High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device

2018 ◽  
Vol 27 (7) ◽  
pp. 2334-2344 ◽  
Author(s):  
Ferdinand Kloos ◽  
Christoph Becher ◽  
Benjamin Fleischer ◽  
Matthias J. Feucht ◽  
Lisa Hohloch ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Biplanar Osteotomy ◽  
Open Wedge Hto ◽  
Patellofemoral Pressure

Open-wedge high tibial osteotomy in patients with discoid lateral meniscus

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110173
Author(s):  
Hee-June Kim ◽  
Ji-Yeon Shin ◽  
Hyun-Joo Lee ◽  
Chul-Hee Jung ◽  
Kyeong-Hyeon Park ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Lateral Meniscus ◽  
Lateral Compartment ◽  
Clinical Results ◽  
Discoid Lateral Meniscus ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Factors Affecting ◽  
The Mean ◽  
Open Wedge Hto

Background: There are concerns about the progression of the lateral osteoarthritis (OA) should be taken into account when high tibial osteotomy (HTO) is performed in patients with discoid lateral meniscus (LM). This study evaluated the clinical results of HTO in patients with discoid LM and elucidated factors affecting the results. Methods: This study evaluated 32 female patients with varus deformity and medial OA. Patients with discoid LM (8 patients) or without discoid LM (24 patients) underwent open-wedge HTO. The mean age was 53.5 years and the mean follow-up period was 35 months. Clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), were evaluated. The progression of OA in the lateral compartment was also evaluated. Finally, we evaluated the factors affecting the clinical results and OA progression in the lateral compartment. Results: Between two groups, all clinical scores were not different (p = 0.964, 0.963, and 0.559, respectively). Three of eight patients (37.5%) in the discoid group developed OA in the lateral compartment, whereas 2 of 24 patients (8.3%) in the control group developed such; however, this was not significantly different (p = 0.085). In discoid group, patients with undercorrection has higher KS relative to patients with acceptable correction (p = 0.044). Other clinical results and OA change in the lateral compartment were not affected by evaluated factors. Conclusions: Patients who underwent open-wedge HTO showed the satisfactory clinical results and lateral OA progression regardless of the presence or absence discoid LM. However, when discoid LM was present, patients with undercorrection showed higher KS in comparison with patients with acceptable correction.

scholarly journals Arthroscopy-Assisted Computer Navigation in High Tibial Osteotomy for Varus Knee Deformity

2009 ◽  
Vol 17 (1) ◽  
pp. 51-55 ◽  
Author(s):  
WN Lo ◽  
KW Cheung ◽  
SH Yung ◽  
KH Chiu
Keyword(s):  
High Tibial Osteotomy ◽  
Computer Navigation ◽  
Mean Deviation ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Varus Knee ◽  
Knee Alignment ◽  
Knee Deformity ◽  
The Mean ◽  
Open Wedge Hto

Purpose. To assess the accuracy of knee alignment after high tibial osteotomy (HTO) for varus knee deformity using arthroscopy-assisted computer navigation. Methods. Six men and 4 women aged 47 to 53 (mean, 49) years underwent medial open wedge HTO for varus knee deformity and medial unicompartmental osteoarthritis using arthroscopy-assisted computer navigation with fluoroscopy. Patients were followed up for a mean of 23 (range, 11–32) months. Intra- and post-operative leg alignments were compared. Results. The mean postoperative coronal plane alignment was 2.7 (range, 1–4) degree valgus; the mean deviation from intra-operative computer images was one (range, 0.1–1.9) degree; 5 knees had less valgus in the postoperative radiographs than the intra-operative computer images. Conclusion. Despite being more technically demanding, time consuming, and costly, arthroscopy-assisted computer navigation is safe, accurate, and reliable for HTO.

scholarly journals Total Knee Arthroplasty Conversion after Open-wedge High Tibial Osteotomy

2021 ◽  
Vol 15 (1) ◽  
pp. 53-56
Author(s):  
Wataru Kusano ◽  
Takatomo Mine ◽  
Koichiro Ihara ◽  
Yasuhiro Tominaga ◽  
Hiroyuki Kawamura ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Soft Tissue Release ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Term Survival ◽  
Wedge High Tibial Osteotomy ◽  
Total Knee ◽  
Open Wedge Hto

Background: Open-wedge High Tibial Osteotomy (HTO) is an effective treatment for Osteoarthritis (OA) of the knee; however, postoperative changes due to HTO can make subsequent Total Knee Arthroplasty (TKA) technically difficult and can affect long-term survival. Case Report: Medio-lateral stability along with balanced flexion and extension gaps provides a good functional outcome. A 71-year-old man underwent TKA conversion after open-wedge HTO 12 years earlier; the conversion was performed due to arthritic deterioration in the knee. Medial instability was noted because of poor ligament balancing. The residual medial instability was managed with a knee brace due to the unavailability of the constrained prosthesis. Management of persistent mediolateral instability persisting after soft tissue release and balancing ideally requires varus-valgus constraint. Conclusion: TKA conversion after open-wedge HTO requires a special technique and careful preparation before surgery.

