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Higuchi T, Koseki H, Yonekura A, Imai C, Tomonaga I, Sunagawa S, Matsumura U, Osaki M. Comparison of short-term clinical outcomes between open-wedge high tibial osteotomy and tibial condylar valgus osteotomy. BMC Musculoskelet Disord 2024; 25:98. [PMID: 38281004 PMCID: PMC10821256 DOI: 10.1186/s12891-024-07205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND This study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures. METHODS Twenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively. RESULTS Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0). CONCLUSIONS Both osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.
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Affiliation(s)
- Takashi Higuchi
- Department of Physical Therapy, Osaka University of Human Sciences, Settsu, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chieko Imai
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Iku Tomonaga
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Umi Matsumura
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ramos Marques N. Author Reply to "Regarding 'Anterior Slope Correction-Flexion Osteotomy in Traumatic Genu Recurvatum'". Arthroscopy 2023; 39:2258-2259. [PMID: 37866860 DOI: 10.1016/j.arthro.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
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Van Genechten W, Van Haver A, Bartholomeeusen S, Claes T, Van Beek N, Michielsen J, Claes S, Verdonk P. Impacted bone allograft personalised by a novel 3D printed customization kit produces high surgical accuracy in medial opening wedge high tibial osteotomy: a pilot study. J Exp Orthop 2023; 10:24. [PMID: 36917322 PMCID: PMC10012299 DOI: 10.1186/s40634-023-00593-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Contemporary medial opening wedge high tibial osteotomy (MOWHTO) still seems to struggle with inconsistent accuracy outcomes. Our objective was to assess surgical accuracy and short-term clinical outcomes when using 3D planning and a patient-specific instrumentation (PSI) kit to prepare customized bone allografts. METHODS Thirty subjects (age 48y ± 13) were included in a double-center prospective case series. A low-dose CT-scan was performed to generate 3D bone models, a MOWHTO was simulated, and PSI was designed and 3D printed based on the complementary negative of the planned osteotomy gap. Clinical outcome was assessed at two, four, 12 weeks and one year using NRS, KOOS, UCLA activity score, EQ-5D and anchor questions. A linear-mixed model approach was implemented for data analysis. RESULTS Preoperative 3D values were 175.0° ± 2.2 mechanical tibiofemoral angle (mTFA), 85.0° ± 3.0 medial proximal tibial angle (MPTA), and 94.1° ± 3.4 medial posterior tibial slope (MPTS). Target planning ranged from slight varus to the lateral tibial spine (slight valgus). Postoperative 3D analysis showed an accuracy of 1.1° ± 0.7 ΔMPTA (p = 0.04) and 1.2° ± 1.2 ΔMPTS (p = 0.11). NRS decreased from baseline 6.1 ± 1.9 to 2.7 ± 1.9 at four weeks (p < 0.001) and 1.7 ± 1.9 at one year (p < 0.001). KOOS increased from 31.4 ± 17.6 to 50.6 ± 20.6 at 12 weeks (p < 0.001) and to 71.8 ± 15.6 at one year (p < 0.001). CONCLUSION The study suggests that 3D printed instrumentation to personalize structural bone allograft is a viable alternative method in MOWHTO that has the benefit of optimizing surgical accuracy while providing early and consistent pain relief after surgery.
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Affiliation(s)
- Wouter Van Genechten
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium. .,More Institute, Antwerp, Belgium. .,Orthopedic Department, AZ Herentals, Herentals, Belgium.
| | | | | | - Toon Claes
- Orthopedic Department, AZ Herentals, Herentals, Belgium
| | | | - Jozef Michielsen
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium
| | | | - Peter Verdonk
- Orthopedic Department, University Hospital Antwerp, Antwerp, Belgium.,More Institute, Antwerp, Belgium.,ORTHOCA, Antwerp, Belgium
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Uçan V, Aliyev O, Demirkiran CB, Yildiz F, Elmali N, Uzer G. Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:51-56. [PMID: 34781390 DOI: 10.1055/a-1611-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO). METHODS From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL). RESULTS No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (- 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01). CONCLUSION SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.
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Affiliation(s)
- Vahdet Uçan
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | | | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Nurzat Elmali
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
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Ryu DJ, Park SJ, Lee DH, Kwon KB, Choi GH, Kim IS, Wang JH. Does the anteromedial plate position affect proximal screw length and worsen the clinical outcomes in medial opening wedge high tibial osteotomy? BMC Musculoskelet Disord 2023; 24:14. [PMID: 36611141 PMCID: PMC9824977 DOI: 10.1186/s12891-022-06080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During medial opening wedge high tibial osteotomy (MOWHTO), sometimes the plate tends to be positioned anteromedially. The plate position can affect the length of the proximal screw, which significantly affects stability after osteotomy. Therefore, research on the correlation among plate position, screw length, and clinical outcomes is needed. METHODS This retrospective review examines 196 knees in 175 patients who underwent MOWHTO from May 2012 to December 2018, for symptomatic medial compartment osteoarthritis with a varus alignment of > 5°. We evaluated the anteroposterior plate position, length of proximal screw, and postoperative computed tomography (CT). We reviewed patients' clinical outcome scores, presence of lateral hinge fracture, neurovascular complications, and infection. The correlation among proximal plate position, proximal screw length, and clinical outcomes was evaluated using Pearson's correlation analysis. A subgroup analysis by screw angle (> 48 ° or < 48 °) was also performed using chi-square test and Student t-test. RESULTS The mean proximal plate position was 16.28% (range, 5.17-44.74) of the proximal tibia's anterior-to-posterior distance ratio, and the proximal screw length averaged 63.8 mm (range, 44-80 mm). Proximal posteromedial plate position and proximal screw length were significantly correlated (r2 = 0.667, P < .001), as were screw angle and length (r2 = 0.746, P < .001). Medial plating (< 48°) can use a longer proximal screw; nevertheless, no significant difference occurred in clinical outcomes between the two groups. Also, no differences occurred in complication rate, including hinge fracture. CONCLUSION With more medially positioned plating during MOWHTO, we can use longer proximal screws. However, there was no significant difference in clinical outcomes and the incidence of lateral hinge fractures regardless of plate position and screw length.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University school of Medicine, Incheon, South Korea
| | - Sang Jun Park
- Department of Orthopaedic Surgery, Cheongju Micro Hospital, Cheongju-si, Chung-cheong bukdo South Korea
| | - Dae Hee Lee
- grid.264381.a0000 0001 2181 989XDepartment of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 South Korea
| | - Kyeu-Back Kwon
- Department of Orthopaedic Surgery, Samsung Bone Hospital, Osan-si, Gyeonggi-do South Korea
| | - Geun Hong Choi
- Department of Orthopaedic Surgery, Samsung Maditop hospital, Sungnam-si, Gyeonggi-do South Korea
| | - Il Su Kim
- grid.264381.a0000 0001 2181 989XDepartment of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 South Korea
| | - Joon Ho Wang
- grid.264381.a0000 0001 2181 989XDepartment of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351 South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
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Gao F, Yang X, Wang C, Su S, Qi J, Li Z, Chen J, Zhong D. Comparison of Clinical and Radiological Outcomes between Calibratable Patient-Specific Instrumentation and Conventional Operation for Medial Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1378042. [PMID: 36467884 PMCID: PMC9711981 DOI: 10.1155/2022/1378042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 08/25/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is an effective surgery in treating medial compartment knee osteoarthritis (KOA) combined with varus deformity. An accurate orthopaedy is the key and challenge to the success of HTO. Therefore, we designed a calibratable patient-specific instrumentation (PSI) to assist surgery and evaluated its accuracy and clinical outcomes by comparing with conventional operation (CO). MATERIALS AND METHODS 37 patients (39 knees) with medial compartment KOA were randomly divided into the PSI and CO groups and underwent medial open-wedge high tibial osteotomy (MOWHTO) from September 2020 to May 2021. The postoperative radiological outcomes were compared with the preoperative measurements or target values to evaluate the accuracy of correction in the two groups. The American Knee Society Score (AKSS), complication rate, number of intraoperative radiation exposures, blood loss volume, and operative duration were analysed to evaluate the clinical outcomes in the two groups. RESULTS The designed target values were better achieved in the PSI group than in the CO group. The mean absolute difference between the postoperative measurements and preoperative targets was significantly lower in the PSI group than in the CO group (weight-bearing line (WBL) ratio, 1.97 ± 1.83% vs.5.42 ± 4.41%, P = 0.002; hip-knee-ankle (HKA) angle, 1.12 ± 0.86° vs. 2.27 ± 1.97°, P = 0.018). The operative duration was significantly shorter (P = 0.014), and the number of radiation exposures (P < 0.001) and volume of intraoperative blood loss (P = 0.003) were significantly lower in the PSI group than in the CO group. The clinical AKSS score at 3 and 6 months postoperatively and the functional AKSS score at 3 months postoperatively were significantly higher in the PSI group than in the CO group (P = 0.042, 0.040, and 0.034, respectively). CONCLUSION For patients with medial compartment KOA, calibratable PSI can assist the surgeon in MOWHTO with superior accuracy and clinical efficacy. This study was conducted under Randomized Controlled Trial Details (RCT) with Registry Number ChiCTR2000038619.
