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Gong Y, Jin L, Wang Y, Liu B, Shen P, Zhang Z, Yuwen P, Zhao K, Ma L, Chen W, Zhang Y. A new technique of autologous bone grafting for open-wedge high tibial osteotomy. Front Surg 2024; 11:1337668. [PMID: 38505406 PMCID: PMC10948400 DOI: 10.3389/fsurg.2024.1337668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose This study aimed to demonstrate the application of orthotopic bone flap transplantation with a fibula transplantation (OBFT-FT) in open-wedge high tibial osteotomy (OW-HTO) and to assess the effect of OBFT-FT on gap healing. Patients and methods From January to July 2020, 18 patients who underwent OW-HTO with OBFT-FT were reviewed for this study. Demographics, postoperative complications, and radiological and clinical outcomes of patients were collected. Finally, the clinical outcomes of patients were analyzed. Results A total of 14 patients were included in this study. The average age and body mass index were 59.6 ± 9.2 years and 28.1 ± 4.5 kg/m2, respectively. The average correction angle and gap width were 9.5 ± 1.8° and 10.2 ± 2.7 mm, respectively. The rates of radiological gap healing at sixth week, third month, and sixth month were 42.9%, 85.7%, and 100%, respectively. The mean Lysholm score, International Knee Documentation Committee score, and visual analog scale scores at sixth-month follow-up were significantly better than the preoperative scores (p < 0.001, p < 0.001, p = 0.001, respectively). And, no delayed union or non-union, collapse, loss of correction, or surgical site infection were found. Conclusions As a new technique for autologous bone graft, the OBFT-FT could be successfully applied in the treatment of gap healing after OW-HTO, and excellent radiological and clinical outcomes could be seen on patients' short-term follow-up.
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Affiliation(s)
- Yongchao Gong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanwei Wang
- Department of Orthopaedic Surgery, North China Medical and Health Group Xingtai General Hospital, Xingtai, Hebei, China
| | - Boxu Liu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Pengfei Shen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhiang Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Peizhi Yuwen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lijie Ma
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Neo M. Effect of lateral hinge fractures for bone union and clinical outcomes following opening-wedge distal tibial tubercle osteotomy in comparison with opening-wedge high tibial osteotomy. J Exp Orthop 2023; 10:140. [PMID: 38095818 PMCID: PMC10721766 DOI: 10.1186/s40634-023-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Although the effects of lateral hinge fractures (LHF) on bone union and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO) have been established, the effects of LHF after opening-wedge distal tibial tubercle osteotomy (OWDTO) are unclear. We hypothesised that LHF after OWDTO would be associated with delayed bone union and result in poorer clinical outcomes than expected for LHF after OWHTO. METHODS This study enrolled 100 patients, with 50 OWDTO patients (18 men; mean age, 63.2 years) and 50 OWHTO patients compared based on the propensity score matched analysis. The effect of LHF on bone union was compared between the groups. Clinical outcomes were assessed using the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the mean follow-up of 28 months. RESULTS There was no between-group difference in the incidence rate of LHF. However, the rate of bone union at the anterior flange in the presence of an LHF was significantly lower in the OWDTO (26%) than in the OWHTO (80%) 3 months postoperatively (p < 0.05), but no difference was observed 12 months postoperatively. The Lysholm score was significantly lower for patients with LHF following OWDTO than for OWDTO patients without LHF or OWHTO patients with/without LHF 3 and 12 months postoperatively (p < 0.001); Lysholm score and KOOS were not different at the final follow-up. CONCLUSIONS LHF after OWDTO was associated with delayed bone union and poor clinical outcomes until 12 months. This information can guide decisions regarding the indications and the management of patients after OWDTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan.
