at a mean follow-up of 3.6 years. Questions were asked pre- and postoperatively regarding work status, job title, working hours, preoperative sick leave, employment status, and whether patients were their family's breadwinner. The validated Work Rehabilitation Questionnaire (WORQ) was used to assess difficulty with knee-demanding activities. Prognostic factors for RTW were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results We identified 402 consecutive patients who underwent HTO, of whom 349 were included. Preoperatively, 299 patients worked, of whom 284 (95%) achieved RTW and 255 (90%) returned within 6 months. Patients reported significant postoperative improvements in performing knee-demanding activities. Being the family's breadwinner was the strongest predictor of RTW (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.27-6.69). In contrast, preoperative sick leave was associated with lower odds of RTW (OR, 0.20; 95% CI, 0.08-0.46). Conclusion After HTO, 95% of patients were able to RTW, of whom 9 of 10 returned within 6 months. Breadwinners were more likely to RTW, and patients with preoperative sick leave were less likely to RTW within 6 months. These findings may be used to improve preoperative counseling and expectation management and thereby enhance work-related outcomes after HTO.
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Affiliation(s)
- Alexander Hoorntje
- Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Berbke T van Ginneken
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Gino M M J Kerkhoffs
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Ronald J van Heerwaarden
- Department of Orthopaedic Surgery, Maartenskliniek Woerden, Woerden, the Netherlands.,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Ehlinger M, Ollivier M, Course S, Guerin A, Lantz É, Zahraa D, Bonnomet F, Bahlouli N. Effect of saw blade geometry on crack initiation and propagation on the lateral cortical hinge for HTO: Finite element analysis. Orthop Traumatol Surg Res 2019; 105:1079-1083. [PMID: 31447398 DOI: 10.1016/j.otsr.2019.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The hinge plays a primary role in the hold and healing of a high tibial osteotomy (HTO). Weakening of the hinge is a risk factor for failure. The aim of our study was to determine whether the geometry of the saw blade's cutting edge impacts crack initiation or propagation on the hinge. HYPOTHESIS A certain cutting edge geometry exists that will reduce this risk. MATERIALS AND METHODS A finite element model with transverse isotropic elastic bone properties was created. A 1.27-mm thick saw cut (full thickness in anteroposterior direction) was made leaving a 1cm lateral cortical hinge. Three different cutting edge geometries were compared: rectangular, U-shaped, V-shaped. Opening of the osteotomy was done over 1mm for 1 s by a load applied distally with the proximal portion fixed. In the first simulation, no crack was initiated at the hinge, while in the second simulation, the beginnings of a 2mm crack angled upward at 15° was added. These two simulations were used to identify whether a local stress riser was present at the hinge. This information was used to calculate the energy release rate to the hinge, which corresponds to the energy needed to initiate and propagate a crack on the hinge. RESULTS In the first simulation (no crack initiation), a rectangular saw blade geometry resulted in the lowest local stress concentration. In the second simulation (with crack initiation), the U-shaped geometry resulted in the lowest local stress concentration. The U-shaped geometry had the lowest energy release rate, meaning that it was the least likely to initiate and propagate a crack on the lateral cortical hinge. DISCUSSION/CONCLUSION Keeping the inherent limitations related to computer modelling in mind, our findings show that a U-shaped cutting edge is least likely to initiate or propagate a crack since it has the lowest energy release rate. This confirms our hypothesis. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France; Laboratoire ICube, équipe MMB, 67400 Illkirch, France.