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Affiliation(s)
- Fawei Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Orthopaedics, Dali Bai Autonomous Prefecture People's Hospital, Dali 671000, China
| | - Xucheng Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Shilong Su
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - Jun Qi
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhigang Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juehao Chen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Da Zhong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
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The benefits of a percutaneous supplemental screw to reinforce the hinge of a medial open wedge tibial osteotomy. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04573-4. [PMID: 35941314 DOI: 10.1007/s00402-022-04573-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/31/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Our earlier studies reported that an additional lag screw placed from the opposite side increases the stability of the fixation construct in medial open wedge high tibia osteotomy (MOWHTO). The aim of the study was to evaluate the clinical relevance of the use of a supplemental screw with immediate post-operative full weight-bearing and its benefits in terms of functional outcome, radiographic outcome and complications. MATERIALS AND METHODS A retrospective study was performed comparing the historical cohort (MOWHTO without opposite screw) (group A) with the current cohort (MOWHTO with opposite screw) (group B). The patients underwent clinical and radiological assessments. We evaluated the WOMAC (The Western Ontario and McMaster Universities) score, IKDC (International Knee Documentation Committee) scores, and Lysholm knee score. Patients' return to sports and work were also recorded. RESULTS We included 123 knees receiving MOWHTO alone (group A) with 114 knees (group B) receiving MOWHTO with an opposite screw. A shorter bone union time (18.3 ± 2.1 weeks v.s. 11.5 ± 2.6 weeks, p < 0.001), earlier return to sports (6.1 months vs. 4.6 months, p < 0.001) and return to works (3.2 months vs. 2.3 months, p < 0.001) and better 6-month functional outcomes were found in group B (p < 0.001). The complications were similar in both groups. One patient experienced irritation at the site of the screw entrance and the screw was removed after union. CONCLUSION The current study evaluated the clinical efficacy of a supplemental lag screw placed from the opposite side in MOWHTO. Comparing to the plate alone, the additional opposite screw improved the implant and fixation stability under immediate weight-bearing without causing complications. A shorter time for returning to sports and work was noted, and a better functional outcome at 6-month follow-up was registered.
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Wake JL, Chung B, Bottoni CR, Zhou L. Management Considerations for Unicompartmental Osteoarthritis in Athletic Populations: A Review of the Literature. J Knee Surg 2022. [PMID: 35798349 DOI: 10.1055/s-0042-1750750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unicompartmental osteoarthritis in the young athlete poses a challenge for both patients and providers. Coronal plane malalignment is frequently a concomitant finding that adds to the complexity of management. Military surgeons are presented unique challenges, in that they must consider optimal joint-preservation methods while returning patients to a high-demand occupational function. Management options range from lifestyle changes to surgical interventions. We present a concise review of the available literature on this subject, with a specific focus on indications and outcomes within the military and young athletic population.
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Affiliation(s)
- Jeffrey L Wake
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Brandon Chung
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Liang Zhou
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
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Role of Osteotomy in Ligament Injuries: Updates on Corrective Osteotomy Combined Ligament Procedure Techniques. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hiramatsu K, Yamada Y, Nakamura N, Mitsuoka T. Factors Associated with Postoperative Knee Joint Line Obliquity After Medial Open Wedge High Tibial Osteotomy. Am J Sports Med 2022; 50:1651-1658. [PMID: 35293800 DOI: 10.1177/03635465221079343] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are still few reports on factors associated with postoperative knee joint line obliquity (KJLO). PURPOSE The purpose was to determine preoperative radiographic factors that are associated with KJLO postoperatively after open wedge high tibial osteotomy (OWHTO) using multivariable linear regression analysis and multivariable logistic regression analysis. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 60 patients with 65 varus knees who underwent OWHTO between December 2012 and June 2018 at a single institution were retrospectively enrolled in this study. The authors evaluated radiologic parameters including the weightbearing line ratio, femorotibial angle, medial proximal tibial angle, mechanical lateral distal femoral angle (LDFA), lateral distal tibial angle, joint line convergence angle (JLCA), KJLO, and ankle joint obliquity. They also categorized these radiographic parameters as preoperative and postoperative and calculated the difference (Δ) between preoperative and postoperative values. To determine which of the radiographic parameters were most associated with postoperative KJLO, multivariable linear regression analysis was performed using the stepwise method. Multivariable logistic regression analysis was used to examine the relative contribution of the preoperative radiographic parameters to an abnormal postoperative KJLO (>4°). RESULTS In the multivariable linear regression analysis, the preoperative LDFA and JLCA showed a statistically significant correlation. Multivariable logistic regression analysis revealed that the mean preoperative LDFA was significantly larger in the group with abnormal KJLO than in the group with the control group (odds ratio, 1.84; 95% CI, 1.12-3.02; P = .02), while preoperative JLCA tended to be larger in the abnormal KJLO group than the control group but not statistically significantly different. CONCLUSION KJLO after OWHTO was associated with preoperative LDFA and JLCA in multivariable linear regression analysis, and preoperative LDFA was the most important factor associated with abnormal KJLO after OWHTO in multivariable logistic regression analysis.
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Affiliation(s)
- Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Tamai Hospital, Osaka, Japan.,Department of Orthopaedic Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Yuzo Yamada
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - Tomoki Mitsuoka
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Osaka, Japan
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Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view.
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Kanakamedala AC, Hurley ET, Manjunath AK, Jazrawi LM, Alaia MJ, Strauss EJ. High Tibial Osteotomies for the Treatment of Osteoarthritis of the Knee. JBJS Rev 2022; 10:01874474-202201000-00002. [PMID: 35020711 DOI: 10.2106/jbjs.rvw.21.00127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» A high tibial osteotomy (HTO) is a joint-preserving procedure that can be used to treat symptomatic unicompartmental cartilage disorders in the presence of limb malalignment. » Appropriate patient selection and careful preoperative planning are vital for optimizing outcomes. » Based on past literature, correction of varus malalignment to 3° to 8° of valgus appears to lead to favorable results. Recently, there has been growing awareness that it is important to consider soft-tissue laxity during preoperative planning. » Although there has been a recent trend toward performing opening-wedge rather than closing-wedge or dome HTOs for unicompartmental osteoarthritis, current data suggest that all 3 are acceptable techniques with varying complication profiles. » Based on current evidence, an HTO provides pain relief, functional improvement, and a high rate of return to sport, with reported survivorship ranging from 74.7% to 97.6% and 66.0% to 90.4% at 10 and 15 years, respectively.
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Affiliation(s)
- Ajay C Kanakamedala
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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High Tibial Osteotomy: An Update for Radiologists. AJR Am J Roentgenol 2021; 218:701-712. [PMID: 34817194 DOI: 10.2214/ajr.21.26659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High tibial osteotomy (HTO) is a surgical procedure to treat symptomatic unicompartmental osteoarthritis (OA) associated with knee malalignment. There has been a recent resurgence of interest in HTO in patients who prefer joint-preserving surgery, as HTO shifts the knee's mechanical axis from the arthritic compartment to a neutral position, thereby reducing knee pain, slowing progression of OA, and delaying the need for a total knee arthroplasty. The ideal candidates for HTO are young, active, nonobese patients with isolated varus deformity of the knee due to medial compartment OA. Radiography is critical in the preoperative evaluation for HTO and can help expand surgical indications to include a wider variety of patients. Radiography is also routinely obtained in postoperative assessment and is typically the first test to suspect complications. This review describes the radiologic aspects of HTO, including preoperative imaging assessment, as well as normal and abnormal postoperative imaging appearances. Surgical techniques and osteotomy fixation devices are described, with a focus on the medial opening wedge approach. Given the growing interest in HTO, radiologists should become familiar with the basics of the procedure and the role of imaging in preoperative and postoperative evaluation.
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Gao F, Wang C, Hu Y, Su S, Qi J, Zhong D. [Clinical application of split three-dimensional printing patient-specific instrumentation in medial open-wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1119-1124. [PMID: 34523276 DOI: 10.7507/1002-1892.202104001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis. Methods Clinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients' knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up. Results One patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements ( P<0.05). There was no significant difference between preoperative and postoperative PTSA ( P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant ( P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant ( P<0.05). Conclusion For patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.
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Affiliation(s)
- Fawei Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China.,Digital Research Institute of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Yihe Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China.,Digital Research Institute of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Shilong Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Jun Qi
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
| | - Da Zhong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China.,Digital Research Institute of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China
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Miettinen S, Nyländen H, Jalkanen J, Miettinen H, Kröger H, Joukainen A. Midterm follow-up results of two different types of implants in opening wedge high tibia osteotomy. Knee 2021; 31:11-21. [PMID: 34102476 DOI: 10.1016/j.knee.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This retrospective study investigated the midterm results of medial opening wedge high tibia osteotomy, with a monoplanar or a biplanar osteotomy using two types of implant system. METHODS Osteotomies were performed on 241 knees (231 patients). The mean follow-up period was 6.0 years (SD 3.0, range 0.2-12.8 years). Two types of implant system were used, a precountered non-locking plate (PP) (n = 74) and a precountered locking plate (LP) (n = 167). A Kaplan-Meier cumulative survival curve and a Cox regression model were used to analyse and revise survival and risk factors. RESULTS Cumulative survival estimates for LP were 80% at 5 years, and 64% at 10 years (SE = 0.4, CI 95%: 9.0-10.5), and for PP, they were 68% at 5 years and 49% at 10 years (SE = 0.5, CI: 95% 6.3-8.2) (p = 0.024). The revision rate was 26% (44/167) for the LP group, and 47% (35/74) for the PP group (p = 0.001). Reoperations on LP osteotomies occurred for the tibial monoplanar cut and biplanar cut groups, in 19/52 (37%) and 25/167 (16%) osteotomies, respectively (p = 0.04). Our Cox regression model showed that PP had a higher risks (RR = 1.7; CI: 95% 1.1-2.6) of revision, when compared with LP (p = 0.026). CONCLUSIONS The risk of revision for any reason and that of early conversion to total knee arthroplasty (TKA) after high tibia osteotomy were significantly increased for PP, when compared with LP.
