Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique

Gaasbeek, Robert D.A.; Sonneveld, Heleen; Heerwaarden, Ronald J van; Jacobs, Wilco C. H.; Wymenga, A. B.

doi:10.1016/j.knee.2004.02.002

Cited by 140 publications

(181 citation statements)

References 7 publications

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“…The surgical technique has previously been described by Staubli et al [17]. In 80 cases, a modification of the biplanar osteotomy using a distal tuberosity osteotomy was performed to prevent lowering of the patella [7].…”

Section: Surgerymentioning

confidence: 99%

Medial Open Wedge High Tibial Osteotomy: Can Delayed or Nonunion Be Predicted?

Houten

Heesterbeek

Heerwaarden

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The opening wedge approach to high tibial osteotomy (HTO) is perceived to have some advantages relative to the closing wedge approach but it may be associated with delayed and nonunions. Because nonunions evolve over months, it would be advantageous to be able to identify risk factors for and early predictors of nonunion after medial opening wedge HTO. Questions/purposes We sought to determine whether (1) preoperatively identifiable patient factors, including tobacco use, body mass index [ 30 kg/m 2 , and degree of correction, are associated with nonunion, and (2) a modified Radiographic Union Score for Tibial Fractures (RUST) score, taken at 6 weeks and 3 months, would be predictive for delayed or nonunion after medial opening wedge HTO. Methods The medical records and radiographs of 185 patients, 21 bilateral cases, treated with a medial open wedge HTO using the TomoFix 1 device were retrospectively evaluated. For all patients, demographic data regarding risk factors were collected from their records. Diagnosis for delayed or nonunion was already done earlier for standard medical care by the orthopaedic surgeon based on clinical and radiographic grounds. For the retrospective radiographic evaluation, a modified RUST score was used in which each tibial cortex is scored by one observer. Logistic regression analysis was used to identify preoperative and postoperative predictive factors for developing delayed or nonunion. In the series, a total of 19 patients (9.2%) developed clinically delayed/nonunion of whom 10 patients (4.9%) developed a nonunion. Results Smoking was identified as a risk factor for developing delayed/nonunion (19% for smokers versus 5.4% for nonsmokers; p = 0.005; odds ratio, 4

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Section: Surgerymentioning

confidence: 99%

Medial Open Wedge High Tibial Osteotomy: Can Delayed or Nonunion Be Predicted?

Houten

Heesterbeek

Heerwaarden

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…It has been well documented that the early results after proximal tibial osteotomy for gonarthrosis are favourable [1][2][3][4]. Osteoarthritis of the knee is often associated with varus malalignment of the affected extremity.…”

Section: Introductionmentioning

confidence: 99%

Opening wedge tibial osteotomy for large varus deformity with CeraverTM resorbable beta tricalcium phosphate wedges

Hernigou

Roussignol

Flouzat-Lachaniette

et al. 2009

International Orthopaedics (SICOT)

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The results in 53 knees that had been treated by proximal tibial opening-wedge osteotomy for large varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of ten years (range, 8-12 years). We used a porous betatricalcium phosphate (β-TCP) wedge because it is resorbable and osteoinductive. All osteotomies were completely consolidated and complete osseointegration of the remnant of the β-TCP wedge took place. However, after a mean maximum follow-up of ten years none of the cases showed complete resorption. After ten years, 40 (81%) of the 53 knees had an excellent or good result, and in 13 knees there was recurrent pain for which six had an arthroplasty. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the knees that had a hip-knee-ankle angle of 183-186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the three knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow. Therefore, proximal tibial osteotomy is a very suitable operation even for patients who have gonarthrosis of the medial compartment and a large varus deformity. Although, a rigidly standardised and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy, and this exact alignment is difficult to obtain for patients with large varus deformity.

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“…An anterior plate position results in an increase in the posterior tibial slope by an average of 6.6° (Rodner et al, 2006). In a large openwedge correction (i.e., >8° to 10°) or in the cases of a preoperative patella infera, the tibial tuberosity is cut distally with a modified distal-tuberosity osteotomy (DTO) (Gaasbeek et al, 2004;Brinkman et al, 2008). (Poignard et al, 2010) recommend open medially and posteriorly to avoid increasing the posterior slope and unducing patella baja.…”

Section: Surgical Techniquementioning

confidence: 99%