Disparity between Preoperative Target Correction Amount and Postoperative Correction Amount in Open Wedge High Tibial Osteotomy

Orthopaedic Journal of Sports Medicine

et al. 2022

Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and –2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°, –3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.

“…We believe that our results support the notion that the individualization of target points could be applied if surgeons expect a change in a patient’s alignment after OWHTO. 15,40…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Medial Tightness and Narrow Medial Joint Space Are Predictive Factors for Lower Extremity Alignment Change Toward Varus After Opening-Wedge High Tibial Osteotomy

Lee

Orthopaedic Journal of Sports Medicine

et al. 2022

“…The WBL (%) was measured as the percentage of the crossing point made by the mechanical axis of the lower extremity and the proximal tibial plateau. The WBL ratios of the medial tibial edge and lateral tibial edge were considered 0% and 100%, respectively [20]. The HKA angle was defined as the angle between the mechanical axis of the femur and the tibia.…”

Section: Methodsmentioning

confidence: 99%

Medially and distally inserted tuberosity screw fixation of the osteotomized tubercle is safe and effective in retro-tubercular bi-planar opening-wedge high tibial osteotomy

Park

Knee Surg Sports Traumatol Arthrosc

Jeong

et al. 2022

Self Cite

Purpose The purpose of this study was to develop a safe and efective method of inserting one tuberosity screw and to determine whether retro-tubercular (RT)-Open-wedge high tibial osteotomy (OWHTO) with tuberosity screw ixation can be conducted to overcome the problem of osteotomized tubercle and produce favorable outcomes compared to RT-OWHTO without tuberosity screw ixation. Methods From 2018 to 2020, patients who underwent bi-planar RT-OWHTO were allocated as two groups (RT-OWHTO without tuberosity screw ixation as group I and with screw ixation as group II). Computed tomography (CT) was used to analyze osteotomy conigurations such as RT gap and tip distance, and union of the main and second plane osteotomy sites. The RT gap distance was measured as the length of the osteotomy gap. The RT tip distance was measured as the length of the gap at the tip of the tibial tubercle. Post-operative complications were analyzed also. To evaluate the neurovascular (NV) approximity of screw ixation group, the pre-operative magnetic resonance imaging (MRI) images were referenced on the post-operative CT for the assessment of the safe zone. Results In total, 44 knees in group I and 46 knees in group II were enrolled. The RT gap distance (2.58 ± 0.69 mm vs. 0.57 ± 0.57 mm; p < .001) and RT tip distance (4.31 ± 1.60 mm vs. 1.48 ± 1.42 mm; p < .001) were signiicantly larger in group I than in group II. The sum of union grade in the second plane osteotomy site (17.93 ± 2.18 points vs. 22.24 ± 2.57 points; p < .001) was statistically diferent between two groups at three months post operatively. Post-operative tuberosity prominence occurred in ive knees only in group I (p = 0.025), although tibial tuberosity fracture developed in seven cases in group II compared with two cases in group I with no statistical signiicance. NV was safe when the screw was inserted medially. Conclusion RT-OWTHO with one-screw ixation for the tuberosity was efective in terms of tuberosity prominence and the union of the second plane osteotomy site. However, it also produced another problem, such as tuberosity fracture. In addition, a tuberosity screw was safe when it was inserted in the medial-distal direction. Level of evidence Cohort study; level III.

“…With use of fluoroscopic guidance, the protector and cutting jig were applied to position the lateral cortical hinge just below the tip of fibular head and sawing was performed until the saw reached approximately 5 to 10 mm from the lateral cortex 18,19 . After biplanar osteotomy, the osteotomy site was distracted according to preoperative planning, and fixation was performed with use of a locking-plate fixation system with a metal block (LCfit HTO; Corentec) 20,21 . After fixation, and based on the group allocation, the opening gap was filled with 15 cm 3 of hydroxyapatite or allogenic chip bone graft up to Zones 3 or 4 without impaction to Zones 1 or 2 16 .…”

Section: Methodsmentioning

confidence: 99%

Comparative Analysis of Serial Union Patterns After Opening-Wedge High Tibial Osteotomy with and without Bone-Void Fillers

Journal of Bone and Joint Surgery

Lee

et al. 2021

Self Cite

Background:Opening-wedge high tibial osteotomy produces opening gaps; however, there is little consensus on bone graft necessity and the material that would produce a superior union. The purposes of the present study were (1) to compare the serial union patterns associated with various bone-void fillers, (2) to determine whether bone-void filler is necessary to achieve bone union of the opening gap, and (3) to determine whether bone union is different according to the correction degree during opening-wedge high tibial osteotomy.Methods:In this retrospective study, 97 knees were randomly assigned to treatment with hydroxyapatite chip bone (Group A), allogenic chip bone (Group B), or no bone graft (Group C) and were analyzed after a minimum 1-year follow-up. To compare the bone union pattern, the area of callus filling located at the most medial side on an anteroposterior radiograph of the knee was recorded, and a modified van Hemert scoring system was used in the mediolaterally divided 5 zones. The correlations between the correction degree and bone union scores were evaluated.Results:There were no significant differences in the extent of mediolateral bone-healing at 6 weeks or 3 months postoperatively (p = 0.172 and p = 0.228). However, Group C showed more prominent progression of the gap filling to the medial side compared with Groups A and B at 6 months postoperatively (p = 0.002). Group C showed slow progression of bone union up to 6 weeks but surpassed the other groups at 6 months. The union pattern was not different between Groups A and B, and the correction degree was not correlated with bone union beyond 3 months postoperatively.Conclusions:Despite the different gap-healing patterns, opening-wedge high tibial osteotomy without bone graft achieved bone union comparable with allogenic and synthetic graft materials. Group C (no bone graft) showed slower progression of bone union but surpassed the other groups at around 6 months. Based on the union pattern, there was no difference depending on the correction degree and the use of bone-void fillers.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.