The Effect of Opening-Wedge High Tibial Osteotomy on the Posterior Tibial Slope Assessed by Three Different Evaluation Methods (original) (raw)
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Knee Surgery, Sports Traumatology, Arthroscopy, 2015
HTO (p < 0.001). Mean leg length decreased 5.7 mm in CW HTO and increased 3.1 mm in OW HTO (p < 0.001). Changes in joint line angles, patellar height indexes and the correction accuracy showed no significant differences comparing the two techniques. Frontal plane reliability measurement intra-and inter-rater intraclass correlation coefficient (ICC) varied from 0.81 to 0.99. Sagittal plane intra-and inter-rater ICC varied from 0.60 to 0.87. Posterior tibial slope intra-and inter-rater ICC showed the lowest values (0.70 and 0.60, respectively) corresponding to a smallest real difference of 4.5° and 5.5°, respectively. Conclusions Posterior tibial slope and leg length changes were significantly different in CW compared to OW HTOs. We recommend that possible alterations in tibial slope and leg length are considered when the technique of HTO is to be chosen. Landmark-based medical planning software shows good reliability and can be used in preoperative planning and postoperative evaluations of HTOs. Level of evidence I.
Knee Surgery, Sports Traumatology, Arthroscopy, 2014
Purpose Opening wedge high tibial osteotomy (HTO) is an accepted treatment option for medial compartment knee osteoarthritis with associated varus lower limb axis in younger, more active patients. A concern with the use of this technique is that posterior tibial slope (PTS) and tibial rotation can be altered. We hypothesized that there is a tendency to increase the PTS and internal rotation of the distal tibia during the procedure and that certain intraoperative parameters may influence the amount of change that can be expected. Methods A cadaveric model and surgical navigation system were used to evaluate the influence of certain intraoperative factors of the degree of PTS and tibial rotation change observed during medial opening HTO. Parameters evaluated included: degree of osteotomy opening, knee flexion angle, location of limb support (thigh versus foot), performance of a posteromedial release, the status of the lateral cortical hinge, and the degree of osteoarthritis present in the knee. Results Combining measurements of all specimens and parameters, a mean PTS increase of 2.7°± 3.9°and a mean tibial internal rotation of 1.5°± 2.9°were observed. Clinically, significant changes in tibial slope ([2°) occurred in 50.4 % of corrections, while significant changes in tibial rotation ([5°) occurred in only 11.9 % of corrections. Patients with significant osteoarthritis and concomitant flexion contracture, cases where large corrections were required, and procedures in which the lateral cortical hinge was disrupted were associated with increased PTS change. The other factors evaluated did not exert a significant influence of the degree of PTS change observed. Conclusions Surgeons should be vigilant for possible PTS change, particularly in high-risk situations as outlined above. Routine use of an intra-operative measure of PTS is recommended to avoid inadvertent slope change. Keywords Opening wedge high tibial osteotomy Á Posterior tibial slope Á Rotation Á Osteoarthritis M. Jacobi (&)
Survivorship of high tibial osteotomy: comparison between opening and closing wedge osteotomy
Annals of Joint
Background: High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis (OA) in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening wedge versus lateral closing wedge) has not been explored. The purpose of this study was to retrospectively compare the results of closing wedge and opening wedge and assess which technique led to lower risk of failure. Methods: A total of 141 knees with indication for TKA, which were previously submitted to HTO (24 opening wedge and 117 closing wedge), were included in this study. At the time of TKA, the Knee Society Score and Knee Society Score function were evaluated. Additionally, the lower limb mechanical angle and Blackburn-Peele index were retrospectively retrieved. The relative risk of failure of the two techniques was compared using the Cox proportional hazard regression model. The impact of the patient's age at HTO on the time to convert to TKA was also analyzed. Results: There was no significant difference in Knee Society Score and Knee Society Score function scores based on osteotomy technique at the time of the TKA. The survival curves were significantly different between the two groups (P<0.001) and patients who underwent opening wedge HTO had a 3-fold higher risk of failure (relative risk =2.91, P<0.001). There was a significant but weak linear correlation between higher age at HTO and lesser time until the TKA (r=0.326, P<0.001). Conclusions: Opening wedge HTO was associated with a 3-fold increase in risk of conversion to TKA, when compared to the closing wedge HTO surgical technique. These results are important for HTO surgical planning and may assist the orthopaedic surgeon in the decision between opening wedge or closing wedge HTO.
