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MacLeod AR, Roberts SA, Gill HS, Mandalia VI. A simple formula to control posterior tibial slope during proximal tibial osteotomies. Clin Biomech (Bristol, Avon) 2023; 110:106125. [PMID: 37922607 DOI: 10.1016/j.clinbiomech.2023.106125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/13/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND High tibial osteotomy surgery is a widely successful joint-preserving procedure which alters the hip-knee-ankle axis which can delay the progression of osteoarthritis; however, conventional osteotomy surgical procedures do not adequately control the posterior tibial slope. This study aimed to determine the key variables influencing posterior tibial slope during high tibial osteotomy and provide a simple means of implementing the findings during pre-operative planning. METHODS A virtual cohort of twenty-eight proximal tibia geometries of knee osteoarthritis patients was used in the study. Firstly, absolute posterior tibial slope values were contrasted using anatomical and posterior mechanical axis measurement approaches. Secondly, the influence of variables affecting posterior tibial slope change during osteotomy surgery was investigated using 3D preoperative planning surgical simulation and analytical modelling. FINDINGS There was a poor correlation (R2 = 0.38) between the different clinical measurements of posterior tibial slope; with an average of 7.0 ± 1.3° and 14.8 ± 2.2° respectively. An analytical solution for the change in posterior tibial slope was derived based on the hinge axis angle and the osteotomy opening angle. For three different opening angles (6°, 9° and 12°) and seven different hinge axis orientations (-30° to +30°), the results obtained were identical for the analytical model and the 3D preoperative planning. INTERPRETATION This study determined that the key variables affecting posterior tibial slope during high tibial osteotomy are the osteotomy opening angle and the hinge axis orientation. The derived formula provides a simple means of determining the change in posterior tibial slope resulting from a particular surgical approach.
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Affiliation(s)
| | | | - Harinderjit S Gill
- Department of Mechanical Engineering, University of Bath, Bath, UK; Centre for Therapeutic Innovation/ Centre for Biosensors, Bioelectronics and Biodevices (C3Bio), University of Bath, Bath, UK
| | - Vipul I Mandalia
- Exeter Knee Reconstruction Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
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Betzler BK, Saggi SS, Liau MYQ, Koh DTS, Lee KH, Bin Abd Razak HR. No significant post-operative limb length difference following medial opening wedge high tibial osteotomy in a multi-ethnic Southeast Asian population. J Exp Orthop 2023; 10:89. [PMID: 37644360 PMCID: PMC10465403 DOI: 10.1186/s40634-023-00654-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE This study aims to assess the significance of post-operative change in limb length in medial opening wedge high tibial osteotomy (MOWHTO), and evaluate the correlation between correction angles and changes in limb length. We hypothesize that opening wedge height and correction angles directly correlate to changes in limb length. METHODS The medical records and radiographs of 91 MOWHTO patients were retrospectively evaluated for relevant radiographical parameters both pre- and post-operatively. The exclusion criteria are: (i) concurrent distal femur osteotomy in the same setting, (ii) other previous unilateral lower limb surgeries prior to MOWHTO and (iii) failure to follow-up with post-operative radiographs. A linear regression model was performed and a line of best fit, Pearson's correlation coefficient (r) and coefficient of determination (R2) were computed. Chi-squared test was also performed, and results with P < 0.05 were considered statistically significant. RESULTS There is a statistically significant increase in post-MOWHTO limb length (Absolute Δ = 4.3 ± 2.86 mm, % Δ = 0.652% ± 0.434%, p < 0.001). There was no significant difference in the limb length change between patients with larger (> 8 mm) and smaller (< 8 mm) opening widths. There was a weakly positive correlation between limb length change versus actual (R2 = 0.140, 95%CI [-0.068, 0.336]) and planned correction angles (R2 = 0.196, 95%CI [-0.012, 0.387]). CONCLUSION In conclusion, post-MOWHTO change in limb length is statistically significant, but the clinical significance is minimal. Further studies are required to assess other factors. Development of a reliable mathematical model that predicts post-MOWHTO limb length change would be useful in predicting the anatomical outcomes. LEVEL OF EVIDENCE Level III. Retrospective Cohort Study.
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Affiliation(s)
- Brjan Kaiji Betzler
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore
| | - Sandip Singh Saggi
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Experimental Medicine Building, Singapore, 636921, Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753, Singapore
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, 31 Third Hospital Ave, Singapore, 168753, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore.
- SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Academia Level 4, 20 College Road, Singapore, 169865, Singapore.
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Rosso F, Rossi R, Neyret P, Śmigielski R, Menetrey J, Bonasia DE, Fucentese SF. A new three-dimensional patient-specific cutting guide for opening wedge high tibial osteotomy based on ct scan: preliminary in vitro results. J Exp Orthop 2023; 10:80. [PMID: 37556100 PMCID: PMC10412513 DOI: 10.1186/s40634-023-00647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the accuracy of a patient-specific cutting guide on both coronal and sagittal alignment compared to the pre-operative planning in OWHTO. METHODS Twelve OWHTO on 6 cadaveric specimens were performed by 3 experienced knee surgeons using patient-specific cutting guides based on 3D pre-operative planning. Since the specimens had no major deformities, a fixed correction of 6° on the left and 10° on the right legs were carried out to simulate different scenarios. A pre-operative and post-OWHTO 3D CT scans were performed, and images were superimposed using the dedicated 3D planning software to align their reference axes. A pre-operative planning was performed considering both Medial Proximal Tibial Angle (MPTA) and Posterior Tibial Slope (PTS), and a patient-specific cutting guide was produced. Planned and post-OWHTO MPTA and PTS were evaluated (mean and standard deviation), and Pearson's correlation coefficient was calculated to assess precision and accuracy of the whole treatment. RESULTS A mean correction of 6,1° (SD 1,9°) and 1,2° (SD 1°) was obtained respectively in the coronal plane (MPTA) and in the sagittal plane (PTS). The average difference between planned and post-OWHTO MPTA and PTS was respectively 1,2° (SD 0,6°) and 1,2° (SD 1°) in the sagittal plane (PTS). Pearson's correlation coefficient demonstrated a good accuracy of the treatment in both coronal and sagittal plane (respectively r=0,95 and r=0,86). No lateral hinge fractures were detected at the post-operative CT scan. CONCLUSION OWTHO performed with the help of 3D patient specific cutting guide on cadaveric specimens demonstrated good accuracy and reliability in obtaining the planned correction. In vivo studies are necessary to confirm these results and evaluate cost-effectiveness of this system. LEVEL OF EVIDENCE Level IV cadaveric study.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy.
