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Hodel S, Hasler J, Roth TA, Flury A, Sutter C, Fucentese SF, Fürnstahl P, Vlachopoulos L. Validation of a Three-Dimensional Weight-Bearing Measurement Protocol for Medial Open-Wedge High Tibial Osteotomy. J Clin Med 2024; 13:1280. [PMID: 38592100 PMCID: PMC10931564 DOI: 10.3390/jcm13051280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Three-dimensional (3D) deformity assessment and leg realignment planning is emerging. The aim of this study was to (1) validate a novel 3D planning modality that incorporates the weight-bearing (WB) state (3D WB) by comparing it to existing modalities (3D non-weight-bearing (NWB), 2D WB) and (2) evaluate the influence of the modality (2D vs. 3D) and the WB condition on the measurements. Three different planning and deformity measurement protocols were analyzed in 19 legs that underwent medial open-wedge high tibial osteotomy (HTO): (1) a 3D WB protocol, after 2D/3D registration of 3D CT models onto the long-leg radiograph (LLR) (3D WB), (2) a 3D NWB protocol based on the 3D surface models obtained in the supine position (3D NWB), and (3) a 2D WB protocol based on the LLR (2D WB). The hip-knee-ankle angle (HKA), joint line convergence angle (JLCA), and the achieved surgical correction were measured for each modality and patient. All the measurement protocols demonstrated excellent intermodal agreement for the achieved surgical correction, with an ICC of 0.90 (95% CI: 0.76-0.96)) (p < 0.001). Surgical correction had a higher mean absolute difference compared to the 3D opening angle (OA) when measured with the WB protocols (3D WB: 2.7 ± 1.8°, 3D NWB: 1.9 ± 1.3°, 2D WB: 2.2 ± 1.3°), but it did not show statistical significance. The novel planning modality (3D WB) demonstrated excellent agreement when measuring the surgical correction after HTO compared to existing modalities.
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Affiliation(s)
- Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (A.F.)
| | - Julian Hasler
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (A.F.)
| | - Tabitha Arn Roth
- Research in Orthopedic Computer Science, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (P.F.)
| | - Andreas Flury
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (A.F.)
| | - Cyrill Sutter
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (A.F.)
| | - Sandro F. Fucentese
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (A.F.)
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (P.F.)
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 320, 8008 Zurich, Switzerland (A.F.)
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Mederake M, Eleftherakis G, Schüll D, Springer F, Maffulli N, Migliorini F, Konrads C. The gap height in open wedge high tibial osteotomy is not affected by the starting point of the osteotomy. BMC Musculoskelet Disord 2023; 24:373. [PMID: 37170106 PMCID: PMC10173475 DOI: 10.1186/s12891-023-06478-8] [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: 12/30/2022] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION In open-wedge high-tibial-osteotomy (OWHTO), most surgeons use a preoperative planning software and realise that they should match the intraoperative alignment correction with the preoperative plan. We aimed to determine whether there is a difference in osteotomy gap height when starting the OWHTO either 3 or 4 cm distal to the joint line. This should help to clarify whether the osteotomy starting point must exactly match the preoperative planning. METHODS 25 patients with constitutional varus alignment were planned for OWHTO. Long-leg-standing-radiographs and mediCAD-software were used. Osteotomy was planned to a neutral Hip-Knee-Ankle angle (HKA) of 0°. The osteotomy-starting-point was either 3 or 4 cm distal to the medial joint line. The following angles were compared: mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal femoral angle (mLDFA), joint line conversion angle (JCA), mechanical Tibio-Femoral angle (mTFA) or Hip Knee Ankle (HKA) angle. RESULTS 25 Patients (18 males, 7 females) had a mean age of 62 ± 16.6 years and showed a varus-aligned leg-axis. The HKA was - 5.96 ± 3.02° with a mMPTA of 82.22 ± 1.14°. After osteotomy-planning to a HKA of 0°, the mMPTA was 88.94 ± 3.01°. With a mean wedge height of 8.08 mm when locating the osteotomy 3 cm and a mean wedge height of 8.05 mm when locating the osteotomy 4 cm distal to the joint-line, there was no statistically significant difference (p = 0.7). CONCLUSION When performing an OWHTO aiming towards the tip of the fibula, the osteotomy starting point does not need to exactly match the planned starting-location of the osteotomy. A starting-point 1 cm more distal or proximal than previously determined through the digital planning does not alter the size of the osteotomy gap needed to produce the desired amount of correction.
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Affiliation(s)
- Moritz Mederake
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | | | - Daniel Schüll
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Fabian Springer
- Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, 84081, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, E1 4DG, England
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bozen, Bozen, 39100, Italy.
