Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up

2019 ◽  
Vol 28 (12) ◽  
pp. 3747-3757 ◽  
Author(s):  
Wouter Van Genechten ◽  
Maxim Van den Bempt ◽  
Wouter Van Tilborg ◽  
Stijn Bartholomeeusen ◽  
Gert Van Den Bogaert ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Consecutive Case ◽  
Opening Wedge ◽  
Structural Allograft ◽  
Wedge High Tibial Osteotomy ◽  
One Year

scholarly journals Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091353 ◽  
Author(s):  
Diego Costa Astur ◽  
Joao Victor Novaretti ◽  
Marcelo Lins Gomes ◽  
Adilson Góes Rodrigues ◽  
Camila Cohen Kaleka ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Meniscal Extrusion ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Return To Activity

Background: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME. Purpose/Hypothesis: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity. It was hypothesized that MME would decrease after HTO and that patients with lower MME after surgery would have improved clinical outcomes and return to activity at short-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: This study included 66 patients who underwent HTO to correct the anatomic axis with a minimum follow-up of 2 years. MME was measured using magnetic resonance imaging preoperatively and 6 weeks after surgery (study protocol). Patients were assessed preoperatively and postoperatively with the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) score for pain, and Tegner score. Results: The mean ± SD preoperative and postoperative MME values were 3.9 ± 0.6 mm and 0.9 ± 0.5 mm, respectively. At 2 years after surgery, KOOS, pain VAS, and Tegner scores were higher than those found preoperatively ( P < .001). Patients with less than 1.5 mm of MME after surgery had better clinical outcomes and return to activity compared with patients who had MME of 1.5 mm or more ( P < .05). Conclusion: Medial opening wedge HTO decreased MME after 6 weeks and improved clinical outcomes and return to activity at a minimum 2-year follow-up. Additionally, patients with postoperative MME of less than 1.5 mm had better clinical outcomes and return to activity compared with patients who had postoperative MME of 1.5 mm or more.

Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

2021 ◽  
Vol 103-B (11) ◽  
pp. 1686-1694
Author(s):  
Hong-Yeol Yang ◽  
Woo-Kyoung Kwak ◽  
Sung Ju Kang ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Status Group ◽  
Second Look ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

scholarly journals Correction to: A case series of lateral opening wedge high tibial osteotomy for valgus malalignment

2017 ◽  
Vol 26 (7) ◽  
pp. 2215-2215
Author(s):  
Brett Collins ◽  
Alan Getgood ◽  
Abdulaziz Z. Alomar ◽  
J. Robert Giffin ◽  
Kevin Willits ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Lateral Opening Wedge ◽  
Valgus Malalignment

Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up

2017 ◽  
Vol 41 (10) ◽  
pp. 2045-2052 ◽  
Author(s):  
Pakpoom Ruangsomboon ◽  
Keerati Chareancholvanich ◽  
Thos Harnroongroj ◽  
Chaturong Pornrattanamaneewong
Keyword(s):  
High Tibial Osteotomy ◽  
The Elderly ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals The difficulty of continuing sports activities after open-wedge high tibial osteotomy in patient with medial knee osteoarthritis: a retrospective case series at 2-year-minimum follow-up

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Shugo Maeda ◽  
Daisuke Chiba ◽  
Eiji Sasaki ◽  
Tetsushi Oyama ◽  
Tomoyuki Sasaki ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Activity Levels ◽  
Open Wedge ◽  
Retrospective Case ◽  
Sports Activity ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Abstract Purpose This study aimed to investigate the rate at which patients returned to sports after open wedge high tibial osteotomy and identify the continuity of sports activity post-operatively. Methods Thirty-five patients (40 knees) who underwent open-wedge high tibial osteotomy (OW-HTO) in medial knee osteoarthritis were included in this study. The mean age of the patients who underwent surgery was 55.1 ± 10.7 years, and the mean follow-up period was 41.0 ± 24.7 months. Clinical results and radiographic parameters calculated in standing whole-leg radiographs preoperatively, post-operatively, and at the final follow-up were evaluated. Results Thirty-one patients (88.6%) were able to return to preoperative sports activity; however, only 14 patients (40.0%) completely returned to preoperative sports activity levels. Of the 31 patients who returned to sports activity, 10 patients (32.3%) maintained post-operative sporting activity levels at the final follow-up. In radiographic parameters, the weight-bearing line ratio was considered loss of correction in the post-operative period leading to the final follow-up. Patients who completely returned to sports and maintained sporting activity levels at the final follow-up had significantly higher the Knee Injury and Osteoarthritis Outcome Score pain subscale values and lower visual analogue scale of knee pain at pre-surgery and final follow-up than other patients, including those who partially returned to sports. Conclusions The proportion of patients who returned to sports after OW-HTO and were able to participate in competitions at the same activity level as before surgery was low and insufficient. Level of evidence Retrospective case series, IV

scholarly journals Accuracy of Correction and Postoperative Complications Associated with a PEEK Opening Wedge High Tibial Osteotomy Implant