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi Takatsuki, Osaka, 569-8686, Japan
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Nakamura R, Takahashi M, Shimakawa T, Kuroda K, Katsuki Y, Okano A. Around-knee osteotomy conversion for failed high tibial osteotomy: Re-correction high tibial osteotomy and additional distal femoral osteotomy may enable return to sporting activities. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 30:14-20. [PMID: 36161103 PMCID: PMC9471187 DOI: 10.1016/j.asmart.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
High tibial osteotomy (HTO) for knee osteoarthritis achieves excellent short- and long-term results. However, failure of HTO due to undercorrection or correction loss may necessitate conversion surgery. For patients with HTO failure who desire a return to sporting activities (RTS), non-prosthetic joint-preserving solutions such as conversion to around-knee osteotomies (AKO-conversion) may be more appropriate than total knee arthroplasty. The present study aimed to introduce potential non-prosthetic joint-preserving solutions for failed HTO and investigate the postoperative RTS. Among the patients who received non-prosthetic solutions for failed HTO from 2015 to 2020, this case series included those who were eager to RTS, were participating in a sporting activity with a Tegner activity scale score of ≥5 immediately before being affected by knee osteoarthritis, and had at least 2 years of follow-up. Deformity analysis for the preoperative planning of the AKO-conversion was based on the mechanical lateral distal femoral angle, joint line convergence angle, and mechanical medial proximal tibial angle. Four patients met the study inclusion criteria: two patients who underwent re-correction HTO and two who received additional distal femoral osteotomy (DFO). The average ages at primary HTO and AKO-conversion were 69.5 ± 11.8 years and 71.5 ± 10.9 years, respectively. The hip-knee-ankle angle was corrected from −2.8 ± 1.5° before conversion surgery to 3.3 ± 1.5° at 2 years after AKO-conversion. All four patients finally achieved a better sporting performance after AKO-conversion than preoperatively, and the Tegner activity scale score was improved from 2.5 ± 1.0 before AKO-conversion to 5.8 ± 0.5 at the 2-year follow-up. The duration between AKO-conversion and full RTS was 11.8 ± 6.7 months. In conclusion, two patients who underwent re-correction HTO and two who underwent additional DFO for undercorrection or correction loss after primary HTO achieved highly satisfactory clinical results, including RTS. The present findings suggest that non-prosthetic joint-preserving solutions using AKO for failed HTO should be considered as options to enable RTS.
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Affiliation(s)
- Ryuichi Nakamura
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Fukui, Japan
- Corresponding author. Joint Preservation and Sports Orthopaedic Center, Harue-cho Haribara 65-7, Sakai City, Fukui, 919-0476, Japan.
| | - Masaki Takahashi
- Department of Orthopaedic Surgery, Yawata Medical Center, Komatsu, Ishikawa, Japan
| | - Tomoyuki Shimakawa
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Fukui, Japan
| | - Kazunari Kuroda
- Department of Orthopaedic Surgery, Yawata Medical Center, Komatsu, Ishikawa, Japan
| | - Yasuo Katsuki
- Department of Orthopaedic Surgery, Yawata Medical Center, Komatsu, Ishikawa, Japan
| | - Akira Okano
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Fukui, Japan
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Handa M, Takahashi T, Hayashi Y, Takeshita K. Restoration of the Knee Medial Collateral Ligament and Complete Soft-tissue Coverage After Medial Open-Wedge High Tibial Osteotomy. Arthrosc Tech 2022; 11:e1675-e1679. [PMID: 36311324 PMCID: PMC9596392 DOI: 10.1016/j.eats.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 02/03/2023] Open
Abstract
High tibial osteotomy (HTO) is used in the treatment of knee osteoarthritis. This surgical procedure is indicated in patients with medial osteoarthritis who are relatively young and active and have a good range of motion. In most medial open-wedge HTO cases, the fascia, medial collateral ligament (MCL), and part of the knee joint capsule are carefully separated and moved to expose the osteotomy site, but many patients experience postoperative swelling and pain in the affected limb due to bleeding from the osteotomy site and MCL failure. We have developed a method of osteotomy followed by a restoration of the MCL to its anatomic position and complete soft-tissue coverage of the osteotomy. This Technical Note aims to provide a comprehensive description of the employment of a soft-tissue envelope for the MOW-HTO protection.
