The Ideal Hinge Axis Position to Reduce Tibial Slope in Opening-Wedge High Tibial Osteotomy Includes Proximalization-Extension and Internal Rotation

Eliasberg, Claire D.; Hancock, Kyle J.; Swartwout, Erica; Robichaud, Hugo; Ranawat, Anil S.

doi:10.1016/j.arthro.2020.12.203

Cited by 14 publications

(11 citation statements)

References 38 publications

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“…Data acquisition from CT scans was performed in a standardized fashion following the Bodycad Imaging Guide (Bodycad) as previously described. 10 In short, the slice thickness could be no greater than 1 to 1.5 mm, and a minimum of 15 cm of the patient’s hip (5 cm proximal to and 10 cm distal to the femoral head), 30 cm of the patient’s knee (15 cm above and below the joint line), and 10 cm of the distal tibia were required to be captured on the CT scans to provide adequate landmarks and data for analysis. Digital Imaging and Communications in Medicine data were extracted using proprietary software (Bodycad Imager; Bodycad), and 3D models of the femur, tibia, and fibula were created.…”

Section: Methodsmentioning

confidence: 99%

“…Virtual osteotomy was performed using Bodycad Osteotomy software (Bodycad) as previously described. 10 In short, 3D images of each patient’s tibia and femur were created and rotated to match the contour of the bones on their respective AP radiographs. After the bony orientation was established, baseline measurements, including the mTFA, the medial proximal tibial angle, and the PTS, were calculated.…”

Section: Methodsmentioning

confidence: 99%

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Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Eliasberg

Kunze

Swartwout

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Both coronal- and sagittal-plane knee malalignment can increase the risk of ligamentous injuries and the progression of degenerative joint disease. High tibial osteotomy can achieve multiplanar correction, but determining the precise hinge axis position for osteotomy is technically challenging. Purpose: To create computed tomography (CT)–based patient-specific models to identify the ideal hinge axis position angle and the amount of maximum opening in medial opening wedge high tibial osteotomy (MOWHTO) required to achieve the desired multiplanar correction. Study Design: Descriptive laboratory study. Methods: A total of 10 patients with lower extremity CT scans were included. Baseline measurements including the mechanical tibiofemoral angle (mTFA) and the posterior tibial slope (PTS) were calculated. Virtual osteotomy was performed to achieve (1) a specified degree of PTS correction and (2) a planned degree of mTFA correction. The mean hinge axis position angle for MOWHTO to maintain an anatomic PTS (no slope correction) was 102.6° ± 8.3° relative to the posterior condylar axis (PCA). Using this as the baseline correction, the resultant hinge axis position and maximum opening were then calculated for each subsequent osteotomy procedure. Results: For 5.0° of mTFA correction, the hinge axis position was decreased by 6.8°, and the maximum opening was increased by 0.49 mm for every 1° of PTS correction. For 10.0° of mTFA correction, the hinge axis position was decreased by 5.2°, and the maximum opening was increased by 0.37 mm for every 1° of PTS correction. There was a significant difference in the trend-line slopes for hinge axis position versus PTS correction ( P = .013) and a significant difference in the trend-line intercepts for maximum opening versus PTS correction ( P < .0001). Conclusion: The mean hinge axis position for slope-neutral osteotomy was 102.6° ± 8.3° relative to the PCA. For smaller corrections in the coronal plane, more extreme hinge axis positions were necessary to achieve higher magnitudes of PTS reduction. Clinical Relevance: Extreme hinge axis positions are technically challenging and can lead to unstable osteotomy. Patient-specific instrumentation may allow for precise correction to be more readily achieved.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Eliasberg

Kunze

Swartwout

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Based on a systematic review of open-wedge HTO studies, the technical factors of open-wedge HTO associated with its prognosis are not fully established. Among various surgical technical factors of medial open-wedge HTO, hinge position is considered one of the most important factor [ 14 , 25 , 26 ]. In general, the standard hinge position for open-wedge HTO is set along a line toward the fibular head 3 cm inferior to the medial tibial plateau and crossing a longitudinal line 1 cm medial to the fibular shaft.…”

Section: Discussionmentioning

confidence: 99%

The influence of different hinge position on PTS during HTO: comparison between open-wedge and closed-wedge HTO

Moon

Seo

Kim

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose The purpose of this study was to determine the significance of hinge position through comparison between open-wedge and closed-wedge high tibial osteotomy (HTO) and to determine the ideal hinge position to minimize the effect of HTO on the posterior tibial slope (PTS) and medial proximal tibial angle (MPTA). Methods Procedures were performed on 32 cadaveric knees using open-wedge HTO with the standard hinge position or a low hinge position or closed-wedge HTO with the standard hinge position or a low hinge position. To define the standard hinge position in open wedge HTO, we drew a line 3-cm inferior to the medial tibial plateau toward the fibular head and located the intersection of this line with a longitudinal line 1-cm medial to fibular shaft. The low hinge position was then defined as the point 1-cm inferior to the standard position. For the standard hinge position for closed-wedge HTO, we drew a line parallel with joint line from 2-cm inferior to the lateral tibial plateau. The low hinge position was then defined as the point 1-cm inferior to the standard position. Results For the open-wedge procedure, osteotomy through the low hinge position resulted in a significantly greater PTS compared to osteotomy through the standard hinge position. MPTA was also significantly greater for the low hinge position compared to standard hinge position. In the closed-wedge HTO, neither the PTS nor MPTA was significantly different for the low and standard hinge positions. Conclusions Hinge position significantly affects changes in the PTS and MPTA following open-wedge but not closed-wedge HTO. Understanding how to hinge position affects the PTS and MPTA is critical for surgeons performing open-wedge HTO procedures. Adopting an accurate hinge position is crucial for preventing complications, especially in open-wedge osteotomy, due to postoperative changes in the PTS and MPTA.

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“…Various optimization methods have been proposed, including insertion of a structural grafting into the posterior part of the gap, hinge axis modification, mathematical formulations, computer simulations, posterior plating, intraoperative temporary additional fixation, or surgical details such as gap ratio adjustment. 1,3,4 In addition, the knee is sometimes forcefully extended and compressed at the anterior gap to maintain the proper ratio between the anterior and posterior gap (approximately two-thirds). 1,5,6 Some surgeons also keep the knee extended for the anterior and retrotubercular gap compression during biplanar…”

Section: See Related Article On Page 2181mentioning

confidence: 99%

Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy

Lee

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The Ideal Hinge Axis Position to Reduce Tibial Slope in Opening-Wedge High Tibial Osteotomy Includes Proximalization-Extension and Internal Rotation

Cited by 14 publications

References 38 publications

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

The influence of different hinge position on PTS during HTO: comparison between open-wedge and closed-wedge HTO

Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy

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