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Affiliation(s)
- Simo Miettinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, Yliopistonranta 1, 70210 Kuopio, Finland.
| | - Henrik Nyländen
- University of Eastern Finland, Faculty of Health Sciences, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Jussi Jalkanen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland
| | - Hannu Miettinen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Antti Joukainen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland
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Kambara S, Nakayama H, Kanto R, Oonishi S, Kanto M, Yoshiya S, Tachibana T, Iseki T. Three dimensional CT analysis of the change in rotational alignment in double level osteotomy after double level osteotomy performed for varus osteoarthritic knees. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:16-21. [PMID: 34141591 PMCID: PMC8167197 DOI: 10.1016/j.asmart.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/08/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
Purpose To analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images. Methods Pre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared. Results The mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)(NS). Conclusions This study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side.
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Affiliation(s)
- Shunichiro Kambara
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Oohama-cho, Nishinomiya, Hyogo, 662-0957, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shintaro Oonishi
- 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, 1-4 Oohama-cho, Nishinomiya, Hyogo, 662-0957, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Oohama-cho, Nishinomiya, Hyogo, 662-0957, Japan
| | - Toshiya Tachibana
- 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
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How the orientation of osteotomy in biplanar lateral closed-wedge distal femoral osteotomy influences the rotational alignment of the knee in all dimensional planes. Knee 2021; 29:167-173. [PMID: 33636565 DOI: 10.1016/j.knee.2021.01.023] [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: 08/14/2020] [Revised: 01/03/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Correction of coronal plane deformity by osteotomies around the knee is theoretically three-dimensional (3D) and can be associated with changes in other planes. It has been shown that 3D rotational changes are induced by biplanar high tibial osteotomy; however, relevant information in biplanar lateral closed-wedge distal femoral osteotomy (LCW-DFO) has not been reported in literatures. This study aimed to investigate rotational changes in axial and sagittal planes in LCW-DFO using computer-aided design (CAD) simulations. METHODS LCW-DFO is composed of three cuts: one ascending cut and two transverse cuts. In the simulations, the following geometrical parameters were adopted as factors potentially influencing 3D changes occurring in the osteotomy. The ascending cut angle measured as the angle between the edge of the ascending cut and the edge of the transverse cut in the lateral view, and the ascending cut obliquity measured as the angle corresponding to anterior/posterior inclination of the ascending cut with reference to the posterior condylar tangent line in the axial view. In the analysis, the effects of these bony cut angles on associated rotational changes in the axial and sagittal planes (internal/external rotation and flexion/extension) were calculated. Variation of wedge size ranged from 2 to 8 mm. RESULTS The degree of the ascending cut obliquity substantially correlated with associated change in the sagittal plane (extension/flexion) while inducing only minimal change in rotation in the axial plane (internal/external rotation). When the osteotomy was made without ascending cut obliquity, the change in knee extension/flexion was minimal for the conditions analyzed while coupled internal rotation of the distal bony segment was induced. CONCLUSIONS In biplanar LCW-DFO, the ascending cut angle substantially influenced the amount of internal rotation of the distal bony segment with little effect on flexion/extension angles. By contrast, ascending cut obliquity in the axial plane yields an effect on flexion/extension angles and little effect on internal rotation of the distal bony segment.
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18
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Jonker L, Bell L, Monda M, Murray J, Dawson M. Longer Term Outcomes Following High Tibial Osteotomy for Osteoarthritis: A Prospective, Multi-Centre Observational Study Comparing Tomofix and OPTY-LINE Devices. Indian J Orthop 2021; 55:967-973. [PMID: 34194655 PMCID: PMC8192599 DOI: 10.1007/s43465-021-00356-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/07/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Assessing surgical accuracy and patient-recorded outcome measures for patients fitted with either the OPTY-LINE intramedullary realignment system or the Tomofix plate for medial opening wedge high tibial osteotomy (HTO). PATIENTS AND METHODS Two matched case series of patients with symptomatic medial compartment osteoarthritis without other significant knee pathology. One group comprised of 19 patients receiving the Tomofix plate, whereas another comprised of 12 patients receiving the OPTY-LINE intramedullary nail. Patella-centred long leg alignment radiographs were assessed to calculate surgical accuracy in all cases. Patients completed knee injury osteoarthritis outcome scores (KOOS) and osteotomy surgery patient satisfaction questionnaires pre-operatively and at 24 months post-surgery. RESULTS Absolute surgical accuracy at 2 years post-surgery was a mean 4.2 [standard deviation 3.7] for OPTY-LINE versus 9.2 [SD 7.8] for Tomofix (p = 0.11, Mann-Whitney U test). On average, patients in either the OPTY-LINE or Tomofix cohort reported at least a minimal perceptible clinical improvement-minimum average improvement of 15-for all five KOOS themes. No significant difference in change of KOOS scores over time or patient satisfaction levels were observed between the two cohorts. CONCLUSION The OPTY-LINE device for HTO performs to a similar level as the Tomofix device. Surgical accuracy data are promising for OPTY-LINE, but does not seem to readily translate into difference in patient-reported outcomes compared to Tomofix. Even longer follow-up periods, to measure survival rates, and true randomised trials on larger samples can elucidate if there is a benefit for using one device over the other.
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Affiliation(s)
- Leon Jonker
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Newtown Road, Carlisle, CA2 7HY Cumbria UK
| | - Lucy Bell
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Newtown Road, Carlisle, CA2 7HY Cumbria UK
| | - Maureen Monda
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Newtown Road, Carlisle, CA2 7HY Cumbria UK
| | | | - Matt Dawson
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Newtown Road, Carlisle, CA2 7HY Cumbria UK
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19
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Van Genechten W, Van den Bempt M, Van Tilborg W, Bartholomeeusen S, Van Den Bogaert G, Claes T, Claes S. Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up. Knee Surg Sports Traumatol Arthrosc 2020; 28:3747-3757. [PMID: 31713662 DOI: 10.1007/s00167-019-05765-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Painful and slow recovery are the presumed disadvantages after opening-wedge high tibial osteotomy (HTO) and play a role in favouring arthroplasty as treatment for moderate isolated medial knee arthritis. The primary study objective was to investigate the effect of press-fit structural impacted bone allograft with locking plate fixation on early ambulation, postoperative pain levels, and resumption of daily-life activities in opening-wedge HTO. METHODS A prospective consecutive opening-wedge HTO case series was conducted, including 103 patients with final follow-up at 1 year. Weight-bearing was allowed from the day after surgery "as tolerated" by the patient. Clinical assessment included the Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Additionally, the Knee Society Score (KSS) was assessed during consultation at 1, 3, and 12 months postoperatively with special attention for clinical anchor questions. Required sample size was calculated and a linear mixed-effect model was used for repeated measures over time of the clinical scores. RESULTS The NRS decreased by 1.5 at 1 month (p < 0.01) and 2.1 at 3 months (p < 0.01), while KOOS pain significantly improved with 19.2 (p < 0.01) by this time compared to baseline. Under reduced pain levels, 98% were able to walk > 500 m without support, while all patients were able to climb up and down the stairs 3 months postoperatively. CONCLUSION The study strongly supports the initial hypothesis that applying structural triangular bone allograft in HTO leads to low postoperative pain levels, early ambulation, and excellent short-term clinical outcomes. Study results have the potential to alter the general perception about HTO being a painful procedure with painstakingly slow recovery and consequently encourage the consideration of HTO as a highly valuable joint-preserving option, while treating unicompartmental knee arthritis. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
| | | | | | | | | | - Toon Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium
| | - Steven Claes
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.,Department of Orthopaedic Surgery, Leuven University Hospital, Leuven University, Leuven, Belgium
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Hai H, Takahashi I, Shima N, Udono K, Yamaguchi N, Ito A. Preliminary Evaluation of the Efficacy of Postoperative Early Weight-bearing Rehabilitation Protocol for Patients after Double-level Osteotomy. Prog Rehabil Med 2020; 5:20200017. [PMID: 32844130 PMCID: PMC7429558 DOI: 10.2490/prm.20200017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: There are no reports describing in detail postoperative rehabilitation after
double-level osteotomy (DLO). Consequently, the establishment of a safe and effective
rehabilitation protocol is required. Methods: This retrospective study included 26 patients with varus knees who underwent DLO. No
patient had obvious fracture around the femoral osteotomy sites, as evaluated using
computed tomography (CT) 3 weeks postoperatively. From 3 days postoperatively, gait
training with early weight bearing was performed using our parallel bar protocol. Range
of motion exercises were permitted as tolerated. Radiological evaluation was performed
to confirm the presence or absence of fracture around the femoral osteotomy sites using
CT at 3 weeks and X-ray at 6 weeks postoperatively. X-ray imaging 6 months
postoperatively indicated no femoral correction loss. Additionally, the time from
initiation to completion of the protocol and the time from initiation to achievement of
independent gait were recorded. Results: No fractures around the femoral osteotomy sites in any patient were found using CT 3
weeks postoperatively and X-rays 6 weeks postoperatively. There was no correction loss
at the femoral osteotomy site according to X-ray findings 6 months postoperatively. The
mean time until completion of the parallel bar protocol was 19.8 ± 6.2 (7–30) days, and
that from the initiation of rehabilitation to the achievement of independent gait was
26.8 ± 7.1 (16–45) days. Conclusion: Patients without fracture around the femoral osteotomy site during the rehabilitation
period could achieve independent gait within an average of <1 month using the
parallel bar protocol. Early weight-bearing walking and independent walking could be
achieved using this protocol.
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Affiliation(s)
- Hironari Hai
- Department of Orthopaedic Surgery, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Ikutaro Takahashi
- Department of Orthopaedic Surgery, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Naoya Shima
- Department of Rehabilitation Technology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Kazuaki Udono
- Department of Rehabilitation Technology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Naoya Yamaguchi
- Department of Rehabilitation Technology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Atsushi Ito
- Department of Rehabilitation Technology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
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Jonker L, Fallahi F, Saraswathy JJ, Edge J, Dawson M. OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method. J Orthop Surg (Hong Kong) 2020; 27:2309499019864721. [PMID: 31379259 DOI: 10.1177/2309499019864721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The objective was to evaluate the clinical and patient-related short- to medium-term performance of the OPTY-LINE nail device for high tibial osteotomy (HTO), comparing a case series of the said device to the established Tomofix fixed-plate device. PATIENTS AND METHODS Males with symptomatic medial compartmental osteoarthritis and no serious (co-morbid) knee pathology were followed up, five Tomofix and six OPTY-LINE patients. Patients underwent computed tomography assessment and completed Knee Injury and Osteoarthritis Outcome score (KOOS) and osteotomy surgery patient satisfaction questionnaires, 3 and 6 months post-surgery. A radiologist impression score and a quantitative digital bone density analysis were performed by two independent radiologists. Mann-Whitney U test was applied for inferential statistical tests. RESULTS At 6 months post-surgery, for Tomofix, the median radiologists' healing impression score was 'progressive healing' versus 'union virtually complete' for the OPTY-LINE nail; bone healing quotient was 1.30 (standard deviation (SD) 1.74) versus 1.78 (SD 1.58), p = 0.18. The post-operative absolute surgical accuracy was a mean 12 (7.5) for Tomofix versus 4.1 (2.3) for OPTY-LINE, p = 0.052. At baseline, however, Tomofix patients had more knee symptoms, as determined by KOOS symptom sub-score, when compared to the OPTY-LINE cohort (p = 0.009). CONCLUSION This initial, non-randomized, comparative evaluation of the OPTY-LINE device for HTO has produced similar outcomes to patients treated with the established Tomofix device. In particular, the rate of post-surgical bone regeneration and surgical accuracy achieved with the OPTY-LINE device are encouraging. Large-scale randomized controlled studies with longer follow-up are indicated to further evaluate the clinical and patient-related outcome performance for OPTY-LINE.
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Affiliation(s)
- Leon Jonker
- 1 Cumbria Partnership NHS Foundation Trust, Research & Development Department, Carlisle, UK
| | - Farshid Fallahi
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
| | - Jayadeep J Saraswathy
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
| | - John Edge
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
| | - Matt Dawson
- 2 North Cumbria University Hospitals NHS Trust, Orthopaedics & Radiology Department, Carlisle, Cumbria, UK
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Mhaskar VA, Maheshwari J, Ugrasen H. Bilateral HTO in same sitting: Perioperative challenge or feasible option? ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jajs.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Critical comments to the publication "Hevesi M, Macalena JA, Wu IT, Camp CL, Levy BA, Arendt EA, et al. (2018) High tibial osteotomy with modern PEEK implants is safe and leads to lower hardware removal rates when compared to conventional metal fixation: a multi-center comparison study. Knee Surgery, Sports Traumatology, Arthroscopy 1-11". Knee Surg Sports Traumatol Arthrosc 2020; 28:662-663. [PMID: 31165181 DOI: 10.1007/s00167-019-05549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
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Hoorntje A, Kuijer PPFM, van Ginneken BT, Koenraadt KLM, van Geenen RCI, Kerkhoffs GMMJ, van Heerwaarden RJ. Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner. Orthop J Sports Med 2020; 7:2325967119890056. [PMID: 31909053 PMCID: PMC6935877 DOI: 10.1177/2325967119890056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Limited evidence exists on patient-relevant outcomes after high tibial osteotomy (HTO), including return to work (RTW). Furthermore, prognostic factors for RTW have never been described. Purpose To investigate the extent and timing of RTW in the largest HTO cohort investigated for RTW to date and to identify prognostic factors for RTW after HTO. Study Design Cohort study; Level of evidence, 3. Methods Consecutive patients who underwent HTO between 2012 and 2015 were included. Patients received a questionnaire at a mean follow-up of 3.6 years. Questions were asked pre- and postoperatively regarding work status, job title, working hours, preoperative sick leave, employment status, and whether patients were their family's breadwinner. The validated Work Rehabilitation Questionnaire (WORQ) was used to assess difficulty with knee-demanding activities. Prognostic factors for RTW were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results We identified 402 consecutive patients who underwent HTO, of whom 349 were included. Preoperatively, 299 patients worked, of whom 284 (95%) achieved RTW and 255 (90%) returned within 6 months. Patients reported significant postoperative improvements in performing knee-demanding activities. Being the family's breadwinner was the strongest predictor of RTW (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.27-6.69). In contrast, preoperative sick leave was associated with lower odds of RTW (OR, 0.20; 95% CI, 0.08-0.46). Conclusion After HTO, 95% of patients were able to RTW, of whom 9 of 10 returned within 6 months. Breadwinners were more likely to RTW, and patients with preoperative sick leave were less likely to RTW within 6 months. These findings may be used to improve preoperative counseling and expectation management and thereby enhance work-related outcomes after HTO.
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Affiliation(s)
- Alexander Hoorntje
- Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Berbke T van Ginneken
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Gino M M J Kerkhoffs
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Ronald J van Heerwaarden
- Department of Orthopaedic Surgery, Maartenskliniek Woerden, Woerden, the Netherlands.,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Safety of simultaneous versus staged bilateral opening-wedge high tibial osteotomy with locked plate and immediate weight bearing. INTERNATIONAL ORTHOPAEDICS 2019; 44:109-117. [PMID: 31385014 DOI: 10.1007/s00264-019-04385-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE With advances in technology and particularly locked screws, patients with high tibial osteotomy (HTO) are frequently allowed full weight bearing for a unilateral procedure. We are aware of no reports comparing the safety of a simultaneous bilateral HTO with staged bilateral HTO. The purpose of this study was to retrospectively compare these two strategies. MATERIAL AND METHODS Ninety patients were treated with bilateral HTO surgery for osteoarthritis from 2009 to 2013; they had opening-wedge HTO and fixed with the same plate fixation and locked screws. A comparison of the outcomes after simultaneous bilateral HTO (35 patients) and after sequential staged bilateral HTO (55 patients) was performed. We considered four measures of medical safety: hypotension, serious intra-operative adverse event, heterologous blood transfusion, and thrombophlebitis. We considered also four measures of orthopaedic safety: infection, patient's inability to walk full weight bearing, changes in correction, and nonunion. RESULTS For the same duration of operation, the duration of anaesthesia and the time in the operating room were 35% longer for patients having a staged bilateral HTO. Blood loss was higher in patients undergoing simultaneous bilateral HTO compared with those who underwent a staged bilateral HTO. For patients undergoing simultaneous bilateral HTO, thrombophlebitis frequency and length of anticoagulation were lower than the sum of each event in the staged bilateral HTO. The patients with simultaneous bilateral HTO had a longer total period of time for crutches than patients with staged bilateral HTO. Patients in the simultaneous bilateral cohort did not develop an infection within one year as patients in the planned-stage cohort. The simultaneous bilateral cohort had a lower rate of delayed union than the planned-stage cohort did. CONCLUSION On the basis of this analysis, simultaneous bilateral HTO is a reasonable treatment option. Individuals who undergo staged bilateral HTO face the risk of complications twice, in addition to two hospitalizations. Patients who undergo simultaneous bilateral HTO have a higher risk of blood transfusion.
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Hoorntje A, Kuijer PPF, van Ginneken BT, Koenraadt KL, van Geenen RC, Kerkhoffs GM, van Heerwaarden RJ. Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach. Am J Sports Med 2019; 47:1854-1862. [PMID: 31157542 PMCID: PMC6604251 DOI: 10.1177/0363546519849476] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. PURPOSE To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. RESULTS We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up (P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). CONCLUSION More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery,
Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Academic Center for Evidence-Based
Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health &
Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the
Netherlands
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - P. Paul F.M. Kuijer
- Amsterdam UMC, University of Amsterdam,
Coronel Institute of Occupational Health, Amsterdam Public Health Research
Institute, Amsterdam, the Netherlands
| | - Berbke T. van Ginneken
- Department of Orthopaedic Surgery, Sint
Maartenskliniek Woerden, Woerden, the Netherlands
| | - Koen L.M. Koenraadt
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - Rutger C.I. van Geenen
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Academic Center for Evidence-Based
Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health &
Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the
Netherlands
| | - Ronald J. van Heerwaarden
- Department of Orthopaedic Surgery, Sint
Maartenskliniek Woerden, Woerden, the Netherlands
- Centre for Deformity Correction and
Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Belsey J, Diffo Kaze A, Jobson S, Faulkner J, Maas S, Khakha R, Pape D, Wilson AJ. The biomechanical effects of allograft wedges used for large corrections during medial opening wedge high tibial osteotomy. PLoS One 2019; 14:e0216660. [PMID: 31075145 PMCID: PMC6510412 DOI: 10.1371/journal.pone.0216660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/25/2019] [Indexed: 11/18/2022] Open
Abstract
The inclusion of an allograft wedge during medial opening wedge high tibial osteotomy has been shown to lead to satisfactory time-to-union in larger corrections (>10°). Such large corrections are associated with greater incidences of intraoperative hinge fracture and reduced construct stability. The purpose of this study was to investigate the biomechanical stability that an allograft wedge brings to an osteotomy. Ten medium-size fourth generation artificial sawbone tibiae underwent 12 mm biplanar medial opening wedge high tibial osteotomy with a standard Tomofix plate. Five tibiae had an allograft wedge inserted into the osteotomy gap prior to plate fixation (allograft group). The gap in the remaining tibiae was left unfilled (control group). Each group underwent static compression testing and cyclical fatigue testing until failure of the osteotomy. Peak force, valgus malrotation, number of cycles, displacement and stiffness around the tibial head were analysed. Intraoperative hinge fractures occurred in all specimens. Under static compression, the allograft group withstood higher peak forces (6.01 kN) compared with the control group (5.12 kN). Valgus malrotation was lower, and stiffness was higher, in the allograft group. During cyclical fatigue testing, results within the allograft group were more consistent than within the control group. This may indicate more predictable results in large osteotomies with an allograft. Tibial osteotomies with allograft wedges appear beneficial for larger corrections, and in cases of intraoperative hinge fracture, due to the added construct stability they provide, and the consistency of results compared with tibial osteotomies without a graft.
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Affiliation(s)
- James Belsey
- Department of Sport, Exercise & Health, University of Winchester, Winchester, Hampshire, England
- Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, England
- * E-mail:
| | - Arnaud Diffo Kaze
- University of Luxembourg, Faculty of Science, Technology and Communication, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Simon Jobson
- Department of Sport, Exercise & Health, University of Winchester, Winchester, Hampshire, England
| | - James Faulkner
- Department of Sport, Exercise & Health, University of Winchester, Winchester, Hampshire, England
| | - Stefan Maas
- University of Luxembourg, Faculty of Science, Technology and Communication, Luxembourg, Luxembourg
| | - Raghbir Khakha
- Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, England
| | - Dietrich Pape
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Adrian J. Wilson
- The Hampshire Clinic, Basing Road, Old Basing, Basingstoke, Hampshire, England
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Belsey J, Diffo Kaze A, Jobson S, Faulkner J, Maas S, Khakha R, Wilson AJ, Pape D. Graft materials provide greater static strength to medial opening wedge high tibial osteotomy than when no graft is included. J Exp Orthop 2019; 6:13. [PMID: 30923931 PMCID: PMC6439028 DOI: 10.1186/s40634-019-0184-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to compare the stability of medial opening-wedge high tibial osteotomy (MOWHTO) with and without different graft materials. Good clinical and radiological outcomes have been demonstrated when either using or not using graft materials during MOWHTO. Variations in the biomechanical properties of different graft types, regarding the stability they provide a MOWHTO, have not been previously investigated. Methods A 10 mm biplanar MOWHTO was performed on 15 artificial sawbone tibiae, which were fixed using the Activmotion 2 plate. Five bones had OSferion60 wedges (synthetic group), five had allograft bone wedges (allograft group), and five had no wedges (control group) inserted into the osteotomy gap. Static compression was applied axially to each specimen until failure of the osteotomy. Ultimate load, horizontal and vertical displacements were measured and used to calculate construct stiffness and valgus malrotation of the tibial head. Results The synthetic group failed at 6.3 kN, followed by the allograft group (6 kN), and the control group (4.5 kN). The most valgus malrotation of the tibial head was observed in the allograft group (2.6°). The synthetic group showed the highest stiffness at the medial side of the tibial head (9.54 kN·mm− 1), but the lowest stiffness at the lateral side (1.59 kN·mm-1). The allograft group showed high stiffness on the medial side of the tibial head (7.54 kN·mm− 1) as well as the highest stiffness on the lateral side (2.18 kN·mm− 1). Conclusions The use of graft materials in MOWHTO results in superior material properties compared to the use of no graft. The static strength of MOWHTO is highest when synthetic grafts are inserted into the osteotomy gap. Allograft wedges provide higher mechanical strength to a MOWHTO than when no graft used. In comparison to the synthetic grafts, allograft wedges result in the stiffness of the osteotomy being more similar at the medial and lateral cortices.
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Affiliation(s)
- James Belsey
- Department of Sport, Exercise & Health, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, England. .,Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, England.
| | - Arnaud Diffo Kaze
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg
| | - Simon Jobson
- Department of Sport, Exercise & Health, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, England
| | - James Faulkner
- Department of Sport, Exercise & Health, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, England
| | - Stefan Maas
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg
| | - Raghbir Khakha
- Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, England
| | - Adrian J Wilson
- The Hampshire Clinic, Basing Road, Old Basing, Basingstoke, Hampshire, RG24 7AL, England
| | - Dietrich Pape
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg
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Zhang K, Wu M. [Study on lateral hinge fracture during open wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:110-114. [PMID: 30644270 DOI: 10.7507/1002-1892.201807049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. Methods To review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. Results The lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the "safe zone" internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. Conclusion The intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.
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Affiliation(s)
- Kuankuan Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - Min Wu
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233000,
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Koh YG, Son J, Kim HJ, Kwon SK, Kwon OR, Kim HJ, Kang KT. Multi-objective design optimization of high tibial osteotomy for improvement of biomechanical effect by using finite element analysis. J Orthop Res 2018; 36:2956-2965. [PMID: 29917265 DOI: 10.1002/jor.24072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023]
Abstract
Medial opening wedge high tibial osteotomy (HTO) makes the proximal tibia a highly unstable structure and causes plates and screws to be the potential sources for mechanical failure. However, asymmetrical callus and incomplete bone formations underneath the plates (TomoFix) have been recent concerns in clinical and experimental studies related to HTO due to the high stiffness. The purpose of this study was to evaluate the biomechanical effect of the TomoFix plate system with respect to changes in design using a computational simulation. A parametric three-dimensional model of HTO was constructed from medical image data. The design parameters for the HTO plate were evaluated to investigate their influence on biomechanical effects, and the most significant factors were determined using Taguchi-style L27 orthogonal arrays. Multi-objective optimization was used to identify the wedge micromotion stability without the stress shielding effect that occurs in the bone plate. The initial design showed that the high stiffness of the plate caused stress shielding on the bone and plate. However, the optimal design led to sharing the stress and load with the bone plate to eliminate stress shielding. In addition, the stability required for the plate could be found in the micromotions of the wedge for the optimal design. The optimal condition of design parameters was successfully determined using the Taguchi and multi-objective optimization method, which was shown to eliminate stress shielding effects. The results showed that an optimal design demonstrated the feasibility of design optimization and improvements in biomechanical stability for HTO. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2956-2965, 2018.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sae Kwang Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Oh-Ryong Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Hyo Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjae-daero, Songpa-gu, Seoul, 05541, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
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Diffo Kaze A, Maas S, Kedziora S, Belsey J, Haupert A, Wolf C, Hoffmann A, Pape D. Numerical comparative study of five currently used implants for high tibial osteotomy: realistic loading including muscle forces versus simplified experimental loading. J Exp Orthop 2018; 5:28. [PMID: 30091026 PMCID: PMC6082749 DOI: 10.1186/s40634-018-0144-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background Many different fixation devices are used to maintain the correction angle after medial open wedge high tibial osteotomy (MOWHTO). Each device must provide at least sufficient mechanical stability to avoid loss of correction and unwanted fracture of the contralateral cortex until the bone heals. In the present study, the mechanical stability of following different implants was compared: the TomoFix small stature (sm), the TomoFix standard (std), the Contour Lock, the iBalance and the second generation PEEKPower. Simplified loading, usually consisting of a vertical load applied to the tibia plateau, is used for experimental testing of fixation devices and also in numerical studies. Therefore, this study additionally compared this simplified experimental loading with a more realistic loading that includes the muscle forces. Method Two types of finite element models, according to the considered loading, were created. The first type numerically simulated the static tests of MOWHTO implants performed in a previous experimental biomechanical study, by applying a vertical compressive load perpendicularly to the plateau of the osteotomized tibia. The second type included muscle forces in finite element models of the lower limb with osteotomized tibiae and simulated the stance phase of normal gait. Section forces in the models were determined and compared. Stresses in the implants and contralateral cortex, and micromovements of the osteotomy wedge, were calculated. Results For both loading types, the stresses in the implants were lower than the threshold values defined by the material strength. The stresses in the lateral cortex were smaller than the ultimate tensile strength of the cortical bone. The implants iBalance and Contour Lock allowed the smallest micromovements of the wedge, while the PEEKPower allowed the highest. There was a correlation between the micromovements of the wedge, obtained for the simplified loading of the tibia, and the more realistic loading of the lower limb at 15% of the gait cycle (Pearson’s value r = 0.982). Conclusions An axial compressive load applied perpendicularly to the tibia plateau, with a magnitude equal to the first peak value of the knee joint contact forces, corresponds quite well to a realistic loading of the tibia during the stance phase of normal gait (at 15% of the gait cycle and a knee flexion of about 22 degrees). However, this magnitude of the knee joint contact forces overloads the tibia compared to more realistic calculations, where the muscle forces are considered. The iBalance and Contour Lock implants provide higher rigidity to the bone-implant constructs compared to the TomoFix and the PEEKPower plates.
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Affiliation(s)
- Arnaud Diffo Kaze
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg. .,Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg. .,Cartilage Net of the Greater Region, 66421, Homburg, Germany.
| | - Stefan Maas
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg.,Cartilage Net of the Greater Region, 66421, Homburg, Germany
| | - Slawomir Kedziora
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg
| | - James Belsey
- University of Winchester & Basingstoke and North Hampshire Hospital, Sparkford Road, Winchester, SO22 4NR Hampshire, England
| | - Alexander Haupert
- Saarland University Medical Center, Kirrberger Str., Homburg, 66421 Homburg, Germany
| | - Claude Wolf
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, L-1359, Luxembourg, Luxembourg
| | - Alexander Hoffmann
- Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg.,Luxembourg Institute of Health, Luxembourg, L-1445, Luxembourg.,Cartilage Net of the Greater Region, 66421, Homburg, Germany
| | - Dietrich Pape
- Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, L-1460, Luxembourg, Luxembourg.,Luxembourg Institute of Health, Luxembourg, L-1445, Luxembourg.,Cartilage Net of the Greater Region, 66421, Homburg, Germany
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Morris J, Grant A, Kulkarni R, Doma K, Harris A, Hazratwala K. Early results of medial opening wedge high tibial osteotomy using an intraosseous implant with accelerated rehabilitation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:147-156. [DOI: 10.1007/s00590-018-2280-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Kobayashi H, Kageyama Y, Shido Y. Calcaneocuboid Distraction Arthrodesis With Synthetic Bone Grafts: Preliminary Results of an Innovative Bone Grafting Procedure in 13 Patients. J Foot Ankle Surg 2018; 56:1223-1231. [PMID: 28843551 DOI: 10.1053/j.jfas.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 02/03/2023]
Abstract
Calcaneocuboid distraction arthrodesis (CCDA) is regarded as an effective method for reconstructing adult-acquired flatfoot deformity. In the present study, we present our experience with newly developed rigid β-tricalcium phosphate wedges to treat CCDA to better understand the outcomes of this synthetic bone grafting procedure. A total of 13 feet in 13 patients underwent CCDA with synthetic bone grafts. One male (7.69%) and 12 females (92.31%), with a mean age of 65.07 ± 11.83 (range 36 to 77) years, were followed up for a mean duration of 32.76 ± 12.81 (range 18 to 55) months. Successful graft union was postoperatively obtained in 12 of the 13 feet (92.31%). The mean preoperative visual analog scale and American Orthopaedic Foot and Ankle Society scale score were 7.97 ± 1.52 (range 5.4 to 10) and 54.46 ± 14.72 (range 18 to 75), respectively. These scores improved to 1.52 ± 1.78 (range 0 to 6.2) and 85.46 ± 13.38 (range 50 to 97) postoperatively (p = .001 for both comparisons). On radiographic analysis, the talonavicular coverage angle, first metatarsal talar angle, calcaneal pitch, and heel alignment angle had significantly improved (p = .001, p = .028, p = .006, and p = .001, respectively). The use of bone graft substitutes in CCDA is a viable treatment option for reconstructing flexible flatfoot deformity. Although good clinical and radiographic outcomes were obtained, our method is even more challenging than conventional methods and should be used with caution. Rigid locking fixation with a long period of protected weightbearing is highly recommended to attain uneventful bone healing.
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Affiliation(s)
- Hayato Kobayashi
- Director, Department of Orthopaedic Surgery, Fujieda Heisei Memorial Hospital, Shizuoka, Japan.
| | - Yasunori Kageyama
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Suzukake Central Hospital, Shizuoka, Japan
| | - Yoji Shido
- Assistant Professor, Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K, Kambara S, Yoshiya S, Higa M. Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc 2018; 26:1873-1878. [PMID: 28831525 DOI: 10.1007/s00167-017-4680-x] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/16/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to analyse the resultant stress induced by joint-line obliquity after HTO for varus knee deformity using a three-dimensional (3D) finite element model analysis. METHODS The geometrical bone data used in this study were derived from commercially available human bone digital anatomy media. The 3D knee models were developed using 3D computer-aided design software. The articular surface was overlaid with a 2-mm-thick cartilage layer for both femoral and tibial condyles. Ligament structures were simulated based on properties reported in previous anatomical studies. Regarding the loading condition, isolated axial loads of 1200 N with lateral joint-line inclinations of 2.5°, 5°, 7.5°, and 10° in reference to the horizontal axis were applied to the femur to simulate the mechanical environment in a knee with joint-line obliquity. RESULTS A steep rise of shear stress in the medial compartment was noted in the model with obliquity of 5° or more. This laterally directed shear stress exhibited an incremental increase in accordance with the obliquity angle. The maximum shear stress value in the medial cartilage increased from 1.6 MPa for the normal knee to 3.3, 5.2, and 7.2 MPa in the joint-line obliquity models with 5°, 7.5°, and 10° of obliquity, respectively. CONCLUSIONS The effects of HTO for varus knee deformity on the amount/distribution of stresses in the articular cartilage were analysed using a 3D finite element model. It was shown that joint-line obliquity of more than 5° induced excessive shear stress in the tibial articular cartilage. A large amount of correction in OWHTO with a resultant joint-line obliquity of 5° or more may induce detrimental stress to the articular cartilage. Double-level osteotomy should be considered as a surgical option in this situation.
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Affiliation(s)
- Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Steffen Schröter
- BG Trauma Center Tübingen, Schnarrenberg str. 95, Tübingen, Germany
| | - Chie Yamamoto
- Department of Mechanical Engineering, University of Hyogo, 2167 Shosha, Himeji, Hyogo, 671-2280, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenji Kurosaka
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shunichiro Kambara
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaru Higa
- Department of Mechanical Engineering, University of Hyogo, 2167 Shosha, Himeji, Hyogo, 671-2280, Japan.
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Intramedullary nailing in opening wedge high tibial osteotomy-in vitro test for validation of a method of fixation. INTERNATIONAL ORTHOPAEDICS 2018; 42:1835-1843. [PMID: 29392383 DOI: 10.1007/s00264-018-3790-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant. METHODS Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test. RESULTS Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions. CONCLUSIONS The results suggest that intramedullary nailing might be used as an alternative concept in HTO.
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Lansdaal JR, Mouton T, Wascher DC, Demey G, Lustig S, Neyret P, Servien E. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:3670-3678. [PMID: 27371292 DOI: 10.1007/s00167-016-4225-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The need for a period of non-weight bearing after medial opening wedge high tibial osteotomy remains controversial. It is hypothesized that immediate weight bearing after medial opening wedge high tibial osteotomy would have no difference in functional scores at one year compared to delayed weight bearing. METHODS Fifty patients, median age 54 years (range 40-65), with medial compartment osteoarthritis, underwent a medial opening wedge high tibial osteotomy utilizing a locking plate without bone grafting. Patients were randomized into an Immediate or a Delayed (2 months) weight bearing group. All patients were assessed at one-year follow-up and the two groups compared. The primary outcome measure was the IKS score. Secondary outcome measures included the IKDC score, the VAS pain score and rate of complications. RESULTS The functional scores significantly improved in both groups. The IKS score increased from 142 ± 31 to 171 ± 26 in the Immediate group (p < 0.001) and from 148 ± 22 to 178 ± 23 in the Delayed group (p < 0.001). The IKDC score increased from 49 ± 17 pre-operatively to 68 ± 14 one-year post-operatively in the Immediate group (p < 0.0001) and from 44 ± 16 to 69 ± 19 in the Delayed group (p < 0.001). The average VAS for pain 2 months after surgery was 3 ± 3 in the Immediate group and 3 ± 2 in the Delayed (n.s.). There was no significant difference between the two groups in any of the outcome measures. The mean mechanical femorotibial angle changed from 6° of varus (0°-15° of varus, SD = 3°) to 4° of valgus (5°-11° of valgus, SD = 3°) in the Immediate group and from 5° of varus (0°-10° of varus, SD = 3°) to 3° of valgus (2° of varus to 8° of valgus, SD = 3°) in the Delayed group. No difference was seen between groups, and no loss of correction was observed in any patient. Two cases of non-union occurred, one in each group. One infection and one deep vein thrombosis occurred in the Immediate group. CONCLUSION Immediate weight bearing after medial opening wedge high tibial osteotomy had no effect on functional scores at 1 year follow-up and did not significantly increase the complication rate. Immediate weight bearing after medial opening wedge high tibial osteotomy appears to be safe and can allow some patients a quicker return to activities of daily living and a decreased convalescence period. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Joris Radboud Lansdaal
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 69004, Lyon, France
| | - Tanguy Mouton
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 69004, Lyon, France
| | - Daniel Charles Wascher
- Department of Orthopaedics and Rehabilitation, School of Medicine, University of New Mexico, MSC10 5600, Albuquerque, NM, USA
| | - Guillaume Demey
- Clinique de la Sauvegarde, Lyon Ortho Clinic, 29B Avenue des Sources, 69009, Lyon, France
| | - Sebastien Lustig
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 69004, Lyon, France
| | - Philippe Neyret
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 69004, Lyon, France
| | - Elvire Servien
- Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon University, 69004, Lyon, France.