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Philippe Neyret
- Infirmerie Protestante, 3 Rue Penthod, 69300, Caluire, France
- Orthopaedics Department, Reem Hospital, Abu Dhabi, UAE
| | - Robert Śmigielski
- Orthopaedics and Sports Medicine Department, Life Institute Biological Treatment Center Lead, Grzybowska 43A/U8, Warsaw, Poland
| | - Jacques Menetrey
- Centre de Medecine du Sport Et de L'Exercice, Hirslanden Clinique La Colline, Genéve, Switzerland
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Sandro Franco Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Dasari SP, Hevesi M, Mameri E, Ferrer-Rivero R, Fortier LM, Jackson GR, Warrier AA, Maheshwer B, Jawanda H, Khan ZA, Kerzner B, Browning RB, Gursoy S, Chahla J. Patient-specific instrumentation for medial opening wedge high tibial osteotomies in the management of medial compartment osteoarthritis yields high accuracy and low complication rates: A systematic review. J ISAKOS 2023; 8:163-176. [PMID: 36931505 DOI: 10.1016/j.jisako.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/15/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023]
Abstract
IMPORTANCE There has been growing interest in the use of patient-specific instrumentation (PSI) to maximise accuracy and minimise the risk of major complications for medial opening-wedge high tibial osteotomies (MOW-HTOs). Numerous studies have reported the efficacy and safety of implementing this technology into clinical practice, yet no systematic review summarising the clinical literature on PSI for MOW-HTOs has been performed to date. AIM The aim of this investigation was to perform a systematic review summarising the evidence surrounding the use of PSI for MOW-HTOs in the management of medial compartment osteoarthritis. EVIDENCE REVIEW PubMed, Scopus, and the Cochrane Library were queried in October 2021 for studies that used PSI for MOW-HTOs when managing medial compartment knee osteoarthritis. Primary outcomes included accuracy in coronal plane correction (mechanical medial proximal tibial angle), sagittal plane correction (posterior tibial slope), and mechanical axis correction (hip-knee-ankle angle [HKA], mechanical femorotibial angle, and weight-bearing line). Accuracy was defined as error between post-operative measurements relative to the planned pre-operative correction. A secondary outcome was the incidence of major complications. FINDINGS This review included eight different techniques among the 14 included studies. There was a weighted mean error of 0.5° (range: 0.1°-1.3°) for the mechanical medial proximal tibial angle, 0.6° (range: 0.3°-2.7°) for the posterior tibial slope, and 0.8° (range: 0.1°-1.0°) for the hip-knee-ankle angle. Four studies compared the correctional error of the mechanical axis between conventional techniques and PSI techniques. The comparative difference between the two techniques favoured the use of PSI for MOW-HTOs (standardised mean difference = 0.52; 95% confidence interval, 0.16 to 0.87; p = 0.004). Among the 14 studies evaluated, four studies explicitly reported no major complications, while five studies reported a non-zero incidence of major complications. Among these nine studies, the weighted mean major complication rate was 7.1% (range: 0.0-13.0%). CONCLUSIONS AND RELEVANCE The findings of this present systematic review suggest that the use of PSI for MOW-HTOs leads to high accuracy relative to the planned corrections in the coronal plane, sagittal plane, and mechanical axis. Furthermore, these findings would suggest there is a low risk of major complications when implementing PSI for MOW-HTOs. LEVEL OF EVIDENCE Systematic review; IV.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Enzo Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert Ferrer-Rivero
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alec A Warrier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bhargavi Maheshwer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Harkirat Jawanda
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert B Browning
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Hasegawa M, Naito Y, Tone S, Sudo A. High rates of outliers in computer-assisted high tibial osteotomy with excellent mid-term outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:399-405. [PMID: 34738158 DOI: 10.1007/s00167-021-06788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The primary aim was to evaluate the accuracy of navigation in opening wedge high tibial osteotomy (HTO). The secondary aim was to examine mid-term outcomes after HTO. METHODS Inclusion criteria were patients with medial compartment knee osteoarthritis who underwent computer-assisted HTOs. Mechanical axis (MA), percentage MA (%MA), and change in posterior tibial slope (ΔPTS) were displayed on the navigation screen. Radiographic examinations included hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and PTS. Preoperative and 5 weeks postoperative standing radiographs of the whole lower extremity and knee were used. Clinical evaluations were performed using American Knee Society knee score and function score both preoperatively and at last follow-up. Radiographic evaluations were performed by orthopedic surgeons. Intraoperative navigation after osteotomy and postoperative standing radiograph were compared. MA (HKA), %MA, and ΔPTS were compared. Outliers were defined as > 3° in MA, > 10% in %MA, and > 10° in ΔPTS. Outlier and non-outlier groups were compared. The rate of conversion to arthroplasty was examined. RESULTS This study involved 38 patients (44 knees) and last follow-up was at a mean of 5 years (range, 1-9 years). Mean American Knee Society knee score and function score improved significantly from 59 to 69 preoperatively to 95 and 85 at last follow-up, respectively. Absolute values of mean errors for MA, %MA, and ΔPTS were 2.1°, 9.3%, 1.2°, respectively. Outlier rates were 18% in MA, 39% in %MA, and 5% in ΔPTS. No significant factors were found in MA and ΔPTS. In %MA, preoperative JLCA was significantly higher in the outlier group compared to the non-outlier group. No knees underwent conversion to total knee arthroplasty. No differences in outcomes were found between outlier and non-outlier groups. CONCLUSION Although rates of outlier values in computer-assisted opening wedge HTO were high, mid-term outcomes were excellent. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Ghasemi SA, Murray BC, Buksbaum JR, Shin J, Fragomen A, Rozbruch SR. Opening wedge high tibial osteotomy for medial compartment knee osteoarthritis: Planning and improving outcomes: Case series and literature review. J Clin Orthop Trauma 2023; 36:102085. [PMID: 36654729 PMCID: PMC9840976 DOI: 10.1016/j.jcot.2022.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background Opening wedge high tibial osteotomy (OWHTO) is a safe surgical procedure to treat medial compartmental osteoarthritis caused by a varus deformity. Over-correction of this varus deformity can lead to lateral compartment over-loading. In our study, we planned our correction by using the mechanical axis deviation (MAD). Purpose The purpose of this study is to evaluate the clinical and radiological results of OWHTO based on planning using the MAD measurements. Study Design Retrospective Case Series. Methods 14 patients with Kellgren- Lawrence classification (KL) grade 3 or above underwent OWHTO, with plans to have the mechanical axis pass through 5-15 mm lateral to the center of the tibial plateau. Pre-operative and post-operative radiographic measurements were made and compared using the student t-test. SF-36 scores were obtained for clinical performance. Results Our patients experienced MAD from 25.9 mm medial to the center of the tibial plateau pre-operatively to 12.7 mm lateral to the center of the plateau post-operatively. The mean change in MAD was 38.7 mm (p < 0.0001). The accuracy of our correction compared to the planned MAD was 98.3%. The mechanical axis angle shifted from 7.35° of varus to 3.5° of valgus (p < 0.0001). All patients had post-operative alignments of 1-6° of valgus, with 11 of out the 14 patients with alignments less than 5° of valgus, preventing over-loading of the lateral compartment. Conclusion Using MAD measurements is an accurate planning method for OWHTO that corrects varus deformity without over-loading the lateral compartment, and leads to improved clinical outcomes.