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Affiliation(s)
- Mikiko Handa
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan,Address correspondence to Tsuneari Takahashi, M.D., Ph.D., Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4 Shimokoyama, 329-0502, Japan.
| | - Yukinori Hayashi
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
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Primadhi RA, Gunawan H, Rachmayati S, Nagar Rasyid H. Autologous osteophyte grafting for ankle arthrodesis. SICOT J 2022; 8:10. [PMID: 35363135 PMCID: PMC8973299 DOI: 10.1051/sicotj/2022007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose: Various graft sources had been identified to facilitate gap-filling in ankle arthrodesis procedures with related articular defects. This was a preliminary study with the aim of analyzing the efficacy and feasibility of using autologous osteophyte as a grafting source. Methods: Retrospective evaluation of ten patients having ankle arthrodesis procedure using identical anterior approach and plate fixation technique was conducted. Basic anthropometric measurements and underlying disease were recorded. Functional outcome and fusion rate were assessed at a 12-month post-surgery follow-up visit. Results: The underlying diseases include primary osteoarthritis (OA), post-traumatic OA, rheumatoid arthritis, and Charcot arthropathy. The patient’s age mean was 56.6 years (range 36–71 years), and BMI varied from 17.9 kg/m2 to 29.3 kg/m2. Nearly all patients had improved functional outcomes as described by foot and ankle ability measure (FAAM) score and fusion rate as described by modified radiographic union score for tibia (RUST). One patient had failed surgery due to implant failure with diminished protective foot sensory. Conclusion: Osteophytes from the distal tibia and talar neck were a viable source of bone graft, especially for ankle arthrodesis using anterior approach among various ages and BMI, in which the surgeons would not need additional incision for graft harvesting.
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Affiliation(s)
- Raden Andri Primadhi
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital Jalan Pasteur 38 Bandung 40161 Indonesia
- Corresponding author:
| | - Hendra Gunawan
- Department of Dermato-Venereology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital Jalan Pasteur 38 Bandung 40161 Indonesia
| | - Sylvia Rachmayati
- Department of Clinical Pathology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital Jalan Pasteur 38 Bandung 40161 Indonesia
| | - Hermawan Nagar Rasyid
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital Jalan Pasteur 38 Bandung 40161 Indonesia
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Tibial Condylar Valgus Osteotomy Combined With Medial Open-Wedge Distal Tuberosity Tibial Osteotomy. Arthrosc Tech 2022; 11:e569-e575. [PMID: 35493060 PMCID: PMC9051885 DOI: 10.1016/j.eats.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023] Open
Abstract
Severe varus deformity in osteoarthritic knees is attributed not only to bony deformity but also to intra-articular deformity as a result of medial joint space narrowing with lateral joint space widening (increased joint line convergence angle). In such knees, correction of bony deformity by high tibial osteotomy (HTO) alone may not be capable of restoring physiological joint geometry and biomechanics. Tibial condylar valgus osteotomy (TCVO), an L-shaped osteotomy in the medial tibial condyle, has been proposed to improve articular stability and congruity by elevating the medial tibial joint line and addressing the articular component of the deformity; however, its surgical efficacy for correction of the valgus deformity is limited. Therefore a procedure combining HTO and TCVO can be a reasonable option to achieve restoration of the knee joint physiology in such situations. In our current practice, medial open-wedge distal tuberosity tibial osteotomy (MOW-DTO) has been the procedure of primary option among the HTO procedures to avoid patellofemoral overload which could be an inherent problem in medial open-wedge HTO. In this article, the surgical rationale and the combined procedure of TCVO and MOW-DTO are described.
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Nakamura R, Kuroda K, Takahashi M, Katsuki Y. Open Wedge High Tibial Osteotomy with Pes Anserinus Preservation and Insertion of Bone Substitutes. Arthrosc Tech 2022; 11:e69-e78. [PMID: 35127431 PMCID: PMC8807857 DOI: 10.1016/j.eats.2021.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023] Open
Abstract
Biplanar open wedge high tibial osteotomy (OWHTO) has become common since the introduction of OWHTO-specific plates. However, the management of soft tissues, including skin, the pes anserinus, and the superficial medial collateral ligament (sMCL) release vary among surgeons. We introduce an OWHTO methodology that avoids pes incision and repair, uses bone substitute insertion into the opening gap and includes management of soft tissues to minimize complications. We adopted a reversed curved oblique incision to reduce the risk of saphenous nerve injury. We avoided pes incision, taking advantage of its posterior component force to allow it to function as a compressor of the ascending osteotomy site. The proximal component force of the pes provides compression between the bone substitute insertions and the proximal/distal cortices. This allows postoperative weight bearing to be distributed to the substitute, which may reduce the risk of implant failure. The sMCL is detached from the distal tibial attachment without cutting, enabling its return to its original position underneath the pes and to be repaired. This sMCL release with complete pes preservation may reduce the risk of deep infection or medial laxity during total knee arthroplasty conversion, and further reduce the risks of OWHTO.