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Hoorntje A, Witjes S, Kuijer PPFM, Koenraadt KLM, van Geenen RCI, Daams JG, Getgood A, Kerkhoffs GMMJ. High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis. Sports Med 2017; 47:2219-2244. [PMID: 28401426 PMCID: PMC5633634 DOI: 10.1007/s40279-017-0726-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Knee osteotomies are proven treatment options, especially in younger patients with unicompartmental knee osteoarthritis, for certain cases of chronic knee instability, or as concomitant treatment for meniscal repair or transplantation surgery. Presumably, these patients wish to stay active. Data on whether these patients return to sport (RTS) activities and return to work (RTW) are scarce. OBJECTIVES Our aim was to systematically review (1) the extent to which patients can RTS and RTW after knee osteotomy and (2) the time to RTS and RTW. METHODS We systematically searched the MEDLINE and Embase databases. Two authors screened and extracted data, including patient demographics, surgical technique, pre- and postoperative sports and work activities, and confounding factors. Two authors assessed methodological quality. Data on pre- and postoperative participation in sports and work were pooled. RESULTS We included 26 studies, involving 1321 patients (69% male). Mean age varied between 27 and 62 years, and mean follow-up was 4.8 years. The overall risk of bias was low in seven studies, moderate in ten studies, and high in nine studies. RTS was reported in 18 studies and mean RTS was 85%. Reported RTS in studies with a low risk of bias was 82%. No studies reported time to RTS. RTW was reported in 14 studies; mean RTW was 85%. Reported RTW in studies with a low risk of bias was 80%. Time to RTW varied from 10 to 22 weeks. Lastly, only 15 studies adjusted for confounders. CONCLUSION Eight out of ten patients returned to sport and work after knee osteotomy. No data were available on time to RTS. A trend toward performing lower-impact sports was observed. Time to RTW varied from 10 to 22 weeks, and almost all patients returned to the same or a higher workload.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne Witjes
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alan Getgood
- Department of Orthopaedic Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2017; 137:903-911. [PMID: 28444438 DOI: 10.1007/s00402-017-2703-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of this systematic review and meta-analysis was to evaluate the effectiveness and safety of early weight-bearing by comparing clinical and radiological outcomes between early and traditional delayed weight-bearing after OWHTO. MATERIALS AND METHODS A rigorous and systematic approach was used. The methodological quality was also assessed. Results that are possible to be compared in two or more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I 2 statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random-effects model was used to calculate the effect size. RESULTS Six articles were included in the final analysis. All case groups were composed of early full weight-bearing within 2 weeks. All control groups were composed of late full weight-bearing between 6 weeks and 2 months. Pooled analysis was possible for the improvement in Lysholm score, but there was no statistically significant difference shown between groups. Other clinical results were also similar between groups. Four studies reported mechanical femorotibial angle (mFTA) and this result showed no statistically significant difference between groups in the pooled analysis. Furthermore, early weight-bearing showed more favorable results in some radiologic results (osseointegration and patellar height) and complications (thrombophlebitis and recurrence). CONCLUSION Our analysis supports that early full weight-bearing after OWHTO using a locking plate leads to improvement in outcomes and was comparable to the delayed weight-bearing in terms of clinical and radiological outcomes. On the contrary, early weight-bearing was more favorable with respect to some radiologic parameters and complications compared with delayed weight-bearing.
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Pape D, Diffo Kaze A, Hoffmann A, Maas S. [Biomechanics of new implants for HTO]. DER ORTHOPADE 2017; 46:583-595. [PMID: 28396901 DOI: 10.1007/s00132-017-3417-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Biomechanical characteristics of 5 tibial osteotomy plates for the treatment of medial knee joint osteoarthritis were examined. Fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy, using TomoFix™ standard, PEEKPower®, ContourLock®, TomoFix™ small stature plates, and iBalance® implants. Static compression load to failure and load-controlled cyclic fatigue failure tests were performed. All plates had sufficient stability up to 2400 N in the static compression load to failure tests. Screw breakage in the iBalance® group and opposite cortex fractures in all constructs occurred at lower loading conditions. The highest fatigue strength in terms of maximal load and number of cycles performed prior to failure was observed for the ContourLock® group followed by the iBalance® implants, the TomoFix™ standard and small stature plates. PEEKPower® had the lowest fatigue strength. All plates showed sufficient stability under static loading. Compared to the TomoFix™ and the PEEKPower® plates, the ContourLock® plate and iBalance® implant showed a higher mechanical fatigue strength during cyclic fatigue testing, suggesting that both mechanical static and fatigue strength increase with a wider proximal T‑shaped plate design together with diverging proximal screws. Mechanical strength of the bone-implant constructs decreases with a narrow T‑shaped proximal end design and converging proximal screws (TomoFix™) or a short vertical plate design (PEEKPower®). Published results indicate high fusion rates and good clinical results with the TomoFix™ plate, which is contrary to our findings. A certain amount of interfragmentary motion rather than high mechanical strength and stiffness seem to be important for bone healing which is outside the scope of this paper.
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Affiliation(s)
- D Pape
- Orthopädische Klinik des Centre Hospitalier de Luxembourg, Akademisches Lehrkrankenhaus der Universitätskliniken des Saarlandes, 78, rue d'Eich, 1460, Luxembourg, Luxemburg. .,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Centre Médical de la Fondation Norbert Metz, 76 rue d'Eich, 1460, Luxembourg, Luxemburg.
| | - A Diffo Kaze
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, 1359, Luxembourg, Luxemburg.,Cartilage Net of the Greater Region, 66421, Homburg/Saar, Deutschland
| | - A Hoffmann
- Orthopädische Klinik des Centre Hospitalier de Luxembourg, Akademisches Lehrkrankenhaus der Universitätskliniken des Saarlandes, 78, rue d'Eich, 1460, Luxembourg, Luxemburg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Centre Médical de la Fondation Norbert Metz, 76 rue d'Eich, 1460, Luxembourg, Luxemburg
| | - S Maas
- Faculty of Science, Technology and Communication, University of Luxembourg, 6, rue R. Coudenhove-Kalergi, 1359, Luxembourg, Luxemburg.,Cartilage Net of the Greater Region, 66421, Homburg/Saar, Deutschland
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Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson JN, Parratte S. Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 2017; 103:245-250. [PMID: 28137553 DOI: 10.1016/j.otsr.2016.11.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of medial tibiofemoral osteoarthritis with a high-tibial osteotomy (HTO) is most effective when the optimal angular correction is achieved. However, conventional instrumentation is limited when multiplanar correction is needed. HYPOTHESIS Use of patient-specific cutting guides (PSCGs) for HTO provides an accurate correction (difference<2°) relative to the preoperative planning. MATERIALS AND METHODS Between February 2014 and February 2015, 10 patients (mean age: 46 years [range: 31-59]; grade 1 or 2 osteoarthritis in Ahlbäck's classification) were included prospectively in this reliability and safety study. All patients were operated using the same medial opening-wedge osteotomy technique. Preoperative planning was based on long-leg radiographs and CT scans with 3D reconstruction. The PSGCs were used to align the osteotomy cut and position the screw holes for the plate. The desired correction was achieved in the three planes when the holes on the plate were aligned with the holes drilled based on the PSCG. Preoperatively, the mean HKA angle was 171.9° (range: 166-179°), the mean proximal tibial angle was 87° (86-88°) and the mean tibial slope was 7.8° (1-22°). The postoperative correction was compared to the planned correction using 3D CT scan transformations. Intraoperative and postoperative complications were assessed at a minimum follow-up of 1 year. RESULTS The procedure was successfully carried out in all patients with the PSCGs. On postoperative long-leg radiographs, the mean HKA was 182.3° (180-185°); on the CT scan, the mean tibial mechanical angle was 94° (90-98°) and the mean tibial slope was 7.1° (4-11°). In 19 out of 20 postoperative HKA and slope measurements, the difference between the planned and achieved correction was <2° based on the 3D analysis of the three planes in space; in the other case, the slope was 13° instead of the planned 10°. The intra-class correlation coefficients between the postoperative and planned parameters were 0.98 [0.92-0.99] for the HKA and 0.96 [0.79-0.99] for the tibial slope. There were no surgical site infections; one patient had a postoperative hematoma that resolved spontaneously. DISCUSSION The results of this study showed that use of PSCGs in HTO procedures helps to achieve optimal correction in a safe and reliable manner. LEVEL OF EVIDENCE IV - Prospective cohort study.
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Affiliation(s)
- M Munier
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - M Donnez
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France; Newclip Technics, 44115 Haute-Goulaine, France
| | - M Ollivier
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - X Flecher
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - P Chabrand
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - J-N Argenson
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France.
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Goshima K, Sawaguchi T, Sakagoshi D, Shigemoto K, Hatsuchi Y, Akahane M. Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:918-923. [PMID: 26531184 DOI: 10.1007/s00167-015-3847-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 10/27/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Open-wedge high tibial osteotomy (OWHTO) is a well-established procedure in the management of medial compartment osteoarthritis and osteonecrosis of the medial femoral condyle. Several studies have evaluated factors that negatively influence outcomes. However, few reports have investigated the effect of age on HTO outcome. We evaluated the influence of the age on the outcome after HTO. METHODS The TomoFix® plate was used to perform 60 consecutive OWHTOs. Twenty-six knees in 23 patients >65 years old (mean age at surgery 68.7 ± 2.9 years; range 65-75 years, group A) were compared with 34 knees in 27 patients <65 years old (mean age at surgery 56.2 ± 7.5 years; range 38-64 years, group B) with respect to the clinical and radiological outcomes after HTO. The clinical evaluation included the Japanese Orthopedic Association Knee Score (JOA score), Oxford Knee Score (OKS) and complications after surgery. RESULTS There were no statistical differences in the background factors between the two groups. Postoperatively, the mean JOA score showed a significant improvement in both groups. The mean OKS after surgery was 41.6 ± 5.9 in group A and 41.4 ± 5.9 in group B. There were no statistical differences in the postoperative knee alignment and clinical outcomes between the two groups. CONCLUSION OWHTO using the rigid long plate was an effective procedure independent of patient's age. The results showed that age did not influence the clinical and radiological outcomes after OWHTO.