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Affiliation(s)
- S. Ali Ghasemi
- Orthopaedic Surgery, Albert Einstein Health Network, Philadelphia, PA, 19141, United States
| | - Benjamin C. Murray
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 19131, United States
| | - Joshua R. Buksbaum
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
| | - Jonggu Shin
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
| | - Austin Fragomen
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY, 10021, United States
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van Haeringen MH, Kuijer PPFM, Daams JG, van Geenen RCI, Brinkman JM, Kerkhoffs GMMJ, van Heerwaarden RJ, Hoorntje A. Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07229-3. [PMID: 36473985 DOI: 10.1007/s00167-022-07229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to establish the gold standard for surgical technique, fixation, and rehabilitation for HTO in patients with unicompartmental knee osteoarthritis. METHODS Medline, Embase, and SPORTDiscus databases were searched up to April 2022. Included were (1) randomized controlled trials (RCTs) comparing opening-wedge HTO (owHTO) and closing-wedge HTO (cwHTO), (2) biomechanical studies and prospective patient studies comparing biomechanical and clinical results for plate fixators, and (3) RCTs comparing an early versus delayed full-weight-bearing (FWB) protocol. RESULTS The pooled results for the surgical technique showed no significant differences between owHTO and cwHTO for most PROMs on pain, activity, and risk for conversion to TKA. The cwHTO group showed a slightly better improvement in KOOS/WOMAC pain scores (4.51; 95% CI 1.18-7.85), and a significantly lower change in posterior tibial slope (p = 0.03). The pooled results for the fixation method showed the highest force at maximum failure for the Activmotion (Newclip Technics, France), Aescula (B. Braun Korea, Korea), 2nd generation Puddu (Arthrex Inc., USA), and TomoFix plate (Depuy Synthes, Switzerland). The pooled results for the rehabilitation protocol showed no significant differences between the early full-weight-bearing (FWB) group and the delayed FWB group for functional scores, complication rates, and delayed unions. CONCLUSION Both owHTO and cwHTO reduced pain and improved knee function. Locking plate fixation should be used for owHTO. An early FWB protocol has proven to be safe in patients with small corrections, no hinge fractures, and non-smokers. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- M H van Haeringen
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, The Netherlands
| | - J M Brinkman
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - A Hoorntje
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Trojani C, Micicoi G, Boileau P. High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum. Orthop Traumatol Surg Res 2021; 107:103025. [PMID: 34329759 DOI: 10.1016/j.otsr.2021.103025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments. HYPOTHESIS Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension. MATERIAL AND METHODS Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores). RESULTS The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved. CONCLUSION Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term. LEVEL OF EVIDENCE IV, retrospective descriptive study.
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Affiliation(s)
- Christophe Trojani
- Institut de chirurgie réparatrice, locomoteur & sport, 7, avenue Durante, 06000 Nice, France.
