Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure™) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5years follow-up

Villatte, Guillaume; Érivan, Roger; Fournier, Patricia; Pereira, Bruno; Galvin, Myriam; Descamps, Stéphane; Boisgard, Stéphane

doi:10.1016/j.otsr.2015.09.023

Cited by 17 publications

(15 citation statements)

References 39 publications

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“…Our findings therefore showed that a more neutral alignment was achieved for patients 6 months after upper partial fibulectomy. Two studies that used opening wedge high tibial osteotomy to treat medial compartment knee osteoarthritis reported mean increases of the HKA angle of 7.8 degrees and 8.6 degrees from a more varus to more neutral alignment. However, the baseline varus deformity of these subjects was 7 degrees and 6.7 degrees, respectively, which were greater than the mean baseline varus deformity (2 degrees) in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies that used opening wedge high tibial osteotomy to treat medial compartment knee osteoarthritis reported mean increases of the HKA angle of 7.8 degrees and 8.6 degrees from a more varus to more neutral alignment. However, the baseline varus deformity of these subjects was 7 degrees and 6.7 degrees, respectively, which were greater than the mean baseline varus deformity (2 degrees) in our study. Thus, the range of HKA alteration for upper partial fibulectomy (mean increase of 1.80 degrees from a more varus to more neutral alignment) is less than high tibial osteotomy (HTO).…”

Section: Discussionmentioning

confidence: 99%

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Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis

Huang

Shen

et al. 2018

Journal Orthopaedic Research

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To investigate the change in short-term clinical outcomes and biomechanical properties of the knee in response to upper partial fibulectomy and to probe into the biomechanical mechanism underlying the clinical benefits of upper partial fibulectomy for medial compartment knee osteoarthritis (KOA). A total of 29 patients with medial compartment KOA underwent upper partial fibulectomy. Visual analog scale (VAS) pain, the hospital for special surgery knee score (HSS), hip-knee-ankle (HKA) angle (measured in the frontal plane), and flexion/extension range of motion of the knee were assessed before and up to 6 months after surgery. Patients and 20 healthy controls were evaluated by 3D gait analysis and dynamic lower limb musculoskeletal analysis. Both VAS pain and HSS score were significantly improved (p < 0.001) one day after surgery and steadily improved during the subsequent 6 months. HKA angle improved (p = 0.025) immediately and remained stable by 3 months after surgery. The decreased overall peak KAM (decreased by 11.1%) and increased HKA angle (increased by 1.80 degrees from a more varus to more neutral alignment) of affected and operated side by 6 months after surgery were observed. Muscle activity of biceps femoris caput longum of affected and operated side increased immediately and was equivalent to healthy controls by 6 months after surgery (p = 0.007). This pilot study provides biomechanical evidence of benefit from partial upper fibulectomy and indicates a plausible rationale for the improvement in clinical symptoms. Long-term clinical outcomes and precise biomechanical mechanism of partial upper fibulectomy should be further investigated. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-10, 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis

Huang

Shen

et al. 2018

Journal Orthopaedic Research

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“…The best indications for HTO [12,[14][15][16][17] are: (1) The patients'age are less than 65 years old (female is less than 60 years old); (2) combined with humeral varus deformity, medial proximal tibial angle (MPTA) < 85°, kneecap varus angle (KVA) > 5° (3) knee joint activity is basically normal, flexion deformity should be less than 10° and force line deformity is less than 15°; (4) lateral cartilage and meniscus function are normal. HTO is an extra-articular surgery that can correct stress concentration in the joint and relieve pain by correcting patella varus outside the joint.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the patient'the body should be carefully examined before surgery and lesions and pain sites should be confined on the medial side. Since combined lateral cartilage wear or lateral meniscus injury cannot be alleviated by HTO, and HTO may even aggravate this symptom after force line migration [15].…”

Section: Discussionmentioning

confidence: 99%

“…Krause et al [14] have reported that subtuberosity osteotomy of tibia can effectively avoid low tibia and tibiofemoral hypertension, but it is easy to cause complications such as tibial tuberosity fracture. Moreover, OWHTO can cause tibial retroversion after surgery [15,16]. The slight increase in tibial retroversion will not have serious consequences, but the excessive tibial retroversion will increase the tension of the cruciate ligament, which can affect the joint activity, and increase the difficulty in changing the joint replacement in the future.…”