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0049
Author(s):  
Derek Axibal ◽  
Christopher Joyce ◽  
Darby Houck ◽  
Stephanie Logterman ◽  
Rachel Frank ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
High Tibial Osteotomy ◽  
Senior Author ◽  
Type I ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Correction Angle ◽  
Medial Cortex ◽  
Wedge High Tibial Osteotomy

Objectives: To evaluate the accuracy of correction angle of an all-PEEK medial opening wedge high tibial osteotomy (HTO) system, as well as determine the effect of correction angle on postoperative complications. Methods: Retrospective review was performed on patients who underwent an HTO by the senior author using an all-PEEK HTO system between 2014-2018 with a >6-month follow-up were included. Measurements were performed and classifications formulated by three senior residents and the senior author. Lateral hinge fractures (LHF) were classified according to Takeuchi classification system. Bivariate statistics were performed. Results: Thirty HTOs in 27 patients were included (50% female; age, 37.8±10.8 years). Average follow-up was 16.2±10.1 months. Average post-operative radiographic valgus correction (Δ, 5.8±2.4°) was significantly less than that of the average implant correction angle (8.1±2.3°; p<0.001), indicating an overall average under-correction of 2.3±2.1°. There were 5 failures (16.7%; defined as approximately >5° loss of planned correction) that shared a common mechanism of medial cortical failure inferior to the implant. When selecting out the construct failures, the average correction accuracy of the 25 (83.3%) non-failures (1.5±1.2°) was significantly better than the 5 (16.7%) failures (6.3±1.8°; p=0.002). Four fractures (13.3%) were identified: 3 (10%) Takeuchi type I and 1 (3.3%) type III. All type I fractures were associated with >5° planned correction loss with medial cortex buckling. Overall, 9 knees (30%) experienced minor complications: neuropathy (n=1; 3.3%), deep vein thrombosis (n=2; 6.7%), and superficial infection (n=3; 10%). Conclusion: The use of an all-PEEK medial opening wedge HTO implant is a safe and effective system, with an acceptable average under-correction of 1.5° in patients not sustaining medial cortex failure. Loss of correction was associated with medial cortex failure and Takeuchi type I LHF. This is the first description of this failure mechanism (medial cortex buckling) that is specific to this implant and technique.

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

2020 ◽  
Author(s):  
Shinichiro Okimura ◽  
Atsushi Teramoto ◽  
Kota Watanabe ◽  
Satoshi Nuka ◽  
Tomoaki Kamiya ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Case Series ◽  
Internal Fixator ◽  
Radiographic Evaluation ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Case Series Study ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

AbstractWe developed a new internal fixator: a rigid T-shaped plate with locking screws and wedge-shaped spacer block for high tibial osteotomy. The purpose of the present study was to evaluate the radiographic outcome of opening-wedge high tibial osteotomy (OWHTO) using this new internal fixator. Sixty OWHTOs were performed in patients with medial compartment osteoarthritis and varus deformity (28 males and 23 females). Patients' mean age was 60.4 years. Preoperative and postoperative radiographs were obtained. The paired t-test was used to evaluate the differences over time with respect to radiographic variables. Union of the osteotomy gap was obtained in all patients, and no implant breakage was found. On anterior–posterior radiographs, a significant difference was observed (p < 0.01) between the preoperative and postoperative mean values of femorotibial angles (179.6 ± 3.2 vs. 170.6 ± 2.5 degrees), weight-bearing line ratios (23.8 ± 13.5 vs. 60.5 ± 11.5%), anatomical medial proximal tibial angles (84.8 ± 2.5 vs. 91.0 ± 2.6 degrees), and joint line coverage angles (3.6 ± 2.0 vs. 2.4 ± 1.7 degrees). On lateral radiographs, posterior tibial slopes were 11.5 ± 3.9 degrees preoperatively and 12.2 ± 4.0 degrees postoperatively (p < 0.01), and Insall–Salvati ratios were 1.04 ± 0.12 preoperatively and 1.06 ± 0.13 postoperatively (p = 0.24). Performing OWHTO using a new internal fixator with a wedge-shaped spacer achieves adequate correction of lower limb alignment without implant-related complications. This is a Level IV, case series study.

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