| | - Grégoire Micicoi
- Service de chirurgie orthopédique et chirurgie du sport, institut universitaire locomoteur et du sport (IULS) - hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - Pascal Boileau
- Institut de chirurgie réparatrice, locomoteur & sport, 7, avenue Durante, 06000 Nice, France
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Iida K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. Evaluation of regenerated cartilage using T2 mapping methods after opening-wedge high tibial osteotomy with microfracture at the cartilage defect: a preliminary study. J Exp Orthop 2021; 8:91. [PMID: 34655391 PMCID: PMC8520536 DOI: 10.1186/s40634-021-00413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. It was hypothesised that cartilage regeneration can be achieved by HTO, but the quality of regenerated cartilage is not normal cartilage. METHODS OWHTO was performed in eight knees of seven patients (mean age, 57.6 ± 5.2 years). Microfracture for the cartilage defect was performed followed by OWHTO, and second-look arthroscopy was performed at the time of plate removal (14.1 ± 4.5 months after OWHTO). MRI was assessed at three months and one year after surgery. The status of articular cartilage regeneration was assessed by the ICRS grade, MOCART score and T2 value. RESULTS The number of subjects in ICRS grade 1/2/3/4 changed significantly from 0/0/4/4 preoperatively to 0/2/6/0 postoperatively in the medial femoral condyle (MFC) (P < 0.05) and 0/0/0/8 preoperatively to 0/0/7/1 postoperatively in the medial tibial plateau (MTP) (P < 0.05). Mean MOCART scores for MFC and MTP at one year after surgery exhibited significant increases compared with the results at three months after surgery. Mean T2 values for MFC and MTP did not differ at three months and one year after surgery. CONCLUSION The appearance and morphological evaluation by ICRS grade and MOCART score of regenerated cartilage were improved after OWHTO with concomitant microfracture. However, there were no significant qualitative differences in T2 values. This suggests that the regenerated cartilage tissue was likely to be insufficient cartilage. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Kumagai K, Fujimaki H, Yamada S, Nejima S, Matsubara J, Inaba Y. Difference in the early postoperative change of the joint line convergence angle between opening wedge and closed wedge high tibial osteotomies. J Orthop Surg Res 2021; 16:66. [PMID: 33468195 PMCID: PMC7816300 DOI: 10.1186/s13018-021-02214-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/06/2021] [Indexed: 12/26/2022] Open
Abstract
Background The purpose of this study was to investigate the correction error associated with soft tissue balance in high tibial osteotomy (HTO) and the difference between opening wedge HTO (OWHTO) and closed wedge HTO (CWHTO). Methods A total of 170 knees of 130 patients (85 knees of 68 patients in OWHTO and 85 knees of 62 patients in CWHTO) were evaluated. Anteroposterior radiographs of the knee and full-length leg were taken preoperatively, immediately under general anesthesia postoperatively, 2 days, and 1 and 12 months postoperatively. The femorotibial angle (FTA), joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA) were measured. Results The postoperative FTA was decreased from 170.5 ± 2.1° at 0 day to 168.6 ± 2.2° at 2 days in OWHTO (P < 0.05), whereas it was not changed from 168.7 ± 2.4° at 0 day to 168.1 ± 2.8° at 2 days in CWHTO. The JLCA was 4.8 ± 1.8° preoperatively, 4.2 ± 1.9° at 0 day, 2.2 ± 1.8° at 2 days (P < 0.05 vs 0 day), 2.6 ± 1.7° at 1 month, and 2.7 ± 1.6° at 12 months in OWHTO, and 7.1 ± 3.2° preoperatively, 4.1 ± 2.4° at 0 day (P < 0.05 vs preoperative), 3.4 ± 2.5° at 2 days, 3.9 ± 2.3° at 1 month, and 4.2 ± 2.6° at 12 months in CWHTO. Multiple regression analysis showed that preoperative factors affecting change of the JLCA from preoperative to postoperative 1 month were the correction angle in OWHTO (P = 0.001) and the preoperative standing JLCA in OWHTO (P < 0.001) and CWHTO (P < 0.001). Conclusions A significant decrease of the JLCA occurred immediately after osteotomy under anesthesia in CWHTO, whereas in OWHTO there was no decrease under anesthesia, but it decreased several days postoperatively.
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Affiliation(s)
- Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Hiroshi Fujimaki
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Joji Matsubara
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Kumagai K, Yamada S, Akamatsu T, Nejima S, Ogino T, Sotozawa M, Inaba Y. Intraoperatively accurate limb alignment after opening wedge high tibial osteotomy can be lost by large knee joint line convergence angle during surgery. Arch Orthop Trauma Surg 2021; 141:23-28. [PMID: 32221704 DOI: 10.1007/s00402-020-03419-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to assess early postoperative loss of achieved correction and associated factors after opening wedge high tibial osteotomy (OWHTO). MATERIALS AND METHODS OWHTO was performed in 121 patients with osteoarthritis of the knee (mean age 66 years, 154 knees). Anteroposterior radiographs of the knee and full-length leg, and varus and valgus stress radiographs of the knee were taken, and the femorotibial angle (FTA), joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA) were measured. The changes in the FTA, JLCA, and MPTA were defined as ΔFTA, ΔJLCA, and ΔMPTA. RESULTS The ΔFTA and ΔJLCA at postoperative 0-2 days were - 1.8 ± 1.2° and - 1.9 ± 1.4°, respectively. The ΔFTA, ΔJLCA and ΔMPTA at postoperative 1-12 months were 0.9 ± 1.3°, 0.2 ± 1.2° and - 0.8 ± 0.8°, respectively. A positive correlation was found between ΔFTA and ΔJLCA at postoperative 0-2 days (ρ = 0.642, P < 0.001) and at postoperative 1-12 months (ρ = 0.402, P < 0.001). A negative correlation was found between ΔFTA and ΔMPTA at postoperative 1-12 months (ρ = - 0.534, P < 0.001). A discrepancy in alignment represented by the FTA occurred in the supine radiographs between the day of surgery and postoperative 2 days. Multiple regression analysis suggested that postoperative JLCA on the day of surgery was the factor related to early postoperative change of the FTA. CONCLUSIONS This study demonstrated the early loss of achieved correction after OWHTO due to change of the JLCA, even if the accurate alignment is obtained intraoperatively.
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Affiliation(s)
- Ken Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomotaka Akamatsu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takehiro Ogino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Ogino T, Kumagai K, Yamada S, Akamatsu T, Nejima S, Sotozawa M, Inaba Y. Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy. BMC Musculoskelet Disord 2020; 21:675. [PMID: 33046054 PMCID: PMC7549202 DOI: 10.1186/s12891-020-03703-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). METHODS A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. RESULTS CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P < 0.05), and a greater soft tissue correction than OWHTO (P < 0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P < 0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. CONCLUSIONS The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.
