Low rates of serious complications but high rates of hardware removal after high tibial osteotomy with Tomofix locking plate

Abstract Background The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO. Methods Three-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery. Results No significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site. Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up. Conclusions The monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient’s condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.

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Critical comments to the publication “Hevesi M, Macalena JA, Wu IT, Camp CL, Levy BA, Arendt EA, et al. (2018) High tibial osteotomy with modern PEEK implants is safe and leads to lower hardware removal rates when compared to conventional metal fixation: a multi-center comparison study. Knee Surgery, Sports Traumatology, Arthroscopy 1–11”

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05549-5 ◽

2019 ◽

Vol 28 (2) ◽

pp. 662-663

Author(s):

Marc-Daniel Ahrend ◽

Steffen Schröter

Keyword(s):

High Tibial Osteotomy ◽

Knee Surgery ◽

Hardware Removal ◽

Tibial Osteotomy ◽

Comparison Study ◽

Removal Rates ◽

Sports Traumatology

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High Tibial Osteotomy Performed With All-PEEK Implants Demonstrates Similar Outcomes but Less Hardware Removal at Minimum 2-Year Follow-up Compared With Metal Plates

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117749584 ◽

2018 ◽

Vol 6 (3) ◽

pp. 232596711774958 ◽

Cited By ~ 9

Author(s):

Troy A. Roberson ◽

Amit M. Momaya ◽

Kyle Adams ◽

Catherine D. Long ◽

John M. Tokish ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Patient Outcomes ◽

Metal Plate ◽

Activity Level ◽

Hardware Removal ◽

Control Group ◽

Tibial Osteotomy ◽

Metal Plates ◽

Chi Square Analysis

Background: High tibial osteotomy (HTO) is a valuable treatment option in the high-demand patient with chondral damage and an altered mechanical axis. Traditional opening wedge HTO performed with metal plates has several limitations, including hardware irritation, obscuration of detail on magnetic resonance imaging, and complexity of revision surgery. Recently, an all-polyetheretherketone (PEEK) HTO implant was introduced, but no studies to date have evaluated the performance of this implant with minimum 2-year outcomes compared with a traditional metal plate. Purpose: To compare patient outcomes and complications of HTO performed using a traditional metal plate with those performed using an all-PEEK implant. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent HTO by a single surgeon with a minimum 2-year follow-up over a 4-year period were identified. Medical records were reviewed for patient demographics, concomitant procedures, implant used, type and degree of correction, complications, reoperations, and failures. Recorded patient outcomes included EuroQol–5 dimensions (EQ-5D), resiliency, Single Assessment Numeric Evaluation (SANE), Tegner activity level scale, International Knee Documentation Committee (IKDC), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. HTO performed using a traditional metal plate served as the control group. Statistical analysis was performed using the Student t test for continuous variables and chi-square analysis for nonparametric data, with P < .05 considered significant. Results: A total of 41 patients (21 in the all-PEEK group, 20 in the control group) were identified with greater than 2-year follow-up. The mean patient age was 44 years, and there were no differences between the groups with regard to demographics, degree of correction, or concomitant procedures. In addition, no significant differences were found for any of the patient-reported outcomes. Complications (10% vs 15%, respectively; P = .59), failures (10% vs 5%, respectively; P = .58), and reoperations (10% vs 30%, respectively; P = .10) were similar for the all-PEEK and control groups. However, the all-PEEK group did not have any hardware removal, while 4 patients in the control group underwent hardware removal ( P = .03). Conclusion: This study suggests that an all-PEEK implant may be safely used with comparable outcomes and complication rates to the traditional method but with less need for hardware removal.

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Biomechanical study of optimum anchorage in dome-shaped high tibial osteotomy

Journal of Orthopaedic Surgery ◽

10.1177/2309499018792406 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901879240

Author(s):

Toshiaki Takahashi ◽

Manabu Takahashi ◽

Haruyasu Yamamoto ◽

Hiromasa Miura

Keyword(s):

Cyclic Loading ◽

High Tibial Osteotomy ◽

Locking Plate ◽

Lower Leg ◽

Biomechanical Study ◽

Osteotomy Site ◽

Tibial Osteotomy ◽

Maximum Displacement ◽

Correction Angle ◽

Biomechanical Strength

Purpose: There has been no report to date on any biomechanical study regarding the strength of fixation at the osteotomy site in dome-shaped high tibial osteotomy (HTