High Tibial Osteotomy

Rudan, John F.; SIMURDA, MICHAEL A.

doi:10.1097/00003086-199006000-00033

Cited by 109 publications

(41 citation statements)

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“…An alignment of the lower extremity is one of the most important factors affecting the clinical outcomes following HTO. Most studies that have assessed the alignments in HTO procedures have focused on the postoperative FTA [5,10,[16][17][18]. However, several factors such as the knee positions in the X-ray examinations, the flexion contracture of the knee and a significant varus deformity in the distal femur and the proximal tibia cause errors in the measurement of the FTA [7,13,16].…”

Section: Discussionmentioning

confidence: 99%

A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy

Bito

Takeuchi

Kumagai

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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Obtaining a correct postoperative limb alignment is an important factor in achieving a successful clinical outcome after an opening-wedge high tibial osteotomy (OWHTO). To better predict some of the aspects that impact upon the clinical outcomes following this procedure, including postoperative correction loss and over correction, we examined the changes in the frontal plane of the lower limb in a cohort of patients who had undergone OWHTO using radiography. Forty-two knees from 33 patients (23 cases of osteoarthritis and 10 of osteonecrosis) underwent a valgus realignment OWHTO procedure and were radiographically assessed for changes that occurred pre- and post-surgery. The mean femorotibial angle (FTA) was found to be 182.1 +/- 2.0 degrees (12 +/- 2.0 anatomical varus angulation) preoperatively and 169.6 +/- 2.4 degrees (10.4 +/- 2.4 anatomical valgus angulation) postoperatively. These measurements thus revealed significant changes in the weight bearing line ratio (WBL), femoral axis angle (FA), tibial axis angle (TA), tibia plateau angle (TP), tibia vara angle (TV) and talar tilt angle (TT) following OWHTO. In contrast, no significant change was found in the weight bearing line angle (WBLA) after these treatments. To assess the relationship between the correction angle and these indexes, 42 knees were divided into the following three groups according to the postoperative FTA; a normal correction group (168 degrees < or = FTA < or = 172 degrees ), an over-correction group (FTA < 168 degrees ), and an under-correction group (FTA > 172 degrees ). There were significant differences in the delta angle [DA; calculated as (pre FTA - post FTA) - (pre TV - post TV)] among each group of patients. Our results thus indicate a negative correlation between the DA and preoperative TA (R(2) = 0.148, p < 0.05). Hence, given that the correction errors in our patients appear to negatively correlate with the preoperative TA, postoperative malalignments are likely to be predictable prior to surgery.

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Section: Discussionmentioning

confidence: 99%

A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy

Bito

Takeuchi

Kumagai

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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“…It is widely accepted that high tibial osteotomy (HTO) is an effective surgical treatment for medial gonarthrosis. However, long‐term follow‐up studies have revealed that the clinical results deteriorate over time [1, 2, 4, 7, 9, 10, 14, 16, 17] and varus deformity often recurs [3, 9, 16, 19]. We used to perform lateral closing wedge osteotomy, but it was technically difficult to obtain an accurate correction angle using this method.…”

Section: Introductionmentioning

confidence: 99%

High tibial osteotomy that does not cause recurrence of varus deformity for medial gonarthrosis

Habata

Uematsu

Hattori

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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It is widely accepted that high tibial osteotomy (HTO) is an effective surgical treatment for medial gonarthrosis. However, long-term follow-up studies have revealed that the clinical results deteriorate over time and varus deformity often recurs. We performed barrel-vault osteotomy in HTO with a correction angle that did not cause arthritic progression in the medial compartment of the knee or recurrence of varus deformity. Thirty patients (44 knees) were followed clinically and radiographically for a minimum of 10 years (average, 11.4 years). We aimed for an average postoperative femorotibial angle (FTA) of 165.3 degrees (range, 162-169 degrees ) according to our method using a correction angle chosen on the basis of the so-called Mikulicz's mechanical axis. The clinical results were good in 30 (68.2%) knees, fair in 7 (15.9%) and poor in 7 (15.9%). Arthritic progression in the medial compartment was only found in 1 (2.3%) knee, while in the lateral compartment it was found in 17 (38.6%) knees. Of the knees with arthritic progression in the lateral compartment, six (35.3%) were classified as poor. The average postoperative FTAs were 164.3 degrees at 1 year, 164.0 degrees at 5 years and 163.5 degrees at 10 years after the operation, indicating that the knees tended to become slightly valgus over time. The clinical results were not poor after slightly overcorrected osteotomy was performed. Since overcorrection tended to occur, when the preoperative lateral tibial thrust was severe, HTO is not a good indication for such cases.

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“…On the contrary, overcorrection of the mFTA was recommended by Ivarsson et al [19]. Rudan and Simurda [20] found that overcorrection (with the mFTA above 15˚) seemed to achieve excellent clinical results, but the patient was not satisfied cosmetically;…”

Section: Discussionmentioning

confidence: 99%

Acute Correction of Varus Knee by Biplanar Medial Opening-Wedge High Tibial Osteotomy and Fixation with TomoFix Plate

Shaheen¹,

Morsy²

2019

OJO

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Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and increase the posterior tibial slope, which can affect the knee joint stability. Objective: The aim of this study was to describe the technique of biplanar MOWHTO and fixation by TomoFix plate, as well as to evaluate the accuracy of the planned correction and the postoperative tibial slope. Patients and Methods: This prospective cohort study was conducted on patients who presented with varus knee deformity and underwent biplanar MOWHTO and fixation by TomoFix plate during the period from March 2016 to March 2017. Assessment of patients included pre-and postoperative Knee and function scores, mechanical femorotibial angle (mFTA), posterior tibial slope angle (pTSA), range of motion (ROM) and radiological evaluation of the healing of the osteotomy site. Results: The recruited patients were 13 (8 men and 5 women), with average age 31.7 years old. The knee and functional scores improved from the preoperative mean of 45 and 41 to the postoperative mean of 85 and 72 points, respectively. The average knee flexion was 115 degrees, which at the final follow-up remained unchanged except for one case. The mean preoperative mFTA was 13.5˚ varus and decreased postoperatively to a mean of 3˚ valgus. The average postoperative follow-up period was 12 months (10 -18 M). Conclusion: The biplanar MOWHTO allows preservation of posterior tibial slope while correcting the varus knee adequately. TomoFix PlateRecently, the MOWHTO procedure has gained more popularity [11]due to its advantages. Compared to CWHTO, the MOWHTO is easier, maintains more bone block, and it avoids injury to the peroneal nerve, proximal tibiofibular joint and the anterior leg compartment [12].The AO principles recommend stable fixation of osteotomy to allow early and safe mobilization. The TomoFix knee osteotomy system is a plating system that allows stable fixation of osteotomies at the knee joint by supporting fixed angle stability between the screw and plate [13].The purpose of this study was to describe the technique of biplanar MOWHTO and fixation by TomoFix plate, as well as to evaluate the accuracy of the planned correction and the postoperative tibial slope.

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High Tibial Osteotomy

Cited by 109 publications

References 0 publications

A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy

A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy

High tibial osteotomy that does not cause recurrence of varus deformity for medial gonarthrosis

Acute Correction of Varus Knee by Biplanar Medial Opening-Wedge High Tibial Osteotomy and Fixation with TomoFix Plate

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