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Affiliation(s)
- Ryuichi Nakamura
- Harue Hospital, Joint Preservation and Sports Orthopaedic Center, Sakai, Japan
| | - Kazunari Kuroda
- Yawata Medical Center, Department of Orthopaedic Surgery, Komatsu, Japan
| | - Masaki Takahashi
- Yawata Medical Center, Department of Orthopaedic Surgery, Komatsu, Japan
| | - Yasuo Katsuki
- Yawata Medical Center, Department of Orthopaedic Surgery, Komatsu, Japan
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Nakashima H, Takahara Y, Itani S, Iwasaki Y, Miyazato K, Katayama H, Kato H, Uchida Y. Good clinical outcomes and return to sports after hybrid closed-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 31:1220-1229. [PMID: 34050769 DOI: 10.1007/s00167-021-06621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to investigate preoperative sports participation and postoperative clinical outcomes including a return to sports (RTS) after hybrid closed-wedge high tibial osteotomy (CWHTO) for medial compartment osteoarthritis of the knee. Characteristic of Hybrid CWHTO was defined as extra-articular lateral closed and medial open wedge osteotomy. METHODS The patients who underwent hybrid CWHTO from January 2016 to December 2018 were retrospectively reviewed and divided them into sports and non-sports groups. The preoperative demographic and radiographic characteristics were compared in both groups. And the clinical outcomes including the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Lysholm score, University of California at Los Angeles (UCLA) activity score, and RTS in the sports group were also investigated. Statistical analysis was performed for comparisons among the preoperative factors between the two groups. Influence of sports impact and bone union of fibular osteotomy was also statistically investigated for RTS. RESULTS Of the 161 knees (129 patients; 46 males, 83 females), 20 knees (16 patients; 13 males, 3 females; 12.3%) belonged to sports group. Although there were no significant differences regarding the age and radiographic parameters, there were significant differences in the body mass index and proportion of males between both groups. The JOA, VAS, Lysholm, and UCLA activity scores significantly improved after surgery. RTS was 80% at a mean duration of 7.2 ± 3.1 months. RTS in the high-impact sports group was significantly lower than that in the low-impact sports group (high-impact 60% vs. low-impact 100%, p = 0.043). There was no significant difference in RTS regarding bone union after fibular osteotomy. CONCLUSION The clinical outcomes including RTS were satisfactory in patients with hybrid CWHTO. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hirotaka Nakashima
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
| | - Yasuhiro Takahara
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan.
| | - Satoru Itani
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
| | - Yuichi Iwasaki
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
| | - Kazuaki Miyazato
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
| | - Haruyoshi Katayama
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
| | - Hisayoshi Kato
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
| | - Yoichiro Uchida
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama-City, Hiroshima, 721-0927, Japan
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Itou J, Kuwashima U, Itoh M, Kuroda K, Yokoyama Y, Okazaki K. Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy. BMC Musculoskelet Disord 2021; 22:157. [PMID: 33557809 PMCID: PMC7871549 DOI: 10.1186/s12891-021-03999-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO. Methods Three-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery. Results No significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site. Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up. Conclusions The monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient’s condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichi Kuroda
- Olympus Terumo Biomaterials Corp., Sasazuka NA Bldg., 1-50-1 Sasazuka, Shibuya-ku, Tokyo, 151-0073, Japan
| | - Yasuharu Yokoyama
- Olympus Terumo Biomaterials Corp., Sasazuka NA Bldg., 1-50-1 Sasazuka, Shibuya-ku, Tokyo, 151-0073, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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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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Kim JH, Jung WH, Jeon SS, Kim JH. Combination of Cylindrical Autologous Bone Grafting Technique With a Metallic Block Insertion in Open-Wedge High Tibial Osteotomy. Arthrosc Tech 2021; 10:e367-e373. [PMID: 33680768 PMCID: PMC7917032 DOI: 10.1016/j.eats.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023] Open
Abstract
Open-wedge high tibial osteotomy (OW-HTO) is an effective surgical intervention for medial-compartment knee osteoarthritis. However, the osteotomized gap might be a disadvantage in OW-HTO because it can cause problems such as delayed bone union or loss of correction. These issues can be minimized by using autologous bone graft in the osteotomized gap, which is known to be the fastest and most clinically satisfactory gap filler. The primary mechanical stability of the osteotomy site in OW-HTO is essential for early weight bearing after surgery. Therefore, we introduce the combination of a cylindrical autologous bone grafting technique and a metallic block insertion for faster bone union and better primary stability of the site in OW-HTO. We expect that the described procedure will enable early postoperative weight bearing and, thereby, allow an early return to normal function.
