The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

Lee, Do Kyung; Kim, Kwang Kyoun; Ham, Chang Uk; Yun, Seok Tae; Kim, Byung Kag; Oh, Kwang-Jun

doi:10.5792/ksrr.17.064

Cited by 17 publications

(21 citation statements)

References 28 publications

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“…8,9 While OW-HTO has been gaining popularity in recent years, it has been shown that the learning curve for OW-HTO ranges from 27 to 42 procedures. 10 Despite good outcomes, complication rates following OW-HTO have been consistently reported to be around 30%. 2 We believe that our described technique can reduce the complications of tibial plateau fractures as well as neurovascular injuries.…”

Section: Discussionmentioning

confidence: 99%

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

Kley

Razak

Khakha

et al. 2021

Arthroscopy Techniques

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Medial opening-wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. Medial collateral ligament (MCL) release and posterior neurovascular structure protection during OW-HTO are steps that often induce stress and nervousness during surgery, especially for surgeons in the earlier stages of their learning curve. While is it well-known that the MCL should be released during OW-HTO, the standard retraction techniques pose challenges in visualization and instrument placement in the surgical field. We present our technique, which illustrates an alternative method to manage the MCL and safely protect the neurovascular structures using a second and more posterior surgical window during OW-HTO.

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Section: Discussionmentioning

confidence: 99%

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

Kley

Razak

Khakha

et al. 2021

Arthroscopy Techniques

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“…The OW-HTO is an excellent option for younger patients with varus OA, given that outcomes following TKA in this patient group are poor. 8,9 Lee et al 10 reported that incidence of undercorrection, lateral hinge fracture, and excessive posterior slope change following OW-HTO could be reduced by surgical experience and concluded that differences in the incidence of surgical errors in OW-HTO may be due to different learning curves of the surgeons. OW-HTO with PSCG offers accuracy and reliability in achieving the desired corrections.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive High Tibial Osteotomy Using a Patient-Specific Cutting Guide

Razak

Jacquet

Wilson

et al. 2021

Arthroscopy Techniques

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Medial opening wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. This article presents a technique of performing a minimally invasive OW-HTO using a patient-specific cutting guide (PSCG). Preoperative 3-dimensional planning with computed tomography imaging is essential. The correction parameters, the final plate position, as well as the 3-dimensional position of the hinge as well as wedge are verified preoperatively before the PSCG is produced. After exposure with an oblique incision over the posteromedial tibia, the hamstring tendons are released for later re-attachment and the medial collateral ligament is released slightly. The PSCG is then used to perform the OW-HTO with protection of the posterior neurovascular structures by a retractor placed posterior to the medial collateral ligament. The final fixation of the osteotomy is achieved with a low-profile locking plate and a femoral head allograft wedge.

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“…Both surgeons used the same indications and surgical principles for HTO and had similar surgical experiences, having performed >50 procedures of each type before the study period. 13 Anteroposterior long-leg weightbearing radiography was used for preoperative planning with the Miniaci method. 17 The postoperative mechanical axis and percentage of the mechanical axis were targeted to be valgus 3° and 62% in both groups.…”

Section: Methodsmentioning

confidence: 99%

Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction

2020

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Background: Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO). Purpose: To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO ( P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups. Results: No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group ( P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367). Conclusion: Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.

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The Learning Curve for Biplane Medial Open Wedge High Tibial Osteotomy in 100 Consecutive Cases Assessed Using the Cumulative Summation Method

Cited by 17 publications

References 28 publications

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

Minimally Invasive High Tibial Osteotomy Using a Patient-Specific Cutting Guide

Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction

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