| | - Matthieu Ollivier
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Arnaud Guerin
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - Éric Lantz
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - Dany Zahraa
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - François Bonnomet
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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Comparable bone union progression after opening wedge high tibial osteotomy using allogenous bone chip or tri-calcium phosphate granule: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:2945-2950. [PMID: 30377715 DOI: 10.1007/s00167-018-5254-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study is to compare the progression rate of bone union and clinical outcomes of opening wedge high tibial osteotomy (OWHTO) using allogenous bone chip or tri-calcium phosphate (TCP) granule as bone graft materials. The hypothesis was that the bone union progression in OWHTOs using TCP granule grafts would be comparable to that of OWHTOs using allogenous bone chip grafts. METHODS Between 2011 and 2013, 54 patients who had undergone OWHTO for genu varum and osteoarthritis were randomized to one of the two groups at five centres. TCP granule was used to fill the defect in 27 patients and lyophilized allogenous bone chip was used in the other 27 patients. The degree of bone union was classified on a five-point scale and evaluated using plain radiographs of the knee at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, pain Visual Analogue Scale (VAS) score and complications were also evaluated. RESULTS The highest degree of bone union observed at 6 and 12 months postoperatively was grade 4, and the number of cases of union progression at each time-point was not significantly different between the two groups (p > 0.05). WOMAC and pain VAS scores also showed no differences between the two groups. No complications were observed during the 12-month period following OWHTO in either group. CONCLUSION OWHTO using TCP granule bone substitute showed similar bone union rates and clinical outcomes compared to allogenous bone chip grafts. TCP granule can be used as bone substitutes instead of allogenous bone chip grafts in OWHTO. LEVEL OF EVIDENCE Level 1.
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Hoorntje A, Kuijer PPF, van Ginneken BT, Koenraadt KL, van Geenen RC, Kerkhoffs GM, van Heerwaarden RJ. Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach. Am J Sports Med 2019; 47:1854-1862. [PMID: 31157542 PMCID: PMC6604251 DOI: 10.1177/0363546519849476] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. PURPOSE To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. RESULTS We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up (P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). CONCLUSION More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery,
Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Academic Center for Evidence-Based
Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health &
Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the
Netherlands
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - P. Paul F.M. Kuijer
- Amsterdam UMC, University of Amsterdam,
Coronel Institute of Occupational Health, Amsterdam Public Health Research
Institute, Amsterdam, the Netherlands
| | - Berbke T. van Ginneken
- Department of Orthopaedic Surgery, Sint
Maartenskliniek Woerden, Woerden, the Netherlands
| | - Koen L.M. Koenraadt
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - Rutger C.I. van Geenen
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Academic Center for Evidence-Based
Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health &
Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the
Netherlands
| | - Ronald J. van Heerwaarden
- Department of Orthopaedic Surgery, Sint
Maartenskliniek Woerden, Woerden, the Netherlands
- Centre for Deformity Correction and
Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Siboni R, Beaufils P, Boisrenoult P, Steltzlen C, Pujol N. Opening-wedge high tibial osteotomy without bone grafting in severe varus osteoarthritic knee. Rate and risk factors of non-union in 41 cases. Orthop Traumatol Surg Res 2018; 104:473-476. [PMID: 29555559 DOI: 10.1016/j.otsr.2018.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/02/2018] [Accepted: 01/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Using locking plates in opening-wedge high tibial osteotomy (OWHTO) via a medial opening theoretically allows early weight-bearing without need for bone or bone-substitute grafting. It incurs a risk of non-consolidation in case of large correction (>10°), although rates and risk factors of non-union are not known. The present retrospective study compared OWHTO with correction <10° versus >10°, with a view to determining: (1) complications rates (non-union) according to degree of correction, and (2) risk factors for such complications. HYPOTHESIS OWHTO with correction greater than 10° without graft shows normal consolidation and allows early weight-bearing. MATERIAL AND METHOD Forty-one patients treated by OWHTO for medial osteoarthritis of the knee between January 2101 and November 2015 were included in a retrospective study. HKA angle was assessed by long-leg axis radiographs, preoperatively and at 3 months. Clinical and radiological follow-up at 6 weeks, 3 months and 6 months assessed consolidation in terms of >40% filling of the osteotomy site. Partial (contact) weight-bearing was allowed from the first postoperative day, with full weight-bearing at 6 weeks. RESULTS Mean patient age was 59±5 years. Mean body-mass index (BMI) was 30.3±5.2; 17 patients (41.5%) had BMI >30. Mean initial HKA angle was 173.5°±3° (range, 167-178°) and mean correction was 10.7°±2.7° (range, 5-15°). There were 27 corrections of 10° or more, and 14 less than 10°. At 3 months, mean HKA was 182.9°±2.5° (range, 178-187°). Twelve cases showed lateral tibial cortex fracture after opening. Thirty-six patients (87.8%) showed consolidation, at a mean 5±3 months. Five patients showed osteotomy site non-union; in all these cases, the lateral cortex was broken initially (P=0.003); all had BMI >30 (mean, 37.2±3.8; P<0.03); none were smokers. On univariate analysis, lateral tibial cortex fracture (OR=10; 95% CI, (1.59-196.30)), BMI >30 (OR=1.18; 95% CI, (1.03-1.41)) and correction ≥10° (OR=10.50; 95% CI, (2.49-53.86)) were associated with delayed consolidation. On multivariate analysis, only degree of osteotomy was significantly associated with delayed consolidation (OR=11.51; 95% CI, (2.13-95.74)). DISCUSSION/CONCLUSION Obesity and initial lateral cortex fracture appeared as risk factors for non-consolidation of OWHTO with large correction. Systematic bone or bone-substitute grafting may therefore be considered in this population in case of >10° correction. LEVEL OF EVIDENCE IV, prospective cohort study.