scholarly journals Return to sport and work after medial open wedge high tibial osteotomy : a case series

2021 ◽  
Vol 87 (1) ◽  
pp. 117-124
Author(s):  
Francis De Neve ◽  
Brecht Braems ◽  
Milan Holvoet ◽  
Marie-Angélique De Scheerder ◽  
Nele Arnout ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
High Tibial Osteotomy ◽  
Mechanical Axis ◽  
Case Series ◽  
Return To Sport ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Work Activity ◽  
Wedge High Tibial Osteotomy ◽  
Open Wedge Hto

Data on return to work and sport following open wedge high tibial osteotomy (HTO) have been underreported. Furthermore, there is no clear consensus in literature about the postoperative alignment goals following HTO. A retrospective case series was performed to evaluate return to sport and work following open wedge HTO. The University of California, Los Angeles scale, the German classification system according to the Reichsausschuß für Arbeitszeitermittlung, the Tegner score and the Knee injury and Osteoarthritis Outcome Score were used to asses the employment status, sport status and clinical outcome at the time of surgery and at final follow-up, minimum 2 years after surgery. The pre- and postoperative hip knee ankle angle (HKA) were documented. The desired postoperative alignment target was 0°-2° valgus mechanical axis. 30 open wedge HTOs were performed of which 27 patients were retrospectively included in the study. 25 out of 26 patients returned to work and 15 out of 17 patients returned to sport following surgery. Outcome scores were significantly higher after surgery. The mean postoperative HKA was 0,9° of valgus mechanical axis. This study shows excellent outcome in sport and work activity and clinical outcome after open wedge HTO. We furthermore suggest that these outcomes can be obtained with a postoperative alignment of 0°-2° of valgus mechanical axis.

Effect of Medial Open-Wedge High Tibial Osteotomy on the Patellofemoral Joint According to Postoperative Realignment

2019 ◽  
Vol 47 (8) ◽  
pp. 1863-1873 ◽  
Author(s):  
Tae-Hwan Yoon ◽  
Chong Hyuk Choi ◽  
Sung-Jae Kim ◽  
Sung-Hwan Kim ◽  
Nam-Hoo Kim ◽  
...  
Keyword(s):  
Regression Analysis ◽  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Characteristic Curve ◽  
Cutoff Point ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Level Of Evidence ◽  
Femoral Trochlea ◽  
Wedge High Tibial Osteotomy

Background: No study has yet assessed the effect of medial open-wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint according to postoperative alignment. Purpose: To evaluate the effect of MOWHTO on the patellofemoral joint according to postoperative alignment by comparing the cartilage status before and after surgery and assessing the clinical and radiological outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 135 patients who underwent MOWHTO were retrospectively investigated. The patients were divided into 3 groups according to the postoperative weightbearing line ratio (WBLR): undercorrection (WBLR <58.3%, lowest quartile), acceptable correction (WBLR of 58.3%-66.3%, middle 2 quartiles), and overcorrection (WBLR >66.3%, highest quartile). The postoperative change in the cartilage status was assessed arthroscopically during implant removal at 2 years after MOWHTO. The clinical and radiological outcomes were evaluated at a mean follow-up of 52.1 months. A regression analysis was performed to identify the factors affecting the deterioration of the patellofemoral joint cartilage status. A receiver operating characteristic curve was employed to identify the cutoff point for the postoperative WBLR associated with the deterioration of the cartilage status in the patellofemoral joint. Results: Of all patients, progression of cartilage degeneration was noted in 39.3% for femoral trochlea and 23.7% for patella. The incidence of cartilage progression was significantly higher in the overcorrection group than in the undercorrection and acceptable correction groups (femoral trochlea: undercorrection group = 30.3%, acceptable correction group = 32.4%, and overcorrection group = 61.8% [ P = .008]; patella: undercorrection group = 15.2%, acceptable correction group = 17.7%, and overcorrection group = 44.1% [ P = .005]). The functional outcomes, including Lysholm knee score, Knee injury and Osteoarthritis Outcome Score (Pain, Symptoms, and Activities of Daily Living subscales), and Shelbourne and Trumper score, were significantly worse in the overcorrection group. The regression analysis showed that only the postoperative WBLR had a significant effect on cartilage deterioration. The cutoff point for the postoperative WBLR associated with progression of the International Cartilage Repair Society grade was 62.1% for the femoral trochlea (sensitivity = 61.5%, specificity = 62.7%, accuracy = 66.2%) and 62.2% for the patella (sensitivity = 59.4%, specificity = 60.2%, accuracy = 67.8%). Conclusion: The patellofemoral joint was adversely affected by MOWHTO. Overcorrection causing excessive valgus alignment led to further progression of degenerative changes in the patellofemoral joint and inferior clinical outcomes. The postoperative WBLR can be used as a predictive factor for deterioration of the cartilage status in the patellofemoral joint after MOWHTO.

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