| | - Christian Konrads
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
- Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, Stralsund, Germany
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Coakley A, McNicholas M, Biant L, Tawy G. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee 2023; 40:97-110. [PMID: 36413904 DOI: 10.1016/j.knee.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/27/2022] [Accepted: 11/03/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Osteoarthritis is a prolific condition in an increasingly ageing and obese population. Research into treatments of this condition and their efficacy are vital. Outcomes of high tibial osteotomy (HTO) for the varus knee is widely reported. There is less evidence for HTO in the valgus knee. This systematic review aimed to compile all literature reporting the outcomes of HTO to correct the valgus knee, focusing on post-operative clinical outcomes. METHODS Ovid MEDLINE, Embase and Web of Science were searched using key terms: Osteoarthritis [All Fields] AND High tibial osteotomy [All Fields] AND Lateral OR Valgus [All Fields]. Papers were screened for eligibility based on an inclusion and exclusion criteria. Full text screening was completed by two reviewers and data was extracted from the agreed included papers by one reviewer. Quality assessments of the papers were also conducted. PROSPERO ID CRD42021239045. RESULTS Across 17 papers reporting 517 knees, the average pre-operative femorotibial and hip-knee-ankle angles were corrected from 13.6 ± 7.0° and 4.9 ± 1.9° valgus to 2.8 ± 2.9° and 1.2 ± 1.7° varus. Studies show that the procedure is successful at offloading the lateral knee compartment and some evidence it can delay the need for a total knee replacement. However, its impact on overall quality of life remains poorly understood. CONCLUSIONS High tibial osteotomy may be a viable treatment option for valgus knee deformities caused by lateral compartment osteoarthritis. Nevertheless, research into the procedure remains limited. Importantly, our understanding of the relationship between the achieved alignment and outcome remains largely unknown. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alannah Coakley
- Division of Medical Education, School of Medical Sciences, The University of Manchester, Manchester UK
| | - Michael McNicholas
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Orthopaedics, Aintree University Hospital, Liverpool University HOspitals NHS Foundation Trust, Liverpool, UK
| | - Leela Biant
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Orthopaedics, Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Centre of Health Sciences Research, University of Salford, Manchester, UK
| | - Gwenllian Tawy
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Xu K, Wang W, Wang Q, Sun J, Fang C, Sun Y, Shi T, Wu X, Yan Q. Comparison of computer-assisted navigated technology and conventional technology in high tibial osteotomy (HTO): a meta-analysis. Comput Assist Surg (Abingdon) 2022; 27:63-73. [PMID: 35882055 DOI: 10.1080/24699322.2022.2078739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Though some studies have reported navigated high tibial osteotomy (HTO) is a useful procedure to correct knee deformity. There is still great controversy whether navigated HTO can achieve better accuracy of limb alignment and greater clinical outcomes. Current meta-analysis was conducted to investigate whether better radiographic outcomes and clinical outcomes could be acquired in navigated HTO compared with the conventional procedure. METHOD We conducted a literature search in the electronic databases, including Medline, Embase, the Cochrane Library, and Web of Science. We identified studies published before August 2020. We also checked the references of the related articles for any relevant studies. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review. This research was performed using Review Manager 5.4 software. RESULTS Fourteen articles were included, involving 1399 knees. Our meta-analysis indicated that patients undergoing navigated HTO had significantly better outcomes in outliers of aimed limb alignment (RD=-0.24, 95% CI: =-0.34 to -0.13, p < 0.01), outliers of aimed tibial posterior slope (TPS) (RD=-0.41, 95% CI: -0.51 to -0.30, p < 0.01), Range of Motion (ROM) (MD = 6.37, 95%CI: 0.83-11.91, p = 0.02), and American knee society knee score (AKS knee score) (MD = 3.88, 95%CI: 1.37-6.39, p = 0.002). No significant differences were found in Lysholm score (MD = 1.30, 95%CI: -0.31 to 2.90, p = 0.11), American knee society function score (AKS function score) (RD = 1.42, 95%CI: -0.15 to 2.99, p = 0.08), complications (RD=-0.01, 95% CI: = -0.05 to 0.04, p = 0.77), delayed union (RD=-0.01, 95% CI: = -0.02 to 0.03, p = 0.59), and reoperation (RD = 0, 95% CI: -0.09 to 0.10, p = 0.98) between the two groups. The operation time in the navigated group was 15.46 min longer than in the conventional group. CONCLUSION Navigated HTO provided more accurate and reproducible radiographic outcomes in the correction of the malalignment than conventional techniques, and there is no difference in the risk of complications compared with conventional HTO. However, it is unclear whether navigation HTO can achieve better clinical results. More randomized controlled trials (RCTs) with high quality, large sample size, and sufficient follow-up period are required.
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Affiliation(s)
- Keteng Xu
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Weichao Wang
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Qin Wang
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Jun Sun
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Chen Fang
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Yusheng Sun
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Tulong Shi
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Xun Wu
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
| | - Qing Yan
- Department of Joint Surgery, Huangshan City People's Hospital, Huangshan, Anhui, China
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Clinical efficacy and feasibility of laser correction technology with an ordinary laser pen and surgical instrument box in open-wedge high tibial osteotomy. BMC Musculoskelet Disord 2022; 23:1019. [PMID: 36435822 PMCID: PMC9701429 DOI: 10.1186/s12891-022-05993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
The clinical outcomes of open-wedge high tibial osteotomy (OWHTO) for medial knee osteoarthritis primarily depend on the corrective precision. The present study aimed to determine the efficacy and feasibility of laser correction technology with an ordinary laser pen and surgical instrument box.
Methods
This prospective and randomized trial included 71 patients randomly divided into laser (n = 36) and traditional groups (n = 35). In the laser group, the hip centre, knee (Fujisawa point), and ankle centre were located preoperatively using the surgical instrument box lid. The leg was aligned with an ordinary laser pen. In the traditional group, the lower limb alignment was corrected by a metal cable. Radiation exposure, operative time, and rate of outliers (lower limb force line does not pass through 62–66% of the lateral tibial plateau) were evaluated. The visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. After 24 months, the femoral tibial angle (FTA), medial proximal tibial angle (MPTA), and posterior slope angle (PSA), were recorded. The Kaplan-Meier method was used to evaluate the survival time of affected knees, and postoperative complications were recorded.