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Affiliation(s)
- Takahiro Ogino
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomotaka Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Pagkalos J, Hussain F, Karargyris O, Snow M. A pilot study to assess the safety and radiological performance of a new low-profile locking plate for high tibial osteotomy. Knee 2018; 25:866-73. [PMID: 30207280 DOI: 10.1016/j.knee.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/17/2018] [Accepted: 05/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND We report the first results of a new low-profile titanium locking plate for fixation of opening wedge high tibial osteotomy (OWHTO). Short spacer plates have been associated with a high hardware complication rate, whilst fixed angle locking plates have been associated with a high incidence of soft tissue irritation. This plate aims to achieve stable fixation whilst maintaining a low profile, allowing space for combined procedures. METHODS All patients undergoing OWHTO with the Activmotion plate were retrospectively reviewed. Patients were allowed to progress to full weight bearing after two weeks. Radiographic assessment included the medial proximal tibial angle (MPTA) and posterior tibial slope at six weeks and then three monthly until union. All complications were recorded. RESULTS Thirty-seven patients with 40 OWHTOs were included in the study. The mean MPTA increased from 85.2 preoperatively to 91.9 postop. Tibial slope changed from 5.2 to 4.2°. The correction was sustained until union with no loss of correction in the MPTA (median change 0.0, 95% CI for median (-0.25, 0.4)) or tibial slope (mean increase 0.32, 95% CI (-0.02, 0.67)). CONCLUSIONS In this pilot study the Activmotion plate raised no safety concerns with regard to implant related adverse events or loss of initial correction. Early rehabilitation with immediate partial weight bearing was possible and all cases proceeded to osteotomy union with the exception of one case that needed to undergo bone grafting with implant retention. Premature removal of the implant was necessary in four cases due to symptomatic hardware irritation.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nerhus TK, Ekeland A, Solberg G, Olsen BH, Madsen JE, Heir S. No difference in time-dependent improvement in functional outcome following closing wedge versus opening wedge high tibial osteotomy: a randomised controlled trial with two-year follow-up. Bone Joint J 2017; 99-B:1157-1166. [PMID: 28860395 DOI: 10.1302/0301-620x.99b9.bjj-2017-0062.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/24/2017] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this prospective randomised study was to compare the time course of clinical improvement during the first two years following a closing or opening wedge high tibial osteotomy (HTO). It was hypothesised that there would be no differences in clinical outcome between the two techniques. PATIENTS AND METHODS Between 2007 and 2013, 70 consecutive patients were randomly allocated to undergo either a closing or opening wedge HTO. All patients had medial compartment osteoarthritis (OA), and were aged between 30 years and 60 years. They were evaluated by independent investigators pre-operatively and at three and six months, and one and two years post-operatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), the Lysholm score, the Tegner activity score, the University of California, Los Angeles (UCLA) activity scale and range of movement (ROM). RESULTS There were no significant differences at any time between the two techniques for any clinical outcome score (p > 0.05). The mean scores for all the systems, except UCLA and Tegner, significantly improved until six months post-operatively (p < 0.001). For some scores, the improvement continued until one and two years. CONCLUSION This prospective randomised study suggests that there are no differences in the time course of the clinical improvement between the closing and opening wedge techniques for HTO during the first two post-operative years. Patients can expect continued improvement in physical function for between six months and one year after HTO regardless of the technique used. Cite this article: Bone Joint J 2017;99-B:1157-66.
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Affiliation(s)
- T K Nerhus
- Martina Hansens Hospital, Sandvika, Norway
| | - A Ekeland
- Martina Hansens Hospital, Sandvika, Norway
| | - G Solberg
- Martina Hansens Hospital, Sandvika, Norway
| | - B H Olsen
- Martina Hansens Hospital, Sandvika, Norway
| | | | - S Heir
- Martina Hansens Hospital, Sandvika, Norway
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Shin YS, Sim HB, Yoon JR. Tibial nerve neuropathy following medial opening-wedge high tibial osteotomy-case report of a rare technical complication. Eur J Orthop Surg Traumatol 2017; 27:563-567. [PMID: 28324204 DOI: 10.1007/s00590-017-1944-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022]
Abstract
A 63-year-old woman developed tibial nerve injury caused by an overlong K wire and 4.5-mm cortical lag screw through the first distal hole below the osteotomy during medial opening-wedge high tibial osteotomy (HTO), leading to a lack of sensation on the sole of the foot with no disturbances in motor functions. The temporary lag screw in the first distal hole below the osteotomy is often inserted by an excessive length in order to compress the potentially fractured opposite cortex. By doing so, posterior neurovascular structures including the tibial nerve and the popliteal vessels can be injured. To avoid this type of injury during medial opening-wedge HTO, proper knee position and appropriate Hohmann retractor position in combination with meticulous insertion of the K wire or screw under fluoroscopic control are essential. In addition, our study reinforces the fact that different presentations of injury to the tibial nerve should be carefully considered in the absence of common diagnostic features, including weakness of the toe flexors and posterior tibial muscle of the leg with intractable pain.
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Affiliation(s)
- Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea
| | - Hyun-Bo Sim
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea.
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Polat G, Balcı Hİ, Çakmak MF, Demirel M, Şen C, Aşık M. Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. J Orthop Surg Res 2017; 12:44. [PMID: 28302132 PMCID: PMC5356246 DOI: 10.1186/s13018-017-0547-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/08/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis. METHODS A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments. RESULTS In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan-Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients. CONCLUSIONS HTO has acceptable long-term clinical and functional results that should not be underestimated by orthopedic surgeons under pressure to perform arthroplasty operations.
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Affiliation(s)
- Gökhan Polat
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey.
| | - Halil İbrahim Balcı
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Mehmet Fevzi Çakmak
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Cengiz Şen
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
| | - Mehmet Aşık
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, 34093, Çapa-Fatih/Istanbul, Turkey
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Nerhus TK, Ekeland A, Solberg G, Sivertsen EA, Madsen JE, Heir S. Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:910-7. [PMID: 26467810 DOI: 10.1007/s00167-015-3817-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 09/24/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of the present study was to examine changes in radiological variables in a prospective randomized study comparing opening wedge (OW) and closing wedge (CW) techniques of high tibial osteotomy (HTO). Our hypothesis was that there would be no differences in joint line angles or correction accuracy between the two groups, that patellar height would increase after CW HTO and decrease after OW HTO, and that leg length and posterior tibial slope would decrease after CW HTO and increase after OW HTO. METHODS Radiological data were collected from 70 patients participating in an ongoing prospective randomized clinical trial comparing OW and CW HTOs. Digital standing hip-knee-ankle (HKA) radiographs as well as lateral radiographs in 30° of flexion were obtained preoperatively and at 6 months for each patient. Joint line angles, HKA angle, leg length, Insall-Salvati index, Miura-Kawamura index and posterior tibial slope were measured using medical planning software. The complete preoperative radiological examinations of the first 50 patients were used in a study of intra- and inter-rater reliability of the measurements. RESULTS The mean posterior slope was reduced by 2.5° in CW HTO, whereas it remained unchanged in OW HTO (p < 0.001). Mean leg length decreased 5.7 mm in CW HTO and increased 3.1 mm in OW HTO (p < 0.001). Changes in joint line angles, patellar height indexes and the correction accuracy showed no significant differences comparing the two techniques. Frontal plane reliability measurement intra- and inter-rater intraclass correlation coefficient (ICC) varied from 0.81 to 0.99. Sagittal plane intra- and inter-rater ICC varied from 0.60 to 0.87. Posterior tibial slope intra- and inter-rater ICC showed the lowest values (0.70 and 0.60, respectively) corresponding to a smallest real difference of 4.5° and 5.5°, respectively. CONCLUSIONS Posterior tibial slope and leg length changes were significantly different in CW compared to OW HTOs. We recommend that possible alterations in tibial slope and leg length are considered when the technique of HTO is to be chosen. Landmark-based medical planning software shows good reliability and can be used in preoperative planning and postoperative evaluations of HTOs. LEVEL OF EVIDENCE I.