[The effect of open wedge osteotomy on the posterior tibial slope]
Acta orthopaedica et traumatologica turcica, 2005
Proximal tibial osteotomy improves the alignment and weight distribution of the lower extremity on the coronary plane. However, upper end osteotomy of the tibia may cause changes in the sagittal plane. In this study, we evaluated open wedge osteotomy operations with regard to its effect on the sagittal plane. The study included 22 knees of 20 female patients (mean age 54.1 years; range 43 to 64 years) who underwent proximal tibial osteotomy for osteoarthritis. Open wedge osteotomy was performed in all the patients with the use of a Puddu plate. Pre- and postoperative posterior tibial slope angles were measured on lateral radiographs. The mean follow-up period was 12.8 months (range 4 to 33 months). Union of the osteotomy line was obtained in all the patients in a mean of 10.8 weeks (range 8 to 14 weeks). While the tibiofemoral range of motion did not change in 15 knees, it decreased by 5 to 10 degrees in seven knees postoperatively. Complaints of pain or limitation of the patellofem...
Comparative Study of Medial Opening-Wedge High Tibial Osteotomy Using 2 Different Implants
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
The purpose of this study was to perform a retrospective clinical and radiographic evaluation after openingwedge high tibial osteotomy (HTO) using a short spacer plate (Aescula; B. Braun Korea, Seoul, South Korea) and rigid long plate (TomoFix plate; Mathys, Bettlach, Switzerland) at follow-up 2 years postoperatively. Methods: We performed 94 opening-wedge HTOs with the Aescula plate (group I) and 92 HTOs with the TomoFix plate (group II). Patients underwent clinical and radiographic evaluations preoperatively and at 2 years postoperatively. Clinical evaluations were performed with Knee Society scores. Radiographic analysis included the mechanical tibiofemoral angle (mTFA) and the slope of the tibia angle with preoperative and postoperative full weightebearing anteroposterior whole-leg views, as well as anteroposterior, lateral, and Merchant views of the knee. We measured the mTFA. In addition, we evaluated the complications in each group. The follow-up period was 2 years. Results: At follow-up 2 years postoperatively, we observed an overall complication rate of 38% in group I and 26% in group II (P ¼ .083). We found plate-related complication rates of 20% in group I and 9% in group II (P ¼ .039). Plate-related complications included loss of correction, fracture of the tibial plateau, screw failure, malunion, and fracture of the lateral cortical bone. The mean mTFA was À6.0 AE 3.2 in group I and À4.6 AE 2.8 in group II preoperatively (P ¼ .262). The mean mTFA was 1.0 AE 3.1 in group I and 1.5 AE 2.3 in group II at the latest follow-up (P ¼ .034). In group I, the mean Knee Society knee score and function score were 60.0 AE 12.9 and 57.9 AE 26.8, respectively, preoperatively. They improved to 92.1 AE 8.1 and 89.0 AE 15.1, respectively, at follow-up (P ¼ .001 and P ¼ .001, respectively). In group II, the mean Knee Society knee score and function score were 57.5 AE 14.8 and 57.4 AE 22.1, respectively, preoperatively. They improved to 95.5 AE 5.4 and 95.0 AE 7.6, respectively, at follow-up (P ¼ .001 and P ¼ .001, respectively). In addition, the mean postoperative knee score and function score in group II were higher than those in group I (P ¼ .001 and P ¼ .001, respectively). Conclusions: We have shown a high plate-related complication rate and a significant loss of correction during a short-term follow-up period (2 years) after opening-wedge HTO using the new short spacer HTO plate compared with the rigid long plate. Level of Evidence: Level IV, therapeutic case series.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2009
The purpose of this randomized, prospective study was to compare radiologic changes in the sagittal plane after closing-wedge and combined high tibial osteotomies (HTOs) performed in patients with medial knee arthrosis associated with a varus deformity and requiring a 10°correction. Methods: The patellar height, determined by the Insall-Salvati index (ISI), and tibial slope (TS) angle, measured by the Dejour-Bonnin method, were compared after 45 closing-wedge osteotomy (CWO) and 46 combined osteotomy (CO) procedures. CO is a relatively new technique effectively being the combination of closing-wedge and opening-wedge HTOs. It involves performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge is transferred to the gap on the medial side. Results: We found that at the end of the study, 12 months after the operation, CO resulted in significantly smaller changes in TS angle (4.7% v 38.2%) and ISI (2.2% v 5.7%) values than CWO. Conclusions: The main conclusion of this study is that based on our radiologic findings, CO results in significantly smaller changes in TS angle and ISI values than CWO; therefore, CO is better at preserving the normal or near normal condition of the knee than CWO. Altogether, when a 10°correction is required during HTO, we recommend choosing CO instead of CWO. Level of Evidence: Level II, prospective comparative study. Key Words: Closing-wedge high tibial osteotomy-Combined high tibial osteotomy-Length of patellar tendon-Tibial slope angle-Insall-Salvati index-Dejour-Bonnin method.