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Affiliation(s)
- R Siboni
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - P Beaufils
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - P Boisrenoult
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - C Steltzlen
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - N Pujol
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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Lee OS, Lee YS. Diagnostic Value of Computed Tomography and Risk Factors for Lateral Hinge Fracture in the Open Wedge High Tibial Osteotomy. Arthroscopy 2018; 34:1032-1043. [PMID: 29229417 DOI: 10.1016/j.arthro.2017.08.310] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/24/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were to evaluate (1) the disparity of detection of lateral hinge fracture (LHF) between postoperative simple radiography and high-resolution computed tomography (CT) and affecting factors of LHF and (2) whether generally recommended postoperative rehabilitation protocols are appropriate according to the type of LHF. METHODS From 2014 to 2015, patients who underwent primary open wedge high tibial osteotomy (OWHTO) for isolated medial compartment osteoarthritis of the knee joint were retrospectively enrolled. The patients with minimum 1-year follow-up were included. The incidence of LHF after OWHTO based on simple radiographs was compared with its incidence based on CT scans. In the stable type of LHF and the non-LHF group, early weight bearing was encouraged immediately after OWHTO. In unstable LHF (types II and III), weight bearing was delayed until 2 weeks postoperatively. RESULTS Twenty-three cases (24.5%) of LHF after 94 OWHTOs were detected (15 cases on simple radiographs, 8 cases on CT scan). The coronal osteotomy slope and the osteotomy gap were significantly larger in the LHF group than in the non-LHF group (coronal osteotomy slope, 20.3° ± 5.1° vs 16.7° ± 4.2°, P = .001; anterior osteotomy gap, 7.9 mm ± 2.1 mm vs 6.7 mm ± 1.8 mm, P = .008; posterior osteotomy gap, 12.7 mm ± 3.7 mm vs 11.2 mm ± 3.2 mm, P = .048). The correction loss of the hip-knee-ankle angle and the medial proximal tibial angle in the LHF group was significantly larger than those in the non-LHF group (1.3° ± 1.8° vs 0.4° ± 1.4°, P < .001; 1.3° ± 1.1° vs 0.7° ± 0.9°, P = .009, respectively). CONCLUSIONS Further evaluation with CT scanning is highly valuable immediately after all OWHTO because of its higher detection rate (24.5%) of LHF compared with simple radiographs (16%). In addition, the coronal osteotomy slope was steeper and the opening gap was larger in the LHF group than in the non-LHF group. Finally, the LHF should be managed conservatively in order to prevent postoperative correction loss. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
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Lee OS, Lee KJ, Lee YS. Comparison of bone healing and outcomes between allogenous bone chip and hydroxyapatite chip grafts in open wedge high tibial osteotomy. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:189. [PMID: 29101660 DOI: 10.1007/s10856-017-5998-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
Allogenous bone chips and hydroxyapatite (HA) chips have been known as good options for filling an inevitable void after open wedge high tibial osteotomy (OWHTO). However, there are concerns regarding bone healing after the use of these grafts. The purpose of this study was to compare the bone healing represented by the osteoconductivity and absorbability between allogenous bone chips and HA chips in OWHTO. The outcomes of bone healing of 53 patients who received an allogenous bone chip graft and 41 patients who received an HA chip graft were retrospectively evaluated, and the results were compared between the two groups. Osteoconductivity and absorbability were serially evaluated for the assessment of bone healing at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The osteoconductivity of the allogenous bone chips was greater than that of the HA chips at 6 weeks postoperatively (p < 0.05). However, there were no statistically significant differences from 3 months to 1 year postoperatively. The absorbability showed no statistically significant differences 6 weeks and 3 months after OWHTO; however, the allogenous bone chip group showed a greater absorbability at 6 months and 1 year postoperatively (42.8 ± 14.2 vs. 34.6 ± 13.8, p = 0.006 at 6 months postoperatively; 54.6 ± 14.4 vs. 43.0 ± 14.0, p < 0.001 at 1 year postoperatively). However, the two graft materials showed similar results of HKA angle, WBL ratio, posterior tibial slope.