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Kuwashima U, Tashiro Y, Okazaki K, Mizu-Uchi H, Hamai S, Murakami K, Iwamoto Y. Comparison of the impact of closing wedge versus opening wedge high tibial osteotomy on proximal tibial deformity and subsequent revision to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:869-875. [PMID: 27017215 DOI: 10.1007/s00167-016-4074-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to assess the differences in proximal tibial deformity between closing wedge (CW) and opening wedge (OW) high tibial osteotomy (HTO) and their effects on the difficulty of total knee arthroplasty (TKA) conversion. METHODS Surgical simulations of CW-HTO and OW-HTO were performed on the same 3D computer-aided design knee models reconstructed from computed tomographic datasets of patients (median age 77 years; range 55-87 years; 40 knees) with medial osteoarthritis or osteonecrosis, and proximal tibial deformities were analysed. Subsequent TKA conversion was simulated in both CW and OW models, and the interference between the tibial implant and endosteal cortex was assessed. RESULTS The difference in the metaphyseal-diaphyseal angle in the CW-HTO and OW-HTO groups was 0.3° ± 0.2° (p < 0.001). The mechanical axis in the CW-HTO group was shifted laterally by 1.8 ± 1.1 mm relative to that in the OW-HTO group (p < 0.001) on the resection surface in TKA. Finally, the TKA tibial implant was substantially closer to the endosteal cortex in the CW-HTO group (mean 5.6 ± 1.6 mm) than to that in the OW-HTO group (mean 7.3 ± 1.6 mm) (p < 0.001). CONCLUSION The difference in the post-operative angular deformities of the proximal tibia between CW-HTO and OW-HTO was considered to be clinically irrelevant. The risk of interference between TKA tibial implant and endosteal bone was greater after CW-HTO than after OW-HTO. For clinical relevance, the difference between the two techniques has little influence on subsequent TKA difficulty regarding the proximal tibial deformity, although preoperative planning is obligatory, particularly after CW-HTO, to prevent interference with the tibial implant. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Umito Kuwashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasutaka Tashiro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Scordino LE, Obopilwe E, Charette R, Edgar CM, DeBerardino TM, Mazzocca AD. Calcium phosphate cement enhances the torsional strength and stiffness of high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2017; 25:817-22. [PMID: 26231147 DOI: 10.1007/s00167-015-3692-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE There has been a resurgence in the use of opening wedge high tibial osteotomy (owHTO). Calcium phosphate cement has been shown to improve strength in compression for augmentation of tibial plateau and owHTO fixation. However, knee kinematics includes a torsional load during ambulation, which is as yet unstudied in this model. The purpose of this paper is to investigate the effect of injectable calcium phosphate cement on the biomechanical stability of standard high tibial osteotomy defect with applied torsional load and ultimate stiffness of the supporting construct. METHODS Testing was performed on 22 bone mineral density-matched and age-matched cadaver specimens. Intact specimens were treated with 10° opening wedge osteotomies, identical surgical techniques as clinically used and fixation provided by iBalance© PEEK implant (Arthrex, Naples FL). Nine specimens were augmented with calcium phosphate injectable cement, Quickset (Arthrex Inc., Naples Fl). Constructs were for construct stiffness, torsional loads to failure, and mechanisms of failure. As a gold-standard comparison group, four samples were tested with a titanium, fixed angle device alone: Contourlock plate (Arthrex Inc., Naples Fl). RESULTS Peak torque to failure was significantly greater in samples augmented with calcium phosphate bone cement (23.0 ± 9.6 Nm) compared with specimens fixed with PEEK implant alone (18.1 ± 7.3). Construct stiffness in torsion was also significantly improved with bone cement application (349.0 ± 126.8 Nm/°) compared with PEEK implant alone (202.2 ± 153.4 Nm/°) and fixed angle implant system (142.9 ± 74.7 Nm/°). CONCLUSION Injectable calcium phosphate cement improves the initial maximal torsional strength and stiffness of high tibial osteotomy construct.
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Mondanelli N, Giron F, Losco M, Buzzi R, Aglietti P. Opening wedge high tibial osteotomy using a monoaxial dynamic external fixator. Knee Surg Sports Traumatol Arthrosc 2017; 25:306-313. [PMID: 25786821 DOI: 10.1007/s00167-015-3564-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To prospectively assess midterm results in 37 patients (41 knees) who were treated with opening wedge high tibial osteotomy (OW-HTO) with the use of a monoaxial dynamic external fixator (MDEF) for medial knee osteoarthritis. METHODS Clinical and subjective evaluations were performed using the IKDC and KOOS evaluation forms and the modified Knee Society Clinical Rating System (KSS). Pin tract infections were evaluated according to Checketts-Otterburns classification. Radiographic evaluation included long-standing AP lower limb, standard lateral, Rosenberg and Merchant views. RESULTS Thirty-six patients (40 knees) were evaluated at a mean follow-up period of 7 years. Ten patients (25 %) developed a minor pin tract infection. Subjective KOOS and IKDC scores showed statistically significant improvement. Clinical evaluation with IKDC and KSS forms showed no patient with instability or a range-of-motion deficit worst than pre-operatively. At MDEF removal, the mechanical axis was on average 4.5° valgus; anatomical axis 6.8° valgus; the Mikulicz' line crossed the tibial plateau on average at 64 % of the width of the tibial plateau measured from medial; the posterior slope 5°; the metaphyseal varus 4.3°; and the Insall/Salvati ratio 1.02. At latest follow-up, five patients had a loss of correction of 1°-2° on mechanical axis and one patient had a loss of correction of 3° on mechanical axis and 4 % of mechanical axis on tibial plateau. CONCLUSIONS The use of a MDEF to perform an OW-HTO showed a good maintenance of correction achieved with satisfactory midterm outcome results in all patients but three who underwent total knee replacement. The only severe post-operative complication was one case of non-union in a heavy smoker. LEVEL OF EVIDENCE Prospective and therapeutic study, Level IV.
