How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?

Kang, Byoung Youl; Lee, Do Kyung; Kim, Hyeon Soo; Wang, Joon Ho

doi:10.1186/s43019-021-00130-2

Cited by 47 publications

(40 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…High tibial osteotomy is an effective procedure for medial compartment osteoarthritis of the knee with varus deformity in middle-aged patients [1][2][3] . It reduces medial compartment pressure of the knee joint by realigning the mechanical axis of the lower extremity from medial to lateral compartment and redistributing the joint pressure, thereby reducing the pain and improving the function [4][5][6] .…”

mentioning

confidence: 99%

Effect of the sagittal osteotomy inclination angle on the posterior tibial slope change in high tibial osteotomy: three-dimensional simulation study

Chung

Choi

Kim

et al. 2022

Sci Rep

View full text Add to dashboard Cite

In performing medial open-wedge high tibial osteotomy, it is recommended not to alter the posterior tibial slope. However, it remains unclear whether the osteotomy inclination angle affects the posterior tibial slope in the sagittal plane. This study aimed to verify how anterior or posterior osteotomy inclination angle affects the tendency of change in the posterior tibial slope and to conduct quantitative analysis of the extent to which the posterior tibial slope changes according to the degree of the osteotomy inclination angle change in MOWHTO. Computed tomography images of 30 patients who underwent MOWHTO were collected. Three-dimensional models of preoperative original tibia were reconstructed, and virtual osteotomies were performed. The sagittal osteotomy inclination angles formed by the osteotomy line and the medial tibial plateau line were classified as positive in case of anteriorly inclined osteotomy and negative in case of posteriorly inclined osteotomy. Thirteen osteotomies were performed for each tibial model at intervals of 5° from − 30° to 30°. The posterior tibial slope was assessed, and the proportional relationship between the sagittal osteotomy inclination angle and the posterior tibial slope change was analyzed. The posterior tibial slope changed significantly after osteotomy (p < 0.001), except for the cases where the sagittal osteotomy inclination angles were 5°, 0°, and − 5°. Anteriorly and posteriorly inclined osteotomy caused increase and decrease in the posterior tibial slope, respectively. As the inclination angle increased by 1°, the posterior tibial slope increased by 0.079° in anterior inclination osteotomy, while in posterior inclination osteotomy, as the inclination angle decreased by 1°, the posterior tibial slope decreased by 0.067°. The osteotomy inclination angle in the sagittal plane significantly affected the posterior tibial slope. When there was an inclination angle occurred between the osteotomy line and the medial tibial plateau line in the sagittal plane, the posterior tibial slope changed after MOWHTO. The posterior tibial slope tended to increase in anteriorly inclined osteotomy and decrease in posteriorly inclined osteotomy. The change in the posterior tibial slope was proportionally related to the absolute value of the osteotomy inclination angle.

show abstract

mentioning

confidence: 99%

Effect of the sagittal osteotomy inclination angle on the posterior tibial slope change in high tibial osteotomy: three-dimensional simulation study

Chung

Choi

Kim

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Previous studies reported that a large opening gap was associated with LHF in medial opening wedge high tibial osteotomy (MOHTO). 8,10,14 Lee et al 14 reported that a large opening gap was a risk factor for LHF in MOHTO (OR, 1.615; 95% CI, 1.232-2.118; P = .001). Han et al 8 demonstrated that the osteotomy gap height was the only predictor of LHF (adjusted OR, 1.831; P = .016).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Lateral Hinge Fracture in Medial Closing Wedge Distal Femoral Osteotomy