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Affiliation(s)
- Jong Hyun Kim
- Samsung Orthopaedic Clinic, Chungju, Republic of Korea
| | - Woon Hwa Jung
- Department of Orthopaedic Surgery, Murup Hospital, Masan, Republic of Korea
| | - Seung Soo Jeon
- Department of Orthopaedic Surgery, Koggiry Hue Hospital, Gwangju, Republic of Korea
| | - Jae Hyoung Kim
- Department of Orthopaedic Surgery, Woori Hospital, Suwon, Republic of Korea,Address correspondence to Jong Hyun Kim, M.D., Ph.D., Samsung Orthopaedic Clinic, 33, Jungang-ro, Chungju-si, Chungcheongbuk-do 27406, Republic of Korea.
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12
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Distal Tibial Tuberosity Focal Dome Osteotomy Combined With Intra-Articular Condylar Osteotomy (Focal Dome Condylar Osteotomy) for Medial Osteoarthritis of the Knee Joint. Arthrosc Tech 2020; 9:e1079-e1086. [PMID: 32874886 PMCID: PMC7451708 DOI: 10.1016/j.eats.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/02/2020] [Indexed: 02/03/2023] Open
Abstract
High tibial osteotomy for medial-compartment knee osteoarthritis (OA) is an established biological knee reconstruction surgical procedure. In open- and closed-wedge high tibial osteotomy, the angulation correction axes are away from the center of rotation and angulation. This results in translation deformity, which alters the orientation of the adjacent joint and the length of the limb. In the present study, we combined the distal tibial tuberosity focal dome osteotomy centered on the center of rotation and angulation with the longitudinal condylar osteotomy (focal dome condylar osteotomy) for knee OA. The advantages of this procedure are as follows: physiological orientation of adjacent joint is achieved; limb length is maintained; joint stabilization in the coronal plane is achieved; patella infra is prevented; sufficient bone contact between the medial and posterior cortex is achieved; early weight-bearing walking is possible; and fibular osteotomy is not required. This study describes the details of the surgical procedure, including our compass cutter for accurate dome osteotomy and the postoperative rehabilitation program for patients with knee OA and moderate-to-severe varus deformity.
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13
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Kawai R, Kawashima I, Maeda A, Tsukada M, Aoshiba H, Kusaka Y, Tsukahara T. The factors affecting the timing of bone union after closing-wedge high tibial osteotomy. J Clin Orthop Trauma 2020; 11:S526-S529. [PMID: 32774023 PMCID: PMC7394782 DOI: 10.1016/j.jcot.2020.04.019] [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: 03/12/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Closing-wedge high tibial osteotomy (CWHTO) for medial osteoarthritis of the knee is one of the effective osteotomy methods, especially for patients with cartilage damage of the patellofemoral joint, flexion contracture, and requiring a large correction angle.While the bone union at the osteotomy site is finally obtained after CWHTO, there are often differences in the period of the bone union. The purpose of the present study is to investigate the factors affecting the timing of bone union after CWHTO. METHODS 16 cases of CWHTO were included; they were performed by the same surgeon using precisely the same implants. Among 16 cases in the present study, nobody used low-intensity pulsed ultrasound (LIPUS) within three months after the operation. The patients were divided into two Groups using Plane X-ray and CT within three months after surgery: Group D (8 knees; bone healing was not seen at all) and Group E (8 knees; bone healing was seen). RESULTS There were no significant differences in mean age between the two groups, but body mass index (BMI) and bone mineral density (BMD) were significantly higher in Group D (p < 0.05). CONCLUSION The present study suggests that BMI and BMD may affect the timing of bone union after CWHTO. BACKGROUND Closing-wedge high tibial osteotomy (CWHTO) for medial osteoarthritis of the knee is one of the effective osteotomy methods. The frequency of selecting CWHTO in our hospital in Japan is high, especially for patients with cartilage damage of the patellofemoral joint, flexion contracture, and requiring a large correction angle. On the other hand, while the bone union at the osteotomy site is obtained with both procedures, there are often differences in bone union time for CWHTO compared to Opening-wedge high tibial osteotomy (OWHTO). This difference might affect the early clinical outcome of the operations. We hypothesized that there is some factor to affect bone healing of CWHTO for individual patients. PURPOSE To investigate the factors affecting the timing of bone union after CWHTO.