Results
The radiation exposure, operative time and rate of outliers were lower in the laser correction group (P < 0.05). Six months postoperatively, the VAS and WOMAC scores were significantly improved in both groups (P < 0.001). At 24 months, the FTA, MPTA, and PSA were corrected in both groups (P < 0.001). There were no differences in the postoperative knee survival time from OWHTO to knee arthroplasty between the groups or postoperative complications (P = 0.53; P = 0.61).
Conclusions
Laser correction technology can effectively reduce radiation exposure, the operative time, and the rate of outliers (trial identification number (retrospectively registered): ChiCTR2200060480; date of register: 03/06/2022).
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MacLeod A, Mandalia V, Mathews J, Toms A, Gill H. Personalised 3D Printed high tibial osteotomy achieves a high level of accuracy: ‘IDEAL’ preclinical stage evaluation of a novel patient specific system. Med Eng Phys 2022; 108:103875. [DOI: 10.1016/j.medengphy.2022.103875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
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Van fraeyenhove B, Oussedik S. Navigation Guided Corrective Osteotomy (based on surgical technique). OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cerciello S, Ollivier M, Corona K, Kaocoglu B, Seil R. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:555-566. [PMID: 32910222 DOI: 10.1007/s00167-020-06253-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Medial open-wedge high tibial osteotomy (MOWHTO) is an accepted option in the treatment of medial compartment osteoarthritis of the knee in young and active patients. Functional results are closely correlated to the correction of the mechanical axis of the lower limb. Although several angular and geometrical methods and values have been proposed in the past, the ideal target is still debated. In addition, it is important to have a deep correlation between the planned correction and the achieved correction after surgery. The aim of the present systematic review was to identify the ideal coronal correction after MOWHTO and the most accurate method to achieve it. METHODS A systematic review of the literature was completed on July 3rd 2020 in the Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the Medical Subject Headings (MeSH) terms: "high tibial osteotomy" AND "accuracy" OR "planning". RESULTS 28 studies were included; 18 were focused on computer-assisted surgery (CAS) and 10 on patient-specific instrumentation (PSI). There were 598 patients in the CAS group and 501 in the control group; the rate of outliers was 16% and 38.2% respectively (P = 0.04), while there was no significant difference between the two groups (SMD = - 0.10; 95% CI 1.31 to 1.12; P = n.s.) in terms of coronal accuracy. Likewise, there were 318 patients in the PSI group and 40 in the control group; the rate of outliers was 15% and 40% respectively (P = 0.98), while there was no significant difference between the two groups (SMD = 0.01; 95% CI 0.58 to 0.59; P = 0.98). CONCLUSIONS A statistically significant reduced outlier rate and a non-significant increased accuracy emerged with the use of CAS when compared to the traditional surgical technique, whereas the results of PSI were still inconclusive. In addition, it emerged clearly that no consensus still exists on the ideal correction target to be achieved after surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S Cerciello
- Casa di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy
| | - M Ollivier
- Department of Orthopedics and Traumatology, Institute for Locomotion, Sainte-Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Marseille, France
| | - K Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - B Kaocoglu
- Department of Orthopaedics and Traumatology, Acibadem University, İstanbul, Turkey
| | - R Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, 76 Rue d'Eich, 1460, Luxembourg, Luxembourg
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Kim MS, Koh IJ, Sung YG, Park DC, Han SB, In Y. Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy. BMC Musculoskelet Disord 2021; 22:585. [PMID: 34172033 PMCID: PMC8235825 DOI: 10.1186/s12891-021-04475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO). Methods Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery. Results The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05). Conclusion Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO. Level of evidence Level III.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Bin Han
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Jud L, Fürnstahl P, Vlachopoulos L, Götschi T, Leoty LC, Fucentese SF. Malpositioning of patient-specific instruments within the possible degrees of freedom in high-tibial osteotomy has no considerable influence on mechanical leg axis correction. Knee Surg Sports Traumatol Arthrosc 2020; 28:1356-1364. [PMID: 30806756 DOI: 10.1007/s00167-019-05432-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/19/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Patient-specific instruments (PSIs) are helpful tools in high tibial osteotomy (HTO) in patients with symptomatic varus malalignment of the mechanical leg axis. However, the precision of HTO can decrease with malpositioned PSI. This study investigates the influence of malpositioned PSI on axis correction, osteotomy, and implant placement. METHODS With a mean three-dimensional (3D) model (0.8° varus), PSI-navigated HTOs were computer simulated. Two different guide designs, one with stabilising hooks and one without, were used. By adding rotational and translational offsets of different degrees, wrong placements of PSI were simulated. After 5° valgisation of the postoperative mechanical axis, the distance between joint-plane and osteotomy screws, respectively, were measured. The same simulations were performed in a patient with varus deformity (7.4° varus). RESULTS In the mean 3D model, the postoperative mechanical axis was within 3.9°-4.5° valgus with mean value of 4.1° ± 0.1° (correct axis 4.2° valgus). Surgical failure concerning osteotomy occurred in 17 of 76 HTOs. Significantly safer screw placement was observed using PSI with stabilising hooks (p = 0.012). In the case of the 3D model with 7.4° varus deformity, the postoperative mechanical axis was within 3.2°-3.9° valgus with mean value of 3.8° ± 0.2° (correct axis 3.9° valgus). Surgical failure concerning osteotomy occurred in 3 of 38 HTOs. Screws were always within the safety distance. CONCLUSION The clinical relevance of the presented study is that malpositioning of a PSI within the possible degrees of freedom does not have a relevant influence on the axis correction. The most vulnerable plane for surgical failure is the sagittal plane, wherefore the treating surgeon should verify correct guide placement to prevent surgical failure, particularly in this plane. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group (CARD), University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Laura Catherine Leoty