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Kyung Jae Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Hoorntje A, Witjes S, Kuijer PPFM, Koenraadt KLM, van Geenen RCI, Daams JG, Getgood A, Kerkhoffs GMMJ. High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis. Sports Med 2017; 47:2219-2244. [PMID: 28401426 PMCID: PMC5633634 DOI: 10.1007/s40279-017-0726-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Knee osteotomies are proven treatment options, especially in younger patients with unicompartmental knee osteoarthritis, for certain cases of chronic knee instability, or as concomitant treatment for meniscal repair or transplantation surgery. Presumably, these patients wish to stay active. Data on whether these patients return to sport (RTS) activities and return to work (RTW) are scarce. OBJECTIVES Our aim was to systematically review (1) the extent to which patients can RTS and RTW after knee osteotomy and (2) the time to RTS and RTW. METHODS We systematically searched the MEDLINE and Embase databases. Two authors screened and extracted data, including patient demographics, surgical technique, pre- and postoperative sports and work activities, and confounding factors. Two authors assessed methodological quality. Data on pre- and postoperative participation in sports and work were pooled. RESULTS We included 26 studies, involving 1321 patients (69% male). Mean age varied between 27 and 62 years, and mean follow-up was 4.8 years. The overall risk of bias was low in seven studies, moderate in ten studies, and high in nine studies. RTS was reported in 18 studies and mean RTS was 85%. Reported RTS in studies with a low risk of bias was 82%. No studies reported time to RTS. RTW was reported in 14 studies; mean RTW was 85%. Reported RTW in studies with a low risk of bias was 80%. Time to RTW varied from 10 to 22 weeks. Lastly, only 15 studies adjusted for confounders. CONCLUSION Eight out of ten patients returned to sport and work after knee osteotomy. No data were available on time to RTS. A trend toward performing lower-impact sports was observed. Time to RTW varied from 10 to 22 weeks, and almost all patients returned to the same or a higher workload.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne Witjes
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alan Getgood
- Department of Orthopaedic Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2017; 137:903-911. [PMID: 28444438 DOI: 10.1007/s00402-017-2703-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of this systematic review and meta-analysis was to evaluate the effectiveness and safety of early weight-bearing by comparing clinical and radiological outcomes between early and traditional delayed weight-bearing after OWHTO. MATERIALS AND METHODS A rigorous and systematic approach was used. The methodological quality was also assessed. Results that are possible to be compared in two or more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I 2 statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random-effects model was used to calculate the effect size. RESULTS Six articles were included in the final analysis. All case groups were composed of early full weight-bearing within 2 weeks. All control groups were composed of late full weight-bearing between 6 weeks and 2 months. Pooled analysis was possible for the improvement in Lysholm score, but there was no statistically significant difference shown between groups. Other clinical results were also similar between groups. Four studies reported mechanical femorotibial angle (mFTA) and this result showed no statistically significant difference between groups in the pooled analysis. Furthermore, early weight-bearing showed more favorable results in some radiologic results (osseointegration and patellar height) and complications (thrombophlebitis and recurrence). CONCLUSION Our analysis supports that early full weight-bearing after OWHTO using a locking plate leads to improvement in outcomes and was comparable to the delayed weight-bearing in terms of clinical and radiological outcomes. On the contrary, early weight-bearing was more favorable with respect to some radiologic parameters and complications compared with delayed weight-bearing.
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