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Affiliation(s)
- Ryosuke Kawai
- Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan,Corresponding author.
| | - Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Akitoshi Maeda
- Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Makoto Tsukada
- Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Hideyuki Aoshiba
- Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Yoshiaki Kusaka
- Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
| | - Takashi Tsukahara
- Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan
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14
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Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1380-1387. [PMID: 30903222 DOI: 10.1007/s00167-019-05463-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the radiological bone union rate after medial opening wedge high tibial osteotomy (MOW-HTO) and stabilization using a TomoFix™ plate (Synthes, Oberdorf, Switzerland) in three patient groups. METHODS Retrospective analysis of 137 knees that underwent MOW-HTO between January 2014 and January 2017 was using a TomoFix™ plate. Osteotomy gaps were filled with β-tricalcium phosphate (β-TCP) (group A), left unfilled (group B), and subject to autologous bone graft and β-TCP (group C). Radiological bone union using simple radiography was determined by a modified version of the Brosset et al. osteotomy filling index. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Lysholm score. Statistical analyses using the Chi-square and ANOVA tests were performed between the groups. RESULTS The mean time for radiological bone union was 8.3 ± 3.1 months in group A, 7.2 ± 3.2 in group B and 3.4 ± 1.5 in group C (p = 0.001). There was statistically significant faster bone union in Group C. If the opening distance was more than 10 mm, group A united in 8.6 ± 3.6 months, group B in 8.8 ± 3.4, and group C in 3.5 ± 1.7 (p = 0.001). IKDC and Lysholm knee scores improved significantly (p = 0.004 for IKDC and 0.001 for Lysholm knee scores) in group C when compared to groups A and B at sixth month follow-up. At final follow-up, there was no difference in IKDC and Lysholm knee scores. Less delayed union occurred in group C. CONCLUSIONS MOW-HTO with autologous bone graft and β-TCP had the fastest radiological bone union and best clinical scores at 6 month follow-up. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S, Schröter S. Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc 2020; 28:742-750. [PMID: 30196434 DOI: 10.1007/s00167-018-5103-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/13/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to examine early radiological and clinical outcomes following minimally invasive double level osteotomy (DLO) procedure performed for osteoarthritic knees with severe varus deformity. METHODS Twenty consecutive patients who underwent DLO for varus osteoarthritic knees were included in the study. All patients could be tracked for a minimum of 1 year. Periodical radiological and clinical evaluations were performed at 6 and 12 months after surgery. In the radiological assessment, the following parameters were measured on full-length weight-bearing radiographs both pre- and postoperatively: mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). In addition, subjective clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) Subjective Score. RESULTS The mean age of the study population was 62.5 ± 6.8 years (range 45-76 years). In the radiological evaluation, the preoperative mTFA, mLDFA, mMPTA, and JLCA values averaged 13.5° ± 3.1° varus, 91.1° ± 1.4°, 82.3° ± 2.0°, and 5.8° ± 2.3°, respectively. At 6 and 12 months, all of the radiological parameters significantly improved and corrected to the values within normal range. In the clinical assessments at the follow-up evaluations, both the KOOS and IKDC subjective scores significantly improved from the preoperative values. No significant changes were noted between the 6 and 12-month results in the radiological and clinical assessments. CONCLUSIONS The minimally invasive DLO technique is a valuable surgical technique accomplishing restoration of physiologic knee joint alignment and orientation with significant improvement in patient-registered clinical outcomes in early postoperative evaluation. Although the follow-up period is still short, the excellent clinical and radiological outcomes shown in the present study support the efficacy of this procedure. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan.
