Differences in preoperative planning for high-tibial osteotomy between the standing and supine positions

Matsushita, Takehiko; Watanabe, Shu; Araki, Daisuke; Nagai, Kazuo; Hoshino, Yuichi; Kanzaki, Noriyuki; Matsumoto, Tomoyuki; Niikura, Takahiro; Kuroda, Ryosuke

doi:10.1186/s43019-021-00090-7

Cited by 39 publications

(38 citation statements)

References 32 publications

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“…This procedure has been reported to have good long-term clinical outcomes such as reduced pain and improved knee joint function [ 5 , 6 , 7 ]. Previous studies on MOWHTO tended to focus mainly on the change of alignment in the coronal plane regarding correction angle and postoperative coronal realignment [ 8 , 9 , 10 ]. However, MOWHTO is the three-dimensional (3D) surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

Chung

Choi

Kim

et al. 2021

JCM

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The posterior tibial slope of the tibiofemoral joint changes after medial open wedge high tibial osteotomy (MOWHTO), but little is known about the effect of the sagittal osteotomy inclination angle on the change in the posterior tibial slope of the tibiofemoral joint. The purpose of this study was to investigate the effect of the osteotomy inclination angle in the sagittal plane on changes in the posterior tibial slope after MOWHTO by comparing how anterior and posterior inclination affect the posterior tibial slope of the tibiofemoral joint. The correlation between the osteotomy inclination angle and the postoperative posterior tibial slope angle was also assessed. Between May 2011 and November 2017, 80 patients with medial compartment osteoarthritis who underwent MOWHTO were included. The patients were divided into two groups according to the sagittal osteotomy inclination angle on the 3D reconstructed model. Patients with an osteotomy line inclined anteriorly to the medial tibial plateau line were classified into group A (58 patients). Patients with posteriorly inclined osteotomy line were classified as group P (22 patients). In the 3D reconstructed model, the preoperative and postoperative posterior tibial slope, osteotomy inclination angle relative to medial tibial plateau line in sagittal plane, and gap distance and ratio of the anterior and posterior osteotomy openings were measured. The preoperative and postoperative hip-knee-ankle angle, weight-bearing line ratio, and posterior tibial slope were also measured using plain radiographs. In the 3D reconstructed model, the postoperative posterior tibial slope significantly increased in group A (preoperative value = 9.7 ± 2.9°, postoperative value = 10.7 ± 3.0°, p < 0.001) and decreased in group P (preoperative value = 8.7 ± 2.7°, postoperative value = 7.7 ± 2.7°, p < 0.001). The postoperative posterior tibial slope (group A = 10.7 ± 3.0°, group P = 7.7 ± 2.7°, p < 0.001) and posterior tibial slope change before and after surgery (group A = 1.0 ± 0.8°, group P = −0.9 ± 0.8°, p < 0.001) also differed significantly between the groups. The Pearson correlation coefficient was 0.875 (p < 0.001) for the osteotomy inclination angle, and multivariate regression analysis showed that the only significant factor among the variables was the sagittal osteotomy inclination angle (β coefficient = 0.216, p < 0.001). The posterior tibial slope changed according to the osteotomy inclination angle in the sagittal plane after MOWHTO. The postoperative posterior tibial slope tended to increase when the osteotomy line was inclined anteriorly with respect to the medial tibial plateau line but decreased when the osteotomy line was inclined posteriorly. To avoid inadvertent change of posterior tibial slope, close attention needs to be paid to maintaining the sagittal osteotomy line parallel to the medial joint line during MOWHTO.

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Section: Introductionmentioning

confidence: 99%

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

Chung

Choi

Kim

et al. 2021

JCM

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“…DLO has additional risks such as hinge fracture [ 33 ] and popliteal artery injury during DFO [ 16 , 34 ]. In a previous study, the amount of correction in HTO was greater when planned from standing radiographs than when planned from supine radiographs [ 35 ]. The present study indicated that more invasive surgical procedures were likely to be chosen when surgical planning was based only on standing radiographs.…”

Section: Discussionmentioning

confidence: 99%

Surgical planning of osteotomies around the knee differs between preoperative standing and supine radiographs in nearly half of cases

Nejima

Kumagai

Yamada

et al. 2022

BMC Musculoskelet Disord

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Background To evaluate the difference in surgical planning of osteotomies around the knee between preoperative standing and supine radiographs and to identify risk factors for discrepancies in surgical planning. Methods This study included 117 knees of 100 patients who underwent osteotomies around the knee for knee osteoarthritis with genu varum. Surgical planning was performed so that the target point of the postoperative weight-bearing line (WBL) ratio was 62.5% in preoperative standing and supine radiographs. If the opening gap would be > 13 mm in open-wedge high tibial osteotomy (OWHTO), closed-wedge HTO (CWHTO) was planned. If the postoperative mMPTA would be > 95° in isolated HTO, double-level osteotomy (DLO) was planned. In DLO, lateral closed-wedge distal femoral osteotomy was performed so that the postoperative mechanical lateral distal femoral angle (mLDFA) was 85°, and any residual varus deformity was corrected with HTO. Results Surgical planning differed between standing and supine radiographs in 43.6% of cases. In all knees for which surgical planning differed between standing and supine radiographs, a more invasive type of osteotomy was suggested by standing radiographs than by supine radiographs. The risk factors for discrepancies in surgical planning were a lower WBL ratio in standing radiographs and a lower joint line convergence angle in supine radiographs. Conclusions Surgical planning of DLO, CWHTO and OWHTO, in standing radiographs differed from that in supine radiographs in nearly half of the cases. Surgical planning based on standing radiographs leads to more invasive surgical procedures compared to supine radiographs.

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“…According to Shetty et al, knee exion deformity > 10° had a signi cant effect on the measurement of the coronal mechanical alignment 32 . Additionally, since the lower extremity alignment varies according to the weight-bearing position 23,24,33 , the measurement value may change each time because it is di cult to evenly bear weight for each measurement in the conventional posture. Therefore, the present study hypothesized that the most physiologic intersegmental alignment could be obtained from the EOS images in a posture with even weight-bearing on both the lower extremities.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Reliability of Lower Extremity Alignment Measurements Using EOS Imaging System While Standing in an Even Weight-Bearing Posture

Cho

Lee

Kim

et al. 2021

Preprint

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Purpose: This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture.Methods: Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated.Results: Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. All values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not.Conclusions: For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

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Differences in preoperative planning for high-tibial osteotomy between the standing and supine positions

Cited by 39 publications

References 32 publications

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

Effect of the Osteotomy Inclination Angle in the Sagittal Plane on the Posterior Tibial Slope of the Tibiofemoral Joint in Medial Open-Wedge High Tibial Osteotomy: Three-Dimensional Computed Tomography Analysis

Surgical planning of osteotomies around the knee differs between preoperative standing and supine radiographs in nearly half of cases

Evaluation of the Reliability of Lower Extremity Alignment Measurements Using EOS Imaging System While Standing in an Even Weight-Bearing Posture

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