Stability of medial opening wedge high tibial osteotomy: a failure analysis
International Orthopaedics, 2010
Medial opening wedge high tibial osteotmy (HTO) is often used to treat varus gonarthrosis in young, active, highly demanding patients, although it has many pitfalls, which were evaluated in a consecutive cohort of patients. A retrospective analysis of a consecutive series of 45 patients with 49 medial opening HTO for varus gonarthrosis using a spacer plate (Puddu I, Arthrex, USA) were included. A Chi square test was used to study the effect between the wedge size and complications. Complications occurred in 22 knees (45%). There was no significant difference between groups for individual complications; however, when combined, there were significantly more complications in the >10 mm wedge group (Chi square p=0.05). The overall complication rate in this series was 45%. The majority were related to intrinsic instability at the osteotomy site (24%) and surgical technique (20%). The evaluated spacer provided inadequate stability. Résumé Analyse des échecs après ostéotomie tibiale d'ouverture interne. L'ostéotomie tibiale d'ouverture interne HTO est très souvent utilisée dans le traitement des gonarthroses en varus chez le sujet jeuneet actif, cependant, il existe beaucoup de pièges. Ceux-ci ont été évalués sur une cohorte de patients consécutifs. Analyse rétrospective d'une série consécutive de 45 patients ayant bénéficié de 49 ostéotomies internes d'ouverture du tibia pour gonarthrose en varus utilisant une plaque spéciale de type Puddu (Arthrex USA). Le Chi test a été utilisé de façon à évaluer les effets secondaires dûs à l'importance de la taille du spacer et ses complications. 45% de complications (22 genoux) sont apparues. Il n'y a pas de différence significative entre les groupes concernant les complications habituelles, cependant il existe un taux significativement plus important de complications si l'ouverture osseuse est supérieure à 10 m (Chi Square p=0,05). Globalement, le taux de complications de cette série est de 45% dont la majorité est secondaire à des problèmes d'instabilité au niveau de l'ostéotomie (24%) ou de la technique chirurgicale (20%). Cette plaque spéciale ne permet pas d'avoir une bonne stabilité de l'ostéotomie.
The Bone & Joint Journal, 2017
AimsThe aim of this prospective randomised study was to compare the time course of clinical improvement during the first two years following a closing or opening wedge high tibial osteotomy (HTO). It was hypothesised that there would be no differences in clinical outcome between the two techniques.Patients and MethodsBetween 2007 and 2013, 70 consecutive patients were randomly allocated to undergo either a closing or opening wedge HTO. All patients had medial compartment osteoarthritis (OA), and were aged between 30 years and 60 years. They were evaluated by independent investigators pre-operatively and at three and six months, and one and two years post-operatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), the Lysholm score, the Tegner activity score, the University of California, Los Angeles (UCLA) activity scale and range of movement (ROM).ResultsThere were no significant differences at any time between the two techniques for any ...
Knee Surgery Sports Traumatology Arthroscopy
Varus medial knee osteoarthritis (OA) can be treated with a closing-wedge (CW) or opening-wedge (OW) high tibial osteotomy (HTO). Little is known about the adverse event (AE) rate of these techniques. The purpose of this study was to examine the AE rate and survival rate of a consecutive series of 412 patients undergoing CW- or OW-HTO. Medical records were retrospectively screened, and all patients who underwent HTO from 1993 to 2012 at the Erasmus University Medical Centre were assessed with a self-administered questionnaire. Patients filled in the intermittent and constant osteoarthritis pain score, knee injury and osteoarthritis outcome score, and a general questionnaire focusing on AE. Medical records of 412 patients (354 CW- and 112 OW-HTOs) were screened. Of the 358 eligible patients, 291 (81 %) returned their questionnaire. A total of 80 AE (17 %) were found in 466 osteotomies. In the CW-group, 47 (13 %) serious adverse events (SAE) and 2 (0.6 %) AE were found. In the OW-grou...