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Shunichiro Kambara
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Makoto Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Tübingen, Germany
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Nemecek E, Chiari C, Valentinitsch A, Kainberger F, Hobusch G, Kolb A, Hirtler L, Trost C, Vukicevic S, Windhager R. Analysis and quantification of bone healing after open wedge high tibial osteotomy. Wien Klin Wochenschr 2019; 131:587-598. [PMID: 31502065 PMCID: PMC6908562 DOI: 10.1007/s00508-019-01541-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/11/2019] [Accepted: 08/05/2019] [Indexed: 12/04/2022]
Abstract
Background The aim of this study was to analyze radiographic imaging techniques and to quantify bone ossification in the osteotomy gap after high tibial osteotomy. Material and methods Study phase 1: high tibial osteotomy was performed on six lower extremities of human body donors and experimental X‑rays and computed tomography (CT) scans were applied. Different techniques were evaluated by three specialists for best representation of the osteotomy gap. Study phase 2: optimized radiological techniques were used for follow-up on 12 patients. The radiographs were examined by 3 specialists measuring 10 different parameters. The CT scans were analyzed with semiautomatic computer software for quantification of bone ossification. Results The osteotomy gap was best represented in 30° of flexion in the knee and 20° internal rotation of the leg. There were significant changes of the medial width over time (p < 0.019) as well as of the length of fused osteotomy, the Schröter score, sclerosis, trabecular structure and zone area measurements. Sclerosis, medial width of the osteotomy and area measurements were detected as reproducible parameters. Bone mineral density was calculated using CT scans, showing a significantly higher value 12 weeks postoperatively (112.5 mg/cm3) than at baseline (54.6 mg/cm3). The ossification of the gap was visualized by color coding. Conclusion Sclerosis and medial width of the osteotomy gap as well as area measurements were determined as reproducible parameters for evaluation of bone healing. Quantification of bone ossification can be calculated with CT scans using a semiautomatic computer program and should be used for research in bone healing.
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Affiliation(s)
- Elena Nemecek
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Catharina Chiari
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Franz Kainberger
- Department for Radiology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hobusch
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Kolb
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Carmen Trost
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Slobodan Vukicevic
- Center for Translational and Clinical Research, University of Zagreb, Zagreb, Croatia
| | - Reinhard Windhager
- Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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17
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Akiyama T, Osano K, Mizu-Uchi H, Nakamura N, Okazaki K, Nakayama H, Takeuchi R. Distal Tibial Tuberosity Arc Osteotomy in Open-Wedge Proximal Tibial Osteotomy to Prevent Patella Infra. Arthrosc Tech 2019; 8:e655-e662. [PMID: 31334025 PMCID: PMC6624185 DOI: 10.1016/j.eats.2019.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Open-wedge high tibial osteotomy is considered to be an effective surgical intervention for medial compartmental knee osteoarthritis. However, patella infra, which has been reported to be a result of tuberosity distalization after open-wedge high tibial osteotomy, changes the native patellofemoral biomechanics. This could raise abnormal patellofemoral contact stresses, which might be the trigger of patellofemoral arthrosis. To minimize the reduction in patellar height, we have developed a technique called open-wedge distal tuberosity tibial osteotomy. The benefits of this technique include increased bone-to-bone contact of the distal tuberosity cut surface after correction by cutting an arc osteotomy around the hinge position, which is the center of rotation. This technique also provides cortical support at the anterior osteotomy site without additional bone defect and, therefore, may be advantageous against weight-bearing stress on the osteotomy site. In all, open-wedge distal tuberosity tibial osteotomy could potentially be a unique open-wedge osteotomy that eliminates the risk for postoperative patellofemoral osteoarthritis and also could theoretically encourage rapid healing of the osteotomy, which could lead to early return to full physical activity.
