Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

Okimura, Shinichiro; Teramoto, Atsushi; Watanabe, Kota; Nuka, Satoshi; Kamiya, Tomoaki; Yamashita, Toshihiko

doi:10.1055/s-0039-1700977

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…Additionally, some HTO plates use metal blocks to increase the initial stability and early weight-bearing during rehabilitation [ 11 , 12 ]. Most HTO blocks have a tapered shape, and the anterior height of the block is lower than the posterior height; therefore, using block in OWHTO is useful to reduce PTS change [ 13 ]. However, there are no reports on how use of the tapered block affects PTS.…”

Section: Introductionmentioning

confidence: 99%

Estimation of the proper gap ratio using preoperative radiography for posterior tibial slope maintenance in biplanar open wedge high tibial osteotomy

2023

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Background This study aimed to estimate the ratio of the anterior and posterior gaps before surgery that can minimize the posterior tibial slope (PTS) change through preoperative radiography, and to confirm whether the use of the block helps maintain the PTS during open wedge high tibial osteotomy (OWHTO). Methods Patients who underwent OWHTO between 2015 and 2018 were included. To measure optimal anterior gap (AG) and posterior gap (PG) ratio, hinge to medial tibial tuberosity length (HTL), total osteotomy length (TOL), and PTS were measured using knee AP X-ray. Real AG and PG were measured using postoperative knee computed tomography. Use of the block was also confirmed. Results Total 107 knees (95 patients) were included. The average ratio between HTL and TOL was 70.9%. The average ratio AG: PG was 72.9%. PTS increased significantly from 10.2° to 11.2° postoperatively (p = 0.006). When the difference in HTL: TOL and AG: PG, and the amount of PTS change were analyzed using linear regression, there was a statistically significant correlation (correlation coefficient: − 25.9; p < 0.001). There was no difference in AG: PG according to the use of the block (p = 0.882). Conclusion In OWHTO, PTS change can be minimized by estimating the ratio of the AG and PG using radiographs, and is was approximately 70%. If the ratio is increased by 10% from the predicted value, the PTS increases by approximately 2.6°. Using a block during OWHTO did not have a considerable advantage in terms of PTS maintenance compared to the group not using a block. Level of evidence Level IV.

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Section: Introductionmentioning

confidence: 99%

Estimation of the proper gap ratio using preoperative radiography for posterior tibial slope maintenance in biplanar open wedge high tibial osteotomy

2023

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“…Uniplane osteotomy and spacer fixation are not new concepts 12 , 13 . However, the β‐TCP/PLGA wedge‐shaped spacer used in this study is a unique design, featuring its material, nonuniform thickness, and fin‐like spikes, which are designed to compensate for the drawbacks of uniplane osteotomy.…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral Joint after Opening Wedge High Tibial Osteotomy: A Comparative Study of Uniplane versus Biplane Osteotomies

Zheng

Wang

et al. 2022

Orthopaedic Surgery

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Objective To the best of our knowledge, there has been no comparative study of changes in radiographic parameters in the sagittal plane between biplane opening wedge high tibial osteotomy (OWHTO) with plate fixation and uniplane OWHTO with spacer implantation. The aim of the study was to compare sagittal radiographs between the procedures of biplane and uniplane OWHTOs in patients with genu varum and to investigate the impact on the patellofemoral joint. Methods A retrospective study of 71 patients (58.0 ± 5.0 years of age, 58 females and 13 males) with varus‐aligned medial compartment knee osteoarthritis treated with OWHTO was performed during the period from January 2016 to February 2019. Thirty‐three patients underwent biplane osteotomy with plate fixation (biplane group), and 38 patients underwent uniplane osteotomy with absorbable wedged spacer fixation (uniplane group). Independent t tests were used to compare the two groups according to the preoperative and postoperative radiographic parameters of hip‐knee‐ankle (HKA) angle, posterior tibial slope (PTS), tibial tubercle prominence (TTP), Caton–Deschamps (CD) index, and Blackburne–Peel (BP) index. During the last follow‐up assessment, patients were asked to rate their patellofemoral joint status using the Samsung Medical Center (SMC) patellofemoral (PF) scoring system. The visual analog scale (VAS) was also used to rate knee joint pain when walking. Results There was no significant difference between the two groups in any of the demographic, clinical, or radiological characteristics at baseline (p > 0.05). Comparisons of postoperative sagittal radiographic parameters between patients in the uniplane group and patients in the biplane group showed significant differences in the PTS (13.4° vs 16.6°, t = 4.465, p < 0.001), TTP (9.0 mm vs 4.2 mm, t = 7.950, p < 0.001), and CD index (0.81 vs 0.70, t = 4.035, p < 0.001). At the final follow‐up assessment (minimum, 2 years), the SMC PF function score was significantly lower in patients in the uniplane group than in patients in the biplane group (27.8 vs. 32.1, t = 2.458, p = 0.016), but there were no significant differences in the SMC PF pain score or VAS score (p > 0.05). Conclusion The essential difference in the postoperative sagittal radiographic changes between biplane and uniplane OWHTO was the tibial tubercle prominence, indicating the posterior displacement of the tibial tubercle. Uniplane OWHTO may yield better function of the patellofemoral joint compared to biplane OWHTO.

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Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

Cited by 2 publications

References 33 publications

Estimation of the proper gap ratio using preoperative radiography for posterior tibial slope maintenance in biplanar open wedge high tibial osteotomy

Estimation of the proper gap ratio using preoperative radiography for posterior tibial slope maintenance in biplanar open wedge high tibial osteotomy

Patellofemoral Joint after Opening Wedge High Tibial Osteotomy: A Comparative Study of Uniplane versus Biplane Osteotomies

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