- Computer Assisted Research and Development Group (CARD), University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Südkamp N, Niemeyer P, Bode G. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Knee Surg Sports Traumatol Arthrosc 2019; 27:2334-2344. [PMID: 30291397 DOI: 10.1007/s00167-018-5194-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Valgus high tibial osteotomy (HTO) and a recently introduced extra-articular absorber have been shown to efficiently unload the medial compartment of the knee. However, only little is known about the influence of these treatment modalities on biomechanics of the patellofemoral joint. The purpose of this study was to investigate and compare the impact of different HTO techniques and implantation of an extra-articular absorber on patellofemoral contact forces. METHODS Fourteen fresh frozen cadaveric knees were tested in a specially designed knee simulator that allowed simulation of isokinetic flexion-extension motions under physiological loading. Mean contact pressure (ACP) and peak contact pressure (PCP) of the patellofemoral joint was measured continuously between 0° and 120° of knee flexion using a pressure sensitive film in the following conditions: native, after biplanar medial open-wedge HTO with 5° and 10° correction angle performing an ascending frontal osteotomy of the tibial tuberosity, and after implantation of an extra-articular absorber system (KineSpring®). Including a second testing cycle with a biplanar medial open-wedge HTO with 5° and 10° correction angle performing descending frontal osteotomy of the tibial tuberosity. Values after each procedure were compared to the corresponding values of the native knee. RESULTS Biplanar proximal osteotomy leaded to a significant increase of retropatellar compartment area contact pressure compared to the first untreated test cycle (Δ 0.04 ± 0.01 MPa, p = 0.04). Similar results were observed measuring peak contact pressure (Δ 1.41 ± 0.15 MPa, p = 0.03). With greater correction angle 5°, respectively, 10° peak and contact pressure increased accordingly. In contrast, the biplanar distal osteotomy group showed significant decrease of pressure values (p = 0.004). The extracapsular, extra-articular absorber had no significant influence on pressure levels in the patellofemoral joint. CONCLUSION HTO with a proximal biplanar osteotomy of the tuberositas tibia significantly increased patellofemoral pressure conditions depending on the correction angle. In contrast a distally directed biplanar osteotomy diminished these effects while implantation of an extracapsular, extra-articular absorber had no influence on the patellofemoral compartment at all. Consequently, patients with varus alignment with additional retropatellar chondropathia should be treated with a distally adverted osteotomy to avoid further undesirable pressure elevation in the patellofemoral joint.
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Affiliation(s)
- Ferdinand Kloos
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
| | - Christoph Becher
- Orthopaedic Department, Hannover Medical School, Hannover, Germany
| | | | - Matthias J Feucht
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Lisa Hohloch
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Norbert Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Bode G, Kloos F, Feucht MJ, Fleischer B, Südkamp N, Niemeyer P, Becher C. Comparison of the efficiency of an extra-articular absorber system and high tibial osteotomy for unloading the medial knee compartment: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2017; 25:3695-3703. [PMID: 27761624 DOI: 10.1007/s00167-016-4358-9] [Citation(s) in RCA: 12] [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: 06/01/2016] [Accepted: 10/07/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The unloading effect of an extra-articular absorber system on the knee joint medial compartment was compared with high tibial osteotomy (HTO) under physiological conditions in vitro. METHODS Seven fresh-frozen cadaveric knees were used to test isokinetic flexion-extension motions under physiological loading using a biomechanical knee simulator. Tibiofemoral area contact and peak contact pressures were measured using pressure-sensitive film in the untreated medial compartment. Pressures were measured after KineSpring System implantation and HTO (5° and 10° correction angles) performed with an angular-stable internal fixator (Tomofix). RESULTS Implantation of the unloading device resulted in significantly decreased medial compartment area contact pressure (Δ0.02 ± 0.01 MPa, p = 0.001) and peak contact pressure (Δ0.3 ± 0.1 MPa, p = 0.001) compared with the first test cycle results in the untreated knee. HTO significantly decreased the pressure (p = 0.001). Compared with the first test cycle, HTO (5° correction angle) decreased the mean contact pressure by Δ0.03 ± 0.01 MPa and peak contact pressure by Δ0.3 ± 0.01 MPa. With a 10° correction angle, HTO decreased contact pressure by Δ0.04 ± 0.02 MPa and peak contact pressure by Δ0.4 ± 0.1 MPa compared with that at the 5° correction angle. CONCLUSION Implantation of an extra-capsular unloading device resulted in a significant unloading effect on the medial compartment comparable to that achieved with HTO at 5° and 10° correction angles. Thus, implantation of an extra-articular, extra-capsular absorber could become the method of choice when treating patients with unicompartmental osteoarthritis that cannot be adequately treated by HTO because of their straight-leg axis.