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Affiliation(s)
- Nicola Mondanelli
- SOD Traumatologia e Ortopedia Generale AOU Careggi, Largo P. Palagi 1, 50139, Florence, Italy
| | - Francesco Giron
- SOD Traumatologia e Ortopedia Generale AOU Careggi, Largo P. Palagi 1, 50139, Florence, Italy.
| | - Michele Losco
- SOD Traumatologia e Ortopedia Generale AOU Careggi, Largo P. Palagi 1, 50139, Florence, Italy
| | - Roberto Buzzi
- SOD Traumatologia e Ortopedia Generale AOU Careggi, Largo P. Palagi 1, 50139, Florence, Italy
| | - Paolo Aglietti
- SOD Traumatologia e Ortopedia Generale AOU Careggi, Largo P. Palagi 1, 50139, Florence, Italy
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Goldbloom D, Makwana N, Laing P, Toullec E, Graff W, Charbel A. A new "tension side" locking plate for Hallux Valgus: A prospective multicentre case series. Foot Ankle Surg 2016; 22:103-8. [PMID: 27301729 DOI: 10.1016/j.fas.2015.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Proximal osteotomy of the first metatarsal is often indicated for Hallux Valgus correction. Previously recognised complications however, include transfer metatarsalgia, first metatarsophalangeal joint stiffness, problems with fixation and prominence of metalware. METHODS We report on one year follow up of an international prospective series between June 2009 and October 2012 involving three centres, including 91 feet (58 patients) that underwent proximal osteotomy, using a new locking plate applied to the plantar surface of the metatarsal. RESULTS Mean Hallux Valgus angle improved from 27.9 (±13.1)° to 12.4 (±8.2)° while mean Intermetatarsal angle improved from 12.5 (±8.4) to 7.1 (±3.4) and there was a statistically significant improvement in both mean AOFAS-HMI score 54.2 (±13.9) to 94.0 (±9.5) and Visual Analogue Pain Scale 4.7 (±1.5) to 0.6 (±1.3). 70% of patients were back at their preoperative employment at five weeks. Mean surgical time was 56min and the plate was generally well tolerated. There were five implant related complications. CONCLUSIONS Locked fixation from the tension side of the construct encourages early weight bearing with a low risk of implant prominence. Our radiological, functional and clinical parameters are comparable with similar series and we therefore recommend this technique.
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Affiliation(s)
- Daniel Goldbloom
- Robert Jones Agnes Hunt Orthopaedic Hospital (Foot and Ankle Department), Oswestry SY10 7AG, United Kingdom.
| | - Nilesh Makwana
- Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, United Kingdom.
| | - Patrick Laing
- Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, United Kingdom
| | - Eric Toullec
- Polyclinique de Bordeaux-Tondu, Service de chirurgie du pied et de la cheville, 143 rue du Tondu, 33082 Bordeaux Cedex, France
| | - Wilfrid Graff
- Groupe Hospitalier Diaconesses Croix saint Simon, 18, rue du Sergent Bauchat, 75018 Paris, France
| | - Antoine Charbel
- Centre Hospitalier universitaire Notre Dame de secours, Boite Postale 3 - Jbeil, Byblos, Lebanon
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Ekeland A, Nerhus TK, Dimmen S, Heir S. Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1702-9. [PMID: 26792566 DOI: 10.1007/s00167-016-3988-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/08/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the time-dependent functional outcome of patients with lateral knee osteoarthritis with increased valgus treated with lateral opening-wedge osteotomy to shift the load from the lateral to the medial compartment of the knee. METHODS Twenty-four consecutive patients with lateral knee osteoarthritis were treated with distal femoral opening-wedge varus osteotomy stabilized with the Puddu plate and bone transplantation. The mean age of the patients was 48 years (CI 40.3-55.7, range 31-62). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at 3 and 6 months, 1, 2, 5 and 10 years post-operatively. The knee osteoarthritis was graded according to the Kellgren-Lawrence radiological scoring system. The mean follow-up time was 7.9 years (CI 6.8-9.0, range 4.0-10.2). RESULTS The mean angular correction measured on pre- and post-operative radiographs was 9.6° (CI 7.7°-11.5°, range 4°-20°). All osteotomies healed. KOOS increased significantly during the first year by 28-122 % beyond the preoperative values for all the five subscores. This improvement remained at 10-year follow-up for those with surviving osteotomy. Six knees were converted to total knee arthroplasty (TKA) mean 6.4 years (CI 3.3-9.6, range 4.0-11.8) post-operatively. The osteotomy survival rate at 5 years was 88 % and at 10 years 74 %. The preoperative osteoarthritic grade did not increase significantly during the follow-up period, but was significantly correlated (r = -0.49), P = 0.019 to the KOOS subscore symptoms at the 2-year follow-up. CONCLUSION Distal femoral opening-wedge osteotomy for lateral knee osteoarthritis resulted in good functional recovery after 1 year and favourable midterm results. It may be a good treatment option for middle-aged patients with valgus knees and lateral osteoarthritis in order to prevent or postpone TKA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Arne Ekeland
- Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway.