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Affiliation(s)
- Takenori Akiyama
- Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan,Akiyama Clinic, Fukuoka, Japan,Address correspondence to Takenori Akiyama, M.D., Akiyama Clinic, 4-17-1 Midorigahama, Shingumachi, Kasuya-gun, Fukuoka, Japan.
| | - Kei Osano
- Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan,Akiyama Clinic, Fukuoka, Japan,Joint Reconstruction Center, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Hideki Mizu-Uchi
- Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan,Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - Ken Okazaki
- Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan,Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Nakayama
- Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan,Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryohei Takeuchi
- Kyushu Around Knee Osteotomy Research Group, Fukuoka, Japan,Joint Surgery Center, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
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18
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Nakamura R, Nishimura H, Katsuki Y. Re-correction osteotomy with osteophyte graft for correction loss with non-union after high tibial osteotomy. BMJ Case Rep 2017; 2017:bcr-2017-221870. [PMID: 29054952 PMCID: PMC5665194 DOI: 10.1136/bcr-2017-221870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 68-year-old man with right knee varus osteoarthritis was treated by lateral closed-wedge high tibial osteotomy. A correction loss with non-union occurred 6 months after surgery and a re-correction osteotomy was performed. Removing the proximal screws of the lateral plate, a medial opening-wedge re-osteotomy was performed. Arthroscopically harvested osteophytes were used to fill the gap after opening. An additional medial locking plate was installed on the medial side. Finally, the proximal lateral screws were reinserted and locked again. Mature trabecular continuity was obtained in the gap by 6 months, and there was no varus deformity 4 years after re-correction. Re-correction osteotomy could be a viable treatment when lateral compartment osteoarthritis has not progressed and good range of motion still exists. Osteophyte grafting may be an effective option not only to avoid iliac bone grafting but also to promote bone healing in re-osteotomy.
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Affiliation(s)
| | | | - Yasuo Katsuki
- Department of Orthopaedic Surgery, Yawata Medical Center, Komatsu, Japan
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19
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Ishihara K, Okazaki K, Akiyama T, Akasaki Y, Nakashima Y. Characterisation of osteophytes as an autologous bone graft source: An experimental study in vivo and in vitro. Bone Joint Res 2017; 6:73-81. [PMID: 28148490 PMCID: PMC5331175 DOI: 10.1302/2046-3758.62.bjr-2016-0199.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/28/2016] [Indexed: 12/02/2022] Open
Abstract
Objectives Osteophytes are products of active endochondral and intramembranous ossification, and therefore could theoretically provide significant efficacy as bone grafts. In this study, we compared the bone mineralisation effectiveness of osteophytes and cancellous bone, including their effects on secretion of growth factors and anabolic effects on osteoblasts. Methods Osteophytes and cancellous bone obtained from human patients were transplanted onto the calvaria of severe combined immunodeficient mice, with Calcein administered intra-peritoneally for fluorescent labelling of bone mineralisation. Conditioned media were prepared using osteophytes and cancellous bone, and growth factor concentration and effects of each graft on proliferation, differentiation and migration of osteoblastic cells were assessed using enzyme-linked immunosorbent assays, MTS ((3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium)) assays, quantitative real-time polymerase chain reaction, and migration assays. Results After six weeks, the area of mineralisation was significantly higher for the transplanted osteophytes than for the cancellous bone (43803 μm2, sd 14660 versus 9421 μm2, sd 5032, p = 0.0184, one-way analysis of variance). Compared with cancellous bone, the conditioned medium prepared using osteophytes contained a significantly higher amounts of transforming growth factor (TGF)-β1 (471 pg/ml versus 333 pg/ml, p = 0.0001, Wilcoxon rank sum test), bone morphogenetic protein (BMP)-2 (47.75 pg/ml versus 32 pg/ml, p = 0.0214, Wilcoxon rank sum test) and insulin-like growth factor (IGF)-1 (314.5 pg/ml versus 191 pg/ml, p = 0.0418, Wilcoxon rank sum test). The stronger effects of osteophytes towards osteoblasts in terms of a higher proliferation rate, upregulation of gene expression of differentiation markers such as alpha-1 type-1 collagen and alkaline phosphate, and higher migration, compared with cancellous bone, was confirmed. Conclusion We provide evidence of favourable features of osteophytes for bone mineralisation through a direct effect on osteoblasts. The acceleration in metabolic activity of the osteophyte provides justification for future studies evaluating the clinical use of osteophytes as autologous bone grafts. Cite this article: K. Ishihara, K. Okazaki, T. Akiyama, Y. Akasaki, Y. Nakashima. Characterisation of osteophytes as an autologous bone graft source: An experimental study in vivo and in vitro. Bone Joint Res 2017;6:73–81. DOI: 10.1302/2046-3758.62.BJR-2016-0199.R1.
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Affiliation(s)
- K Ishihara
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - K Okazaki
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | | | - Y Akasaki
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Y Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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