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Affiliation(s)
- Gerrit Bode
- Department of Orthopedic Surgery and Traumatology, Clinic of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany.
| | - Ferdinand Kloos
- Department of Orthopedic Surgery and Traumatology, Clinic of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany
| | - Matthias J Feucht
- Department of Orthopedic Surgery and Traumatology, Clinic of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany
| | - Benjamin Fleischer
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Norbert Südkamp
- Department of Orthopedic Surgery and Traumatology, Clinic of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopedic Surgery and Traumatology, Clinic of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany
| | - Christoph Becher
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
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Effect of Computer Navigation on Accuracy and Reliability of Limb Alignment Correction following Open-Wedge High Tibial Osteotomy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3803457. [PMID: 29130040 PMCID: PMC5654296 DOI: 10.1155/2017/3803457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/06/2017] [Indexed: 11/18/2022]
Abstract
Background It is unclear whether computer navigation can improve the accuracy and reliability of targeted lower limb alignment correction following open-wedge high tibial osteotomy (HTO). This meta-analysis was designed to compare the accuracy and reliability of limb alignment correction between computer navigated and conventional open-wedge HTOs. Methods Studies that compared postoperative coronal alignment, including mechanical axis (MA) and weight bearing line (WBL) ratio, outliers of alignment correction, and change in tibial posterior slope, following open-wedge HTO performed using computer navigated and conventional methods were included. Results Ten studies were included in the meta-analysis. The MA (0.93°; 95% confidence interval [CI]: 0.45–1.41°; P < 0.001) and WBL ratio (1.5%; 95% CI: 0.03–2.98%; P = 0.048) were significantly greater for computer navigated HTO than for conventional HTO. Outliers of alignment correction after surgery were significantly lower in patients who underwent computer navigated HTO than in those who underwent conventional HTO (odds ratio: 0.25; 95% CI: 0.08–0.79; P = 0.02). Changes in posterior tibial slope from before to after surgery, however, were similar for the two approaches. Conclusion Computer navigated HTO resulted in slightly more valgus postoperative alignment and effectively reduced outliers of alignment correction but had no effect on change in posterior tibial slope when compared with conventional HTO.
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Kim MS, Son JM, Koh IJ, Bahk JH, In Y. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2017; 137:1035-1045. [PMID: 28593581 DOI: 10.1007/s00402-017-2729-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A considerable percentage of outliers with under- or over-correction continue to be reported despite precise preoperative planning and cautious intraoperative correction of lower limb alignment in medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether our novel technique for the intraoperative adjustment of alignment under valgus stress reduces the number of outliers in patients undergoing MOWHTO compared to the conventional technique, which corrects alignment according to the cable method only. MATERIALS AND METHODS One hundred seventeen consecutive knees were enrolled in this case-control study. The first 52 knees (51 patients) were corrected in accordance with preoperative plans using the Dugdale method with modification with an intraoperative cable (group 1). In the other 65 knees (60 patients), the angle was corrected using the Dugdale method and limb alignment was adjusted using the intraoperative cable technique by applying valgus stress to the knee joint (group 2). The postoperative weight bearing line ratios and mechanical axis of the lower limb were compared at postoperative one year. Each knee was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative one year. RESULTS A significant reduction in the number of outliers was seen in group 2 compared to group 1 (group 1 = 48.1%, group 2 = 9.2%, p < 0.001). Nineteen of 52 knees (36.5%) were under-corrected in group 1, whereas 6 of 65 knees (9.2%) were under-corrected in group 2 (p < 0.001). Six of 52 knees (11.6%) were over-corrected in group 1, whereas 0 of 65 knees (0.0%) were over-corrected in group 2 (p = 0.005). At one -year after operation, group 2 showed significantly lower WOMAC score than group 1 (p = 0.014). CONCLUSIONS Intraoperative adjustment of alignment under valgus stress significantly reduced the number of outliers compared to a technique that corrected alignment using the cable method in patients undergoing MOWHTO. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jong Min Son
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hoon Bahk
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea.
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Kochergin PG, Kornilov NN, Kulyaba TA. THE INFLUENCE OF COMPUTER-ASSISTED SURGERY ON CLINICAL AND RADIOGRAPHIC OUTCOMES OF PERIАRTICULAR FEMUR AND TIBIA OSTEOTOMIES IN OSTEOARTHRITIC PATIENTS (REVIEW). TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2017. [DOI: 10.21823/2311-2905-2017-23-1-163-175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Song SJ, Bae DK. Computer-Assisted Navigation in High Tibial Osteotomy. Clin Orthop Surg 2016; 8:349-357. [PMID: 27904715 PMCID: PMC5114245 DOI: 10.4055/cios.2016.8.4.349] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 11/25/2022] Open
Abstract
Computer-assisted navigation is used to improve the accuracy and precision of correction angles during high tibial osteotomy. Most studies have reported that this technique reduces the outliers of coronal alignment and unintended changes in the tibial posterior slope angle. However, more sophisticated studies are necessary to determine whether the technique will improve the clinical results and long-term survival rates. Knowledge of the navigation technology, surgical techniques and potential pitfalls, the clinical results of previous studies, and understanding of the advantages and limitations of the computer-assisted navigation are crucial to successful application of this new technique in high tibial osteotomy. Herein, we review the evidence concerning this technique from previous studies.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3529-3555. [PMID: 27665094 DOI: 10.1007/s00167-016-4327-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates radiographic and clinical outcome reporting following navigated high tibial osteotomy (HTO). Conventional HTO was used as a control to compare outcomes and furthermore investigate the quality of evidence in studies reporting outcomes for navigated HTO. It was hypothesized that navigated HTO will show superior clinical and radiographic outcomes compared to conventional HTO. METHODS Two independent reviewers searched PubMed, Ovid (MEDLINE), EMBASE, and Cochrane databases for studies reporting outcomes following navigated HTO. Titles, abstracts, and full-text were screened in duplicate using an a priori inclusion and exclusion criteria. Descriptive statistics were calculated using Minitab ® statistical software. Methodological Index for Nonrandomized Studies (MINORS) and Cochrane Risk of Bias Scores were used to evaluate methodological quality. RESULTS Thirty-four studies which involved 2216 HTOs were analysed in this review, 1608 (72.6 %) navigated HTOs and 608 (27.4 %) conventional HTOs. The majority of studies were of level IV evidence (16). Clinical outcomes were reported in knee and function scores or range of motion comparisons. Postoperative clinical and functional scores were improved by navigated HTO although it is not demonstrated if there is significant improvement compared to conventional HTO. Most common clinical outcome score reported was Lysholm scores (6) which report postoperative scores of 87.8 (standard deviation 5.9) and 88.8 (standard deviation 5.9) for conventional and navigation-assisted HTO, respectively. Radiographic outcomes reported commonly were weight-bearing mechanical axis, coronal plane angle, and posterior tibial slope angle in the sagittal plane. Studies have shown HTO gives significant correction of mechanical alignment and navigated HTO produces significantly less change in posterior tibial slope postoperatively compared to conventional. The mean MINORS for the 17 non-comparative studies was 9/16, and 15/24 for the 14 non-randomized comparative studies. CONCLUSION Navigation HTO results in improved mechanical axis alignment and demonstrates significantly better control over the tibial slope angle change postoperatively compared to conventional methods; however, these improvements have not yet been reflected in clinical outcome scores. Overall the studies report HTO does create significantly improved knee scores and functions compared to patients' preoperative ratings regardless of technique. Future studies on HTO outcomes need to focus on consistency of outcome reporting. LEVEL OF EVIDENCE IV.