et al. 2022

View full text Add to dashboard Cite

Background: Recent studies have reported that lateral hinge fracture (LHF) has a negative effect on bone healing at the osteotomy site after medial closing wedge distal femoral osteotomy (MCDFO). However, limited evidence exists in the literature regarding the predictive factors for LHF in MCDFO. Hypothesis: A large medial closing gap and a lateral hinge position in the supracondylar area would increase plain radiography–based and/or computed tomography (CT)–based LHF in MCDFO. Study Design: Case control study; Level of evidence, 3. Methods: We retrospectively evaluated 67 knees of 53 patients (mean age, 37.4 ± 16.9 years) who underwent MCDFO between May 2009 and June 2021. The surgical indications for MCDFO were genu valgum deformity combined with either lateral compartment osteoarthritis or recurrent patellar dislocation. The presence of LHF was evaluated based on immediate postoperative plain radiography and CT scans. The predictive factors for LHF in MCDFO were investigated using multivariate logistic regression analysis. Results: LHFs were identified in 21 knees (31.3%) through plain radiography and in 40 knees (59.7%) through CT. Multivariate logistic regression analysis showed that the medial closing gap and lateral hinge position were predictive factors for plain radiography– and CT-based LHF after MCDFO. Controlling for other variables, we found that an increase in the medial opening gap by 1 mm increased the likelihood of plain radiography–based LHF by a factor of 1.805 (95% CI, 1.291-2.525; P = .001) and CT-based LHF by 1.333 (95% CI, 1.003-1.772; P = .048). Moreover, a lateral hinge position in the supracondylar area increased the likelihood of plain radiography–based LHF by a factor of 9.870 (95% CI, 2.179-44.720; P = .003) and CT-based LHF by 5.686 (95% CI, 1.124-28.754; P = .036). Conclusion: A large medial closing gap and lateral hinge position in the supracondylar area are associated with LHF in MCDFO. Care should be taken to prevent LHF in MCDFO with a large medial closing gap. Moreover, a lateral hinge position in the supracondylar area should be avoided to decrease the incidence of LHF in MCDFO.

show abstract

“…18 The postoperative mechanical axis (MA) was targeted to be at valgus angles of 2 to 3 degrees. 19,20 Arthroscopic procedures, including cartilage debridement, microfracture, partial meniscectomy, or meniscus repair, were performed in the medial compartment, when necessary, before the osteotomy procedure.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Use of Grafts on an Open Gap Is Advantageous for Preventing Correction Loss in 1-Week Staged Bilateral Open-Wedge High Tibial Osteotomies

et al. 2022

View full text Add to dashboard Cite

One-week staged bilateral open-wedge high tibial osteotomies (OWHTOs) can be a safe procedure, with the added advantage of fast functional recovery, cost saving, and reduced hospital stay. However, there can be concerns about correction loss after one-week staged OWHTOs because high loading is inevitably applied to osteotomy sites during postoperative weight bearing. Although leaving the osteotomy site with no grafts is possible in OWHTOs, use of grafts can provide additional stability to the osteotomy site and prevent correction loss. We compared the amount and incidence of correction loss between one-week staged bilateral OWHTOs with and without allogenic bone grafts. Seventy-five patients who underwent one-week staged bilateral OWHTOs with a locking spacer plate (Nowmedipia, Seoul, Korea) by a single surgeon were retrospectively reviewed. Allogenic cancellous bone grafts were applied in 53 patients (Group G; 106 knees, operated consecutively between 2012 and 2017), but not in 22 patients (Group N; 44 knees, operated consecutively between 2017 and 2019). Demographics were similar between the groups. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated preoperatively and within 1 year postoperatively. Unstable hinge fracture was investigated using computer tomography in all cases. The incidence of correction loss (MPTA loss ≥ 3°) was determined. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively. The incidence of unstable hinge fractures did not differ. The losses in MA, MPTA, and PTS during the first postoperative year were significantly greater in group N than in group G (MA, -5.5° vs. -2.3°; MPTA, -3.0° vs. 0°; PTS, -2.0° vs. -0.7°; p < 0.05° on all parameters). The correction loss incidence was 6.6% (7/106) and 31.8% (14/44) in groups G and N, respectively (p < 0.001). Appropriate treatment is necessary to prevent correction loss in one-week staged bilateral OWHTOs. Grafting, which provides additional stability to the osteotomy site, is a recommended method.

show abstract

How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?

Cited by 47 publications

References 75 publications

Effect of the sagittal osteotomy inclination angle on the posterior tibial slope change in high tibial osteotomy: three-dimensional simulation study

Effect of the sagittal osteotomy inclination angle on the posterior tibial slope change in high tibial osteotomy: three-dimensional simulation study

Predictive Factors for Lateral Hinge Fracture in Medial Closing Wedge Distal Femoral Osteotomy

Use of Grafts on an Open Gap Is Advantageous for Preventing Correction Loss in 1-Week Staged Bilateral Open-Wedge High Tibial Osteotomies

Contact Info

Product

Resources

About