| | - Tor Kjetil Nerhus
- Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway
| | - Sigbjørn Dimmen
- Orthopaedic Department, Lovisenberg Diaconal Hospital, Lovisenberggata 17, 0456, Oslo, Norway
| | - Stig Heir
- Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway
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Madelaine A, Lording T, Villa V, Lustig S, Servien E, Neyret P. The effect of lateral opening wedge distal femoral osteotomy on leg length. Knee Surg Sports Traumatol Arthrosc 2016; 24:847-54. [PMID: 25326764 DOI: 10.1007/s00167-014-3387-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/10/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Varisation distal femoral osteotomy is a well-described treatment for lateral compartment arthrosis in the young, active patient. This treatment may potentially alter the length of the lower limb . The objective of this study was to quantify the change in leg length following lateral opening wedge distal femoral osteotomy using a blade plate. METHODS Between 1998 and 2011, 29 lateral opening wedge distal femoral osteotomies were performed for symptomatic genu valgum with signs of lateral compartment arthrosis or patello-femoral symptoms. The mean age was 44.4 years (±11.3). Average follow-up was 80.2 months (±50.6). RESULTS The mean osteotomy opening was 8.3° (±2.3). The femoro-tibial mechanical axis (mFTA) was improved significantly, from 187.8° (±3.5) to 180.4° (±2.6) post-operatively (p < 0.001). The pre-operative leg length discrepancy was -0.7 cm, compared to -0.6 cm post-operatively, which was not significant (n.s.). There were five revisions to arthroplasty for disease progression at meantime of 166.6 months post-operatively. The probability of survival at 60 months was 91.4% (95% CI 74.9-100%) with end-point of revision to total knee arthroplasty and 87.6% (95% CI 74.1-100%) of revision for complications. CONCLUSIONS Lateral opening wedge distal femoral osteotomy, performed for symptomatic genu valgum, has no effect on leg length. This technique allows good correction of the axis of the lower limb; however, the complication rate is not insignificant (14%). Complications occurred mainly in post-traumatic cases and may be avoidable with attention to technique and optimum rehabilitation. The procedure should be reserved for young, active patients with significant symptoms. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Madelaine
- Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard, Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France.
| | - T Lording
- Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard, Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France
- Frankston Hospital, Hastings Rd, Frankston, VIC, 3199, Australia
| | - V Villa
- Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard, Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France
| | - S Lustig
- Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard, Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France
| | - E Servien
- Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard, Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France
| | - P Neyret
- Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard, Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France
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Kim KJ, Song EK, Seon JK, Seol JH. Biomechanical Study of the Fixation Plates For Opening Wedge High Tibial Osteotomy. Knee Surg Relat Res 2015; 27:181-6. [PMID: 26389072 PMCID: PMC4570954 DOI: 10.5792/ksrr.2015.27.3.181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/02/2015] [Accepted: 01/29/2015] [Indexed: 12/30/2022] Open
Abstract
Purpose The purpose of this study was to compare the mechanical stability of three types of plate systems for opening wedge high tibial osteotomy. Materials and Methods Forty-eight fresh frozen porcine tibia specimens were assigned to three different fixation device groups: Aescular group (16 specimens) was fixed with Aescular plates; Puddu group (16 specimens) with a Puddu plate, and TomoFix group (16 specimens) with a TomoFix plate. We compared axial displacements under compression loads from 200 to 2,000 N and maximal loads at failure among 8 specimens per group. We also compared displacements under cyclic load after 100 cycles at a compressive load of 2,000 N among 8 specimens per group. Results In all three groups, displacement under compression load increased with the increase in the axial compressive load; however, no significant intergroup differences were observed in the mean values under tested loading conditions. The mean maximal loads at failure were not significantly different (6,055, 6,798, and 6,973 N in the Aescular, Puddu, and TomoFix groups, respectively; p=0.41). While the TomoFix group showed less extension and strain during the cyclic load test, the mean values showed no significant differences among groups. Conclusions All three plate systems were found to provide fixation stability suitable for bearing axial compression and cyclic loads while walking.
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Affiliation(s)
- Kug Jin Kim
- Department of Orthopedic Surgery, Wolchul Ki-Chan Hospital, Yeongam, Korea
| | - Eun Kyoo Song
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong Keun Seon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong Hwan Seol
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Kugan R, Currall VA, Johal P, Clark CIC. Proximal first metatarsal opening wedge osteotomy: geometric analysis on saw bone models. Foot (Edinb) 2015; 25:1-4. [PMID: 25450169 DOI: 10.1016/j.foot.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/10/2014] [Accepted: 09/21/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND For hallux valgus correction, distal first metatarsal osteotomy is generally used for minor to moderate deformities, diaphyseal osteotomy for moderate deformities and basal osteotomy or arthrodesis for severe deformities. With the advent of locking plates, there has been renewed interest in opening wedge basal osteotomy. OBJECTIVE We undertook this study in order to understand the power and limitations of this osteotomy. METHOD Proximal opening wedge osteotomies were performed on saw bone models in four orientations, with three different wedge sizes: (1) perpendicular to the ground (PG); (2) perpendicular to the shaft (PS); (3) perpendicular to shaft with 30° declination (DEC); (4) 30° oblique (OB). Pre- and post-osteotomy measurements were made of axial and plantar translation and inter-metatarsal angle. RESULTS Plantar translation and intermetatarsal angle correction increased with increasing wedge size. The DEC osteotomy produced the greatest increase in length of metatarsal shaft, while the PS osteotomy gave the least. The most plantar translation was achieved with the DEC osteotomy. Overall, the PS osteotomy gave the largest correction of the intermetatarsal angle. CONCLUSION Although there are several published clinical case series of the proximal opening wedge osteotomy, this is the first study to fully evaluate its geometry.
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Affiliation(s)
- R Kugan
- Heatherwood and Wexham Park Hospitals, NHS Foundation Trust, Heatherwood Hospital, London Road, Ascot, SL5 8AA, UK
| | - V A Currall
- Heatherwood and Wexham Park Hospitals, NHS Foundation Trust, Heatherwood Hospital, London Road, Ascot, SL5 8AA, UK.
| | - P Johal
- Heatherwood and Wexham Park Hospitals, NHS Foundation Trust, Heatherwood Hospital, London Road, Ascot, SL5 8AA, UK
| | - C I C Clark
- Heatherwood and Wexham Park Hospitals, NHS Foundation Trust, Heatherwood Hospital, London Road, Ascot, SL5 8AA, UK
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