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Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015; 23:1949-55. [PMID: 24241123 DOI: 10.1007/s00167-013-2762-y] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Open-wedge high tibial osteotomy using internal plate fixation is a well-established and frequently performed treatment option for the management of medial compartment osteoarthritis (OA) in the young and active patients. The present study provides survival rate and functional outcome preoperatively and after 6, 12, 24, 36 and 60 months following open-wedge high tibial osteotomy. Hypothesis of the authors was high survival rates after 5 years with still remaining satisfying functional results. METHODS Sixty-two patients suffering from tibial conditioned knee joint varus deformity and medial compartment OA that underwent high tibial osteotomy using an internal plate fixator (TomoFix™, Synthes) were included. Functional outcome was evaluated prior to surgery and in the further clinical course using standard instruments (IKDC score, Lysholm score). Treatment failure was defined as the need for total knee arthroplasty (TKA). RESULTS Fifty-one patients (mean age 46.8 ± 10.2 years) were available at a mean of 60.5 (SD ± 2.5) months (follow-up rate 82.3 %) postoperatively. Sixty-month IKDC (69.4 % SD ± 18.6) and Lysholm (76.6 SD ± 20.5) improved significantly when comparing with preoperative values (IKDC 44.6 SD ± 17.8; Lysholm 52.1 SD ± 20.8). Two of 51 subjects underwent TKA, resulting in a survival rate of 96 % among those patients followed (51 of 60; 85 %). Overall complication rate was 8.6 %. CONCLUSION With a survival rate of over 96 % at 5 years, high tibial osteotomy seems to be a reliable treatment option with satisfying clinical outcome. Functional outcome was stable following 60 months. While a delay of the necessity for TKA seems likely with regard to the survival rate demonstrated in this article, possible avoidance needs to be demonstrated by longer follow-up studies. LEVEL OF EVIDENCE Therapeutic case series, Level IV.
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Hasan K, Rahman QA, Zalzal P. Navigation versus conventional high tibial osteotomy: systematic review. SPRINGERPLUS 2015; 4:271. [PMID: 26090318 PMCID: PMC4469593 DOI: 10.1186/s40064-015-1040-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/13/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION One major use for high tibial osteotomy aims at improving alignment in the symptomatic, varus malaligned, medial compartment osteoarthritic knee. The importance of achieving correct alignment is obvious upon considering the increased potential for significant complications with over- or undercorrection in any plane. The aim of this systematic review was to compare navigation and conventional high tibial osteotomy. METHODS This systematic review searched the MEDLINE and EMBASE databases to compare the short-term clinical and radiological outcomes between patients undergoing either conventional or navigated high tibial osteotomy. RESULTS We retrieved 71 articles, which ultimately resulted in 14 eligible studies for inclusion. Though heterogeneity prevented statistical analysis, only one study failed to suggest superiority of navigation over conventional techniques. CONCLUSION Navigated high tibial osteotomy improves accuracy over conventional techniques, though the current best evidence presented herein must be advanced by higher quality studies.
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Affiliation(s)
- Khaled Hasan
- Department of Orthopedic Surgery, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
| | - Qusai Abdel Rahman
- University of Toronto, 3359 Mississauga Rd, Mississauga, ON L5L 1C6 Canada
| | - Paul Zalzal
- Department of Orthopedic Surgery, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8 Canada
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Opening wedge high tibial osteotomy: navigation system compared to the conventional technique in a controlled clinical study. INTERNATIONAL ORTHOPAEDICS 2014; 38:1627-31. [PMID: 24722788 DOI: 10.1007/s00264-014-2341-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to verify if the navigation system used in high tibial osteotomy (HTO) adds precision to the procedure regarding mechanical axis correction and prevention of tibial slope increases. METHODS In this historically controlled study, patients with medial osteoarthrosis and genuvarum underwent HTO between 2004 and 2012; the first 20 were operated with the conventional technique, using pre-planning correction by the Dugdale method and 18 further patients were operated with the navigation system introduced in our hospital. RESULTS The two groups were similar for pre-operative mechanical axis (mean 8.10 ± 3.14 for the control and 6.60 ± 2.50 for the navigated group), pre-operative tibial slope (mean 8.95 ± 3.47 versus 8.17 ± 3.11, respectively) and Lyshom score (40.85 ± 15.46 and 44.83 ± 16.86). After surgery, the control group presented mean mechanical axis of 3.35 ± 3.27, tibial slope of 13.75 ± 3.75 and Lyshom score of 87.60 ± 11.12. The navigated group showed a postoperative mechanical axis mean of 3.06 ± 1.70, tibial slope of 10.11 ± 0.18 and Lyshom score of 91.94 ± 11.61. CONCLUSIONS The navigation system allowed a significantly better control of tibial slope. Patients operated with the navigation system had significantly better Lysholm scores.
