Comparative analysis of fixation configurations and their effect on outcome after medial open-wedge high tibial osteotomy

Lee, Eui Soo; Kim, Tae Woo; Jo, In Ho; Lee, Yong Seuk

doi:10.1016/j.jos.2019.06.018

Cited by 7 publications

(14 citation statements)

References 22 publications

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“…It has already been demonstrated that posteromedial plating shows superior fixation stability in contrast to anteromedial plating. 11 While the screw length was also longer in the TomoFix group than in the TDM or OhtoFix group, this is probably because the TomoFix plate did not fit well on the osteotomized tibia. The distance from the neurovascular structure to the screw extension line was also farther in the LCfit group because the screw angle was small and all proximal screws were far lateral to the neurovascular structures.…”

Section: Discussionmentioning

confidence: 90%

“…First, the plate should be appropriately contoured and positioned at the central area of both proximal and distal fragments. 11 Second, screws should be headed toward hinge direction for the support of the thin lateral bridge. 9 In addition, the screws should be safe for the posterior neurovascular structures.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 18 , 23 In our previous study, the lateral hinge–directed fixation system showed fixation configurations that have theoretical mechanical advantages over conventional anatomic locking plates. 11 …”

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confidence: 99%

“…9,18,23 In our previous study, the lateral hinge-directed fixation system showed fixation configurations that have theoretical mechanical advantages over conventional anatomic locking plates. 11 The aims of this study were to evaluate (1) how neurovascular injuries during fixation can be prevented and (2) whether a lateral hinge-directed fixation system provides comparable neurovascular safety to conventional and custom-made locking plate systems. Our hypothesis was that laterally directed fixation would provide more safety to neurovascular structures than would posterolaterally directed fixation.…”

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confidence: 99%

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Reducing the Risk of Neurovascular Injury With Posteromedial Plating and Laterally Directed Screw Insertion During Opening-Wedge High Tibial Osteotomy

Shim

Jeong

Park

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Neurovascular injury is a serious complication after opening-wedge high tibial osteotomy (OWHTO). Purpose: To evaluate (1) how neurovascular injuries during fixation can be prevented and (2) whether a lateral hinge–directed posteromedial fixation system provides comparable neurovascular safety during OWHTO to conventional and custom-made locking plate systems. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 275 knees that underwent OWHTO from March 2014 to May 2018. The knees were divided into 4 groups based on the type of fixation system used: (1) lateral hinge–directed system (LCfit HTO; LCfit group), (2) TDM decisive wedge locking plate (TDM group), (3) OhtoFix anatomic locking metal block plate (OhtoFix group), and (4) TomoFix titanium locking plate (TomoFix group). Using postoperative computed tomography, the following variables among the groups were compared: screw insertion angle relative to the tibia posterior cortex in the axial plane, length, proximity to neurovascular structures, and safety angle of screw fixation (angle between the most proximal posterior screw insertion line and a line tangent to the popliteal artery from the screw hole). Radiological and clinical outcomes were also compared between groups. Results: The screw angle was significantly smaller and the distance from neurovascular structures to the screw extension line was significantly farther in the LCfit group compared with the other 3 groups ( P < .001 for both). The safety angle was also wider in the LCfit group than in the other groups ( P < .001). There were no significant differences in radiologic or clinical outcomes between the groups during follow-up. Conclusion: The distance from the neurovascular structures to the screw extension line was significantly farther, and the safety angle was also significantly wider with the laterally directed posteromedial plate system compared with the other systems. There were no neurovascular injuries in any group or significant differences in clinical outcomes or radiological parameters between the LCfit and the other locking plate systems.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Reducing the Risk of Neurovascular Injury With Posteromedial Plating and Laterally Directed Screw Insertion During Opening-Wedge High Tibial Osteotomy

Shim

Jeong

Park

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Although some biomechanical studies and finite-element analyses were reported [ 16 ], there were only a few clinical studies about the plate position, screw length, and clinical outcomes. These clinical studies have reported different results for stability and clinical outcome after MOWHTO depending on the location of the plate [ 17 , 18 ]. Lee et al reported no significant difference in clinical results despite the change in plate position using various plate designs [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Does the anteromedial plate position affect proximal screw length and worsen the clinical outcomes in medial opening wedge high tibial osteotomy?

Ryu

Park

Lee

et al. 2023

BMC Musculoskelet Disord

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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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Effect of plate design on maintenance of anterior and posterior gaps and posterior tibial slope after cyclic loading in medial open‐wedge high tibial osteotomy: A biomechanical study using porcine's tibia

Nibe,

Takahashi,

Matsumura

et al. 2024

J. exp. orthop.

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PurposeWe aimed to investigate whether a plate adapted to the anatomy of the proximal medial porcine's tibia would provide maintenance of the anterior gap (AG), posterior gap (PG) and posterior tibial slope (PTS).MethodsTwenty‐seven porcine tibias were biomechanically evaluated by performing MOWHTO and placing TOMOFIX (n = 9), AC plate (n = 9) and TriS (n = 9) anteromedially. Cyclic testing (800 N, 2000 cycles, 0.5 Hz) was performed to investigate the PTS over time for MOWHTO. The particular displacement calculated from the maximum to the minimum point with the load‐displacement curve along the mechanical axis during cyclic testing, the final AG and PG changes at the osteotomy site, the increased PTS calculated by subtracting AG from PG after 2000 cycles were compared among the three groups. The displacement was evaluated by repeated‐measures analysis of variance (ANOVA), and changes in AG and PG and increased PTS were evaluated by one‐way ANOVA. The sample size for α and β errors were <0.05 and <0.20, and the effect size was 0.64 for one‐way ANOVA and 0.49 for repeated‐measures ANOVA.ResultsThere were no significant differences in displacement among the groups. A significant difference was observed in the AG (p = 0.044) and PG (p = 0.0085) changes. There were no significant differences in increased PTS among the groups.ConclusionWhen anteromedially placed, the AC plate and TriS resulted in significant maintenance of AG and PG compared with that of TOMOFIX in MOWHTO after cyclic loading.Level of EvidenceLevel Ⅳ.

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Comparative analysis of fixation configurations and their effect on outcome after medial open-wedge high tibial osteotomy

Cited by 7 publications

References 22 publications

Reducing the Risk of Neurovascular Injury With Posteromedial Plating and Laterally Directed Screw Insertion During Opening-Wedge High Tibial Osteotomy

Reducing the Risk of Neurovascular Injury With Posteromedial Plating and Laterally Directed Screw Insertion During Opening-Wedge High Tibial Osteotomy

Does the anteromedial plate position affect proximal screw length and worsen the clinical outcomes in medial opening wedge high tibial osteotomy?

Effect of plate design on maintenance of anterior and posterior gaps and posterior tibial slope after cyclic loading in medial open‐wedge high tibial osteotomy: A biomechanical study using porcine's tibia

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