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Affiliation(s)
- Kenichi Goshima
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan.
| | - Takeshi Sawaguchi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Daigo Sakagoshi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Kenji Shigemoto
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Yu Hatsuchi
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
| | - Mika Akahane
- Department of Orthopedic Surgery and Joint Reconstructive Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama, 939-8511, Japan
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van der Woude JAD, Wiegant K, van Heerwaarden RJ, Spruijt S, van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:876-886. [PMID: 27106926 PMCID: PMC5332499 DOI: 10.1007/s00167-016-4131-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. METHODS Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. RESULTS All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). CONCLUSION Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- J. A. D. van der Woude
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands ,0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - K. Wiegant
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - R. J. van Heerwaarden
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - S. Spruijt
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - P. M. van Roermund
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - R. J. H. Custers
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - S. C. Mastbergen
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F. P. J. G. Lafeber
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Schröter S, Ateschrang A, Löwe W, Nakayama H, Stöckle U, Ihle C. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 2017; 25:325-332. [PMID: 25854499 DOI: 10.1007/s00167-015-3592-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 03/27/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Open wedge high tibial osteotomy is a widespread treatment option in patients with varus malalignment and medial compartment osteoarthritis. There is no standardised protocol for post-operative rehabilitation available. The purpose of this study was to compare two post-operative rehabilitation protocols and to evaluate the clinical outcome of early full weight-bearing after open wedge HTO. METHODS One hundred and twenty consecutive patients with varus malalignment and medial compartment osteoarthritis received an open wedge HTO using an angular locking plate fixation between December 2008 and December 2011. All patients were assigned randomly into one of two groups with different post-operative rehabilitation protocols (11-day vs. 6-week 20-kg partial weight-bearing). Clinical outcome was evaluated using established instruments (Lequesne, Lysholm, HSS and IKDC scores) preoperatively, 6, 12 and 18 months post-operatively. Deformity analysis was performed preoperatively and during follow-up. RESULTS All clinical scores showed a significant pre- to post-operative improvement. After 6 months, there was a higher improvement in the group of early full weight-bearing. The difference between preoperative and 6-month follow-up for the group with early full weight-bearing and for the group with 20-kg PWB for 6 weeks was 28 ± 26 and 18 ± 22, respectively, for the Lysholm score and -5.0 ± 5.1 and -3.0 ± 3.6, respectively, for the Lequesne score. CONCLUSIONS Early full weight-bearing (11-day 20-kg partial weight-bearing) after open wedge HTO without bone graft leads to earlier improvement of the clinical results and can be recommended for post-operative rehabilitation after open wedge HTO and fixation with an angular locking plate. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- S Schröter
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany.
| | - A Ateschrang
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - W Löwe
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | | | - U Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - C Ihle
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
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Pipino G, Indelli PF, Tigani D, Maffei G, Vaccarisi D. Opening-wedge high tibial osteotomy: a seven - to twelve-year study. JOINTS 2016; 4:6-11. [PMID: 27386441 DOI: 10.11138/jts/2016.4.1.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory mid-term results when accurate patient selection and precise surgical techniques were applied. This study was conducted to investigate the clinical and radiographic seven- to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. METHODS we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. RESULTS good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. CONCLUSIONS medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid- to long-term results. LEVEL OF EVIDENCE Level IV, therapeutic cases series.
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Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. THE ARCHIVES OF BONE AND JOINT SURGERY 2016; 4:204-12. [PMID: 27517063 PMCID: PMC4969364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/15/2016] [Indexed: 06/06/2023]
Abstract
High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes.
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Affiliation(s)
- Soheil Sabzevari
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Adel Ebrahimpour
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | - Amir R Kachooei
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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Ghinelli D, Parma A, Baldassarri M, Olivieri A, Mosca M, Pagliazzi G, Buda R. High tibial osteotomy for the treatment of medial osteoarthritis of the knee with new iBalance system: 2 years of follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:523-35. [PMID: 27015833 DOI: 10.1007/s00590-016-1768-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/14/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND A new system for performing open-wedge high tibial osteotomy (HTO), the iBalance HTO System-Arthrex, has been recently developed in order to make the surgery more reproducible and safe. The aim of this study was to determine the short-term outcomes of the iBalance technique in medial compartment osteoarthritis and varus malalignment of the knee. METHODS Fifteen patients with a mean age of 50.7 years (SD 5.09), affected by symptomatic varus knee, with medial compartment osteoarthritis (1-2 Ahlbäck degree), were treated with iBalance HTO between July 2011 and February 2012 and evaluated retrospectively. Patients were assessed against the following benchmarks: subjective International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and VAS for pain and Tegner scores, along with X-rays and MRI, before surgery and after a 2-year follow-up. RESULTS No severe intraoperative complications or implant failures occurred. The mean preoperative scores were as follows: subjective IKDC 66.8 (SD 1.18), KOOS 61.3 (SD 0.86), Vas for pain 8.6 (SD 1.72) and Tegner 4.1 (SD 2.06), while at follow-up the scores were 73.6 (SD 1.01), 88.1 (SD 1.23), 2.9 (SD 2.35) and 3.1 (SD 1.83), respectively. Correction ranged between 3° and 8°. All patients showed complete articular recovery, no loss of correction, no substantial variation in A/P slope and no hardware problems. CONCLUSIONS iBalance proved to be effective and safe and produced good overall results. Consolidation and osseointegration of the system took place rapidly, while recovery was precocious, comparable with traditional methods and with no severe complications. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Diego Ghinelli
- San Marino ISS - State Hospital, Via Vittorio Scialoja no 40, 47893, Borgo Maggiore, CA, San Marino
| | - Alessandro Parma
- Rizzoli Orthopaedic Institute, Via Pupilli, 1, 40134, Bologna, Italy
| | | | | | | | | | - Roberto Buda
- Rizzoli Orthopaedic Institute, Via Pupilli, 1, 40134, Bologna, Italy
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Cotic M, Vogt S, Feucht MJ, Saier T, Minzlaff P, Hinterwimmer S, Imhoff AB. Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015; 23:3707-16. [PMID: 25209206 DOI: 10.1007/s00167-014-3287-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/27/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the clinical, radiographic, and sports-related outcome at 24 months after valgus-producing medial open-wedge high tibial osteotomy (owHTO) using a 2nd generation peek-carbon composite plate. METHODS Between 2010 and 2011, the 2nd generation PEEKPower HTO-Plate(®) was used for medial owHTO in 28 consecutive patients (19 men, 9 women; mean age ± SD: 45 ± 11 years; mean varus deviation ± SD: 4° ± 2°). All of the patients had an osteotomy gap height of ≤12 mm without bone grafting. Visual analog scale (VAS) for pain, WOMAC score, and Lysholm score were evaluated preoperatively and at 12 and 24 months postoperatively. Sports-related outcomes included the Tegner scale, and a self-designed questionnaire preoperatively and 24 months postoperatively. Fixation stability of the implant was evaluated radiographically in two planes by comparing the medial proximal tibial angle (MPTA) and tibial slope 2 days after medial owHTO (baseline measurements) and after implant removal (follow-up measurements). Complications were recorded during the whole study period. RESULTS Compared to preoperative conditions, VAS, WOMAC, and Lysholm scores improved significantly (p < 0.05) at the 12- and 24-month follow-up. No significant differences were found between the 12- and 24-month follow-up. After 24 months, the sports frequency increased significantly (p < 0.05). No significant differences between baseline and follow-up measurements for the MPTA and tibial slope were observed. Total complication rate was 4 %, with one patient developing non-union. CONCLUSION In the clinical practice, the 2nd generation PEEKPower HTO-Plate(®) is a safe and efficient implant for medial owHTO without bone grafting in patients with an osteotomy gap of ≤12 mm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthias Cotic
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stephan Vogt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Orthopaedic Sports Medicine, Hessing Stiftung Augsburg, Augsburg, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Orthopedic Surgery and Traumatology, University Hospital Freiburg, Freiburg, Germany
| | - Tim Saier
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Philipp Minzlaff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stefan Hinterwimmer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
- Sportsclinic Germany GmbH, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
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Kobayashi H, Kageyama Y, Shido Y. Treatment of Varus Ankle Osteoarthritis and Instability With a Novel Mortise-Plasty Osteotomy Procedure. J Foot Ankle Surg 2015; 55:60-7. [PMID: 26190784 DOI: 10.1053/j.jfas.2015.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 02/03/2023]
Abstract
Although joint-preserving surgery for intermediate ankle osteoarthritis has been reported to be effective, failures of supramalleolar osteotomy and plafond-plasty can occur because of persistent malalignment of the distal tibia and incongruent ankle mortise. We introduce a novel opening wedge distal tibial osteotomy procedure (mortise-plasty) with rigid plate fixation combined with synthetic bone wedges. We performed 27 mortise-plasties in 25 patients with varus ankle osteoarthritis and instability. Six males (24%) and 19 females (76%), with a mean age of 63 (range 28 to 79) years, were followed up for a mean of 27.3 (range 14 to 45) months. The mean preoperative visual analog scale score, American Orthopaedic Foot and Ankle Society score, and Takakura ankle scale score were 7.4 (range 5.4 to 10), 58.7 (range 18 to 84), and 55.9 (range 29 to 88), respectively. These scores improved significantly to 2.1 (range 0 to 6.5), 89.3 (range 67 to 100), and 84.7 (range 55 to 100) postoperatively (p < .001). The mean preoperative tibial-anterior surface angle and talar tilt angle were 84.9° (range 78° to 90°) and 8.3° (range 3° to 21°), respectively. At the most recent follow-up visit, the corresponding values were 95.0° (range 82° to 99°) and 1.8° (range 0° to 8°), respectively (p < .001). Computed tomography scans indicated that the ankle mortise narrowed by approximately 1.8 mm and the tibial plafond was lowered after osteotomy. No patients underwent lateral ligament reconstruction, ankle joint replacement, or arthrodesis. Mortise-plasty osteotomy corrects the intra-articular and extra-articular deformities simultaneously and provides good clinical and radiographic outcomes for patients with varus ankle osteoarthritis and instability.
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Affiliation(s)
- Hayato Kobayashi
- Department of Orthopaedic Surgery, Fujieda Heisei Memorial Hospital, Shizuoka, Japan.
| | - Yasunori Kageyama
- Department of Orthopaedic Surgery, Hamamatsu Minami Hospital, Shizuoka, Japan
| | - Yoji Shido
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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