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Abstract
Problems of the proximal tibiofibular joint (pTFj) after high tibial osteotomy (HTO) are rare. With this case report, we strive to highlight the importance of investigating the pTFj in patients with unexplained knee pain after HTO. A 44 year old male patient presented with diffuse pain on his left knee 3 years after medial opening wedge HTO due to medial compartment overloading in a varus knee. Patient described persistent anterior tibial and lateral knee pain. 2 years after HTO, patient underwent implant removal but the knee pain persisted. As the reason for the persistent pain was not identified, further radiological evaluation was done. Single photon emission computerized tomography/computerized tomography (SPECT/CT) revealed that there was no increased uptake within the tibiofemoral joint, indicating a biologically well performed correction of the varus deformity. However, markedly increased tracer uptake was found at the pTFj. On the inherent axial CT scans, it was seen that the proximal screws were too long and placed within the pTFj. Along with this a severe osteoarthritis of the pTFj was identified. The cause of the patient's pain was then confirmed by a CT guided infiltration of local anesthetic. An arthrodesis of the pTFj was performed and at 12 months followup after the arthrodesis the patient was pain free. This case highlights how important it is to evaluate the pTFj in patients with unexplained pain after HTO. SPECT/CT was helpful in identifying the patient's problem in this challenging case.
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Affiliation(s)
- Enrique Adrian Testa
- Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Standort Bruderholz, CH 4101Bruderholz, Switzerland,Address for correspondence: Dr. Enrique Adrian Testa, Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Standort Bruderholz, CH 4101Bruderholz, Switzerland. E-mail:
| | - David L Haeni
- Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Standort Bruderholz, CH 4101Bruderholz, Switzerland
| | - Gerrit Behrens
- Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Standort Bruderholz, CH 4101Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Standort Bruderholz, CH 4101Bruderholz, Switzerland
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Preoperative surgical planning versus navigation system in valgus tibial osteotomy: a cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2013; 37:1483-6. [PMID: 23775452 DOI: 10.1007/s00264-013-1960-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of this study was to verify whether the correction obtained using a navigation system (NS) corresponds to the wedge calculated by the Dugdale method (DM) in high tibial osteotomy (HTO). METHODS We included 17 patients with primary varus and HTO indication, consecutively admitted to a public university hospital. All patients underwent panoramic radiography with bipedal load for the wedge calculation by DM. They underwent HTO with an opening wedge, fixed with an HTO plate and monitored by the OrthoPilot NS. Bone grafts were used in every case. The wedge opening obtained by the NS was compared to that calculated in the radiographs. RESULTS The mean opening by DM was 9.53° and by the NS 11.8° (p < 0.045). CONCLUSIONS There was a significant difference in the calculation of the wedge opening between the DM and NS. HTO without the aid of the NS could theoretically lead to undercorrection of the deformity.
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Young SW, Safran MR, Clatworthy M. Applications of computer navigation in sports medicine knee surgery: an evidence-based review. Curr Rev Musculoskelet Med 2013; 6:150-7. [PMID: 23483407 DOI: 10.1007/s12178-013-9166-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Computer-assisted surgery (CAS) has been investigated in a number of sports medicine procedures in the knee. Current barriers to its widespread introduction include increased costs, duration, and invasiveness of surgery. Randomized trials on the use of CAS in anterior cruciate ligament reconstruction have failed to demonstrate a clinical benefit. Data on CAS use in high tibial osteotomy are more promising; however, long-term studies are lacking. CAS has a number of research applications in knee ligament surgery, and studies continue to explore its use in the treatment of osteochondral lesions. This article reviews the applications of CAS in sports medicine knee surgery and summarizes current literature on clinical outcomes.
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Affiliation(s)
- Simon W Young
- Department of Sports Medicine, Stanford Hospital, 450 Broadway St., MC 6342, Redwood City, CA, 94036, USA,
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Computer-assisted navigation for the intraoperative assessment of lower limb alignment in high tibial osteotomy can avoid outliers compared with the conventional technique. Knee Surg Sports Traumatol Arthrosc 2013; 21:181-8. [PMID: 22760216 DOI: 10.1007/s00167-012-2088-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Longterm outcomes after valgization high tibial osteotomy (HTO) to treat varus osteoarthritis seem to depend mainly on correction precision. Intraoperative assessment of leg alignment based on radiological visualization of the mechanical axis is difficult and its precision is limited. A promising approach to improving precision is to make use of navigation systems. The case-control study reported here involved the evaluation of patients whose varus osteoarthritis had been treated by open-wedge high tibial ostoetomy, and an analysis of the effect of computer-guided navigation on postoperative leg alignment. METHODS Forty patients with medial varus osteoarthritis managed by open-wedge high tibial osteotomy using a surgical navigation system were included in the present study (Group 1). They were compared with a retrospective control group (Group 2) of 40 patients with respect to postoperative leg alignment, correlation of planned and definitive correction, and postoperative deviation from the Fujisawa point. RESULTS The mean values for planned and definitive correction showed no significant differences for identical demographic data. As a percentage of the width of the tibial plateau the postoperative weight-bearing radiographs showed a mechanical line that intersected with the knee base line at the desired value of 62% (Fujisawa point) in 58.8% (SD ± 6.1) in Group 1 and in 58.6% (SD ± 8.1) in Group 2. Despite similar mean values a significantly higher number of corrections were outside the reference area (n = 7) in the non-navigated group, whereby all corrections were within the desired range in the navigated group. There were no significant differences in operation time. CONCLUSIONS This study showed that the use of a navigation system can not increase the precision of the open-wedge HTO procedure in patients with varus osteoarthritis but it can eliminate the outliers of a well defined range. LEVEL OF EVIDENCE Case-control study, Retrospective comparative study, Level III.