Section: Discussionmentioning

confidence: 99%

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Effect Analysis of Opening Wedge High Tibial Osteotomy (OWHTO) for the Treatment of Medial Compartment Osteoarthritis

Huan¹,

Liu²,

Luo³

et al. 2019

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To investigate the clinical efficacy of open wedge high tibial osteotomy (OWHTO) in the treatment of medial compartment osteoarthritis of the knee.The authors used open OWHTO combined with TomoFix internal fixation to treat 46 cases (52 knees) with knee osteoarthritis with patella varus deformity from 2015.01 to 2017.10. HSS score and VAS score of Knee joint were used to evaluate the improvement of knee function and pain before and after surgery. The femorotibial angle (FTA), medial proximal tibial angle (MPTA), kneecap varus angle (KVA), and Weight-bearing line ratio of lower limbs (WBL) were measured by videography, which can evaluate the correction effect of postoperative knee varus. There were no happenings of internal fixation failure, delayed bone healing or non-union in these follow-up patients. At the follow-up of 3 months, 6 months, and 12 months, the HSS scores of the patients were significantly higher than those before the operation, and the difference was statistically significant (P<0.05). On March, June, and December after surgery, the HSS scores of patients were significantly higher than those before surgery and the difference was statistically significant (P<0.05). The VAS scores were lower than those before surgery, and the difference was statistically significant (P<0.05). These scores had no significant difference in the different follow-up time points (P>0.05). Imaging examination indexes showed that FTA, MPTA, KVA and WBL were improved after surgery and the varus deformity was corrected. Moreover, the difference was statistically significant (P<0.05). These scores had no significant difference in the different follow-up time points (P>0.05). In general, OWHTO can relieve joint pain and improve joint function by correcting lower limb line, showing good effect on medial compartment osteoarthritis of knee joint with varus.

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Infection in osteotomy around the knee: Incidence, management and outcomes in a high‐volume case series

Hancock,

Martin,

Bell

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeCurrent evidence around the management of osteotomy‐related infection is insufficient to robustly underpin the expert statements formulated by a recent European consensus statement. We present a review of a large case series in a high‐volume osteotomy practice to contribute to the understanding of the incidence, management and outcome of infection in this subspecialty area.MethodsAnalyses of two prospectively collected databases for all osteotomy around the knee and infections related to osteotomy were performed, along with a review of hospital readmission data to capture all osteotomy‐related infections. Clinical notes were reviewed to assess patient demographics, incidence of infection, how infection was managed and clinical outcome.ResultsIn a series of 822 osteotomies in 755 patients, there were 21 (2.8%) cases of suspected infection. Twelve (1.6%) were contemporaneously deemed ‘superficial’ and nine confirmed ‘deep’ infections (1.2%). Deep infections were all successfully managed with wound debridement, with or without plate removal, depending on union and time from initial surgery. One of these infections was noted during a revision procedure, but no revision was carried out as a direct result of infection, no external fixation was required and no infected nonunions were experienced.ConclusionAll of the cases in this series were managed successfully with debridement ± removal of the plate, without the need for revision or external fixation. Any potential signs of infection around an osteotomy, especially in the case of medial high tibial osteotomy, should raise awareness for deep infection and the need for further surgery due to the limited overlying soft tissue cover. This evidence supports the recent European Society of Sports Traumatology, Knee Surgery and Arthroscopy algorithm.Level of EvidenceLevel IV, case series.

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Opening-wedge high tibial osteotomy with a secure bone allograft (Osteopure™) and locked plate fixation: Retrospective clinical and radiological evaluation of 69 knees after 7.5years follow-up

Abstract: IV, retrospective case-series study.

Cited by 17 publications

References 39 publications

Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis

Evidence and mechanism by which upper partial fibulectomy improves knee biomechanics and decreases knee pain of osteoarthritis

Effect Analysis of Opening Wedge High Tibial Osteotomy (OWHTO) for the Treatment of Medial Compartment Osteoarthritis

Infection in osteotomy around the knee: Incidence, management and outcomes in a high‐volume case series

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