Background: Opening-wedge valgus high tibial osteotomy (OWHTO) is a common surgical procedure used to treat symptomatic varus femorotibial malalignment in adults. Several intraoperative methods are available to determine the correct correction alignment, but achieving the desired alignment correction is difficult. Purpose/Hypothesis: The aim of this study was to assess a 4-reference K-wire technique that is relatively easy to apply and can reliably assess actual alignment correction during surgery after determination of the desired corrective angle. We hypothesized that this technique would accurately determine the coronal correction and properly maintain the tibial slope intraoperatively during OWHTO. Study Design: Descriptive laboratory study. Methods: This study was conducted using 12 fresh-frozen cadavers; 12 randomly chosen knees were corrected 5° and 12 knees were corrected 10° by use of 2 coronal and 2 sagittal K-wires. The first and second coronal K-wires were drilled at 4 cm and 1 to 2 cm below the medial joint line toward the tibiofibular joint, respectively. The angles of these 2 coronal K-wires were measured before and after the gap was opened via a modified goniometer. The difference in the angle formed by these 2 coronal K-wires from before to after opening of the gap was the alignment correction angle. In addition, 2 sagittal K-wires were drilled parallel to each other before the gap opening above and below the osteotomy site. Ensuring that these 2 sagittal K-wires remained parallel after the gap opening confirmed that the tibial slope had been maintained. The paired t test was used to compare the desired alignment corrections and the different angles measured between the pre- and postoperative radiographic alignments. Results: The mean ± SD differences in angles between the pre- and postoperative alignments of the 5° and 10° corrections were 5.04° ± 0.68° and 10.03° ± 0.68°, respectively, indicating no statistically significant differences between pre- and postoperative alignment in both groups. As well, no significant difference was noted between the pre- and postoperative medial tibial slope ( P = .54). Conclusion: The coronal alignment correction and maintenance of the tibial slope using the 4-reference K-wire technique was found to be highly accurate and reliable. Clinical Relevance: Achieving the correct angle in OWHTO is difficult, and the 4-reference K-wire technique provides an easier and more reliable way to obtain the correct angle. This technique can be used in most hospital settings, with no need for expensive equipment.
Open-wedge high tibial osteotomy is a common procedure to treat young adult and adult patients with symptomatic varus malalignment. The purpose of the high tibial osteotomy is to shift the mechanical load from the medial compartment to the lateral compartment. There are several methods to determine the correct alignment, such as the cable method, the gap measurement method, the navigator system, or the patient-specific cutting guide method. The cable and gap measurement techniques are easy to use, but the results of these techniques are unpredictable. The navigator and patient-specific cutting guide methods have high accuracy in attaining the desired correction alignment, but they are quite costly. We propose a technique we call the Kirschner wire reference method, which is easy to use to achieve the desired alignment correction, without requiring specialized or expensive equipment.
BackgroundGlobally, 1% of the population is affected by arthritis of the foot and ankle. Post-traumatic osteoarthritis, resulting from ankle injury or chronic ankle instability, accounts for more than 50% of these cases. Total ankle replacement (TAR) was developed as an alternative to fusion to treat end-stage arthritis whilst preserving some natural biomechanics. However failure rates are relatively high and are often related to bony damage. Finite element (FE) analysis may be used to investigate the damage to the bone surrounding the TAR implant.ObjectiveThe objective of this study was to develop a FE model of a TAR, which is a sufficiently accurate representation of the real world for further use to examine the failure mechanisms.DesignExperimental.SettingNot applicable.Patients (or participants)Not applicable.Interventions (or assessment of risk factors)Zenith™ TARs (Corin, UK) were inserted into polyurethane foam blocks (Sawbones, USA) representing the tibial and talar bones. The constructs were loaded in an electromechanical testing machine (Instron, USA) with increasing compressive force until reaching plastic deformation. A corresponding FE model was generated and analysed using Abaqus (Dassault Systèmes, France).Main outcome measurementsExperimental contact pressure, which was captured by pressure mapping sensor (Tekscan, USA), and deformation data were used to validate the FE results.ResultsGood agreement was found in the location of damage and average depth of plastic deformation in the synthetic bone (experimental depth was 2.8% smaller than the similar value obtained from analysis). Experimentally, there was some difference in deformation laterally, which corresponded to a difference in contact pressures measured on either side of the mid-plane, illustrating that there was some degree of inclination between the interfaces of the TAR.ConclusionsThe good agreement indicates the FE model can be used for further predictions of bone failure. Importantly, the model will be used to investigate clinically relevant misalignment, which this study shows may have an effect on bone damage.
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