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A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5°. Arch Orthop Trauma Surg 2013; 133:43-9. [PMID: 23109095 DOI: 10.1007/s00402-012-1637-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE High tibial osteotomy (HTO) is a recommended concomitant surgery when treating cartilage lesions of the medial femoral condyle (MFC). Varus deformities of 5° and more were considered an indication for HTO in patients with cartilage defects. This study compares clinical outcome in patients with ACI and concomitant varus deformity of <5° with or without additional HTO. METHODS 43 patients with isolated cartilage defect of the MFC and varus deformity between 1° and 5° (mean age 39.14 ± 8.35 years; mean varus deformity 2.84 ± 1.19°) were included (follow-up 71.88 ± 23.99 months). Group A (n = 19) was treated with ACI and additional HTO; group B (n = 24) received ACI only. Survival rate in terms of absence of the need of reintervention was defined as main outcome parameter. In the subgroup without reintervention, functional outcome (KOOS and WOMAC) was evaluated. RESULTS Overall rate of reintervention was 12 (27.9 %). Survival was significantly higher in group A (group A 89.5 %, group B 58.33 %; p = 0.023). Although a trend for better clinical outcome was observed for group A in the subgroup without reintervention, this observation lacked statistical significance (KOOS(symptoms) group A 73.23, group B 59.64; p = 0.274). CONCLUSION While there is general consensus for treating varus deformities of >5° in patients with cartilage lesions of the medial femoral condyle, HTO also leads to a reduced rate of reinterventions and longer survival rates in patients with varus deformities of <5°.
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Lee DH, Nha KW, Park SJ, Han SB. Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy. Arthroscopy 2012; 28:1842-50. [PMID: 22863330 DOI: 10.1016/j.arthro.2012.05.881] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 05/28/2012] [Accepted: 05/31/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether navigation-assisted intraoperative lower limb alignment in open wedge high tibial osteotomy (HTO) correlates with preoperative and postoperative radiographic alignment. METHODS This prospective study involved 35 patients (39 knees) who underwent navigation HTO for primary medial osteoarthritis. The mechanical axis (MA) and weight-bearing line (WBL) ratio were calculated from preoperative radiographs, intraoperative navigation, and postoperative (6 months) radiographs. Reliability between navigation and radiographic alignment was analyzed by use of intraclass correlation coefficients (ICCs) with thresholds as follows: good, greater than 0.75; fair, 0.4 to 0.75; and poor, less than 0.4. The surgical target for the MA was a final valgus overcorrection of 2° to 8°, and the WBL ratio target was between 50% and 70%. Outliers for differences between intraoperative navigation and postoperative radiographic results were defined as greater than ±3° for the MA and greater than ±10% for the WBL ratio. RESULTS The MA target was achieved in 33 of 39 knees (84.6%), and the WBL ratio target was achieved in 30 of 39 knees (74.4%). ICCs for navigational reliability were good for preoperative MA and WBL ratio and fair for postoperative MA and WBL ratio. The ICCs for the MA were better than those for the WBL ratio for both preoperative and postoperative measurements. The differences between the number of outliers between the navigation and radiographic MA and WBL were greater postoperatively than preoperatively. In addition, the postoperative differences in the extent of the outliers between navigation and radiographic measurements were greater for WBL ratios than the MA (P = .023). CONCLUSIONS This study found that use of a navigation system achieved the target value for MA lower limb correction in over 80% of open wedge HTO cases, using radiographic data as the gold standard for alignment. Because the navigational measurements of lower limbs during open wedge HTO did not correlate with postoperative radiographic alignment, corrections should not be based solely on navigational results. In assessing the reliability of navigational open wedge HTO for correction of lower limb alignment, the MA is a better radiologic parameter than the WBL ratio. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Korea University, Anam Hospital, Seoul, South Korea
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Picardo NE, Khan W, Johnstone D. Computer-assisted navigation in high tibial osteotomy: a systematic review of the literature. Open Orthop J 2012; 6:305-12. [PMID: 22896778 PMCID: PMC3415684 DOI: 10.2174/1874325001206010305] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/28/2012] [Accepted: 03/10/2012] [Indexed: 12/02/2022] Open
Abstract
High tibial osteotomy (HTO) is a procedure which aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success. In this article, we systematically review the computer-assisted techniques that have been used in attempts to increase the accuracy of the surgery and improve postoperative outcomes. The results of the cadaveric and clinical studies to date are presented and the benefits and pitfalls of navigation are discussed.
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Affiliation(s)
- Natasha E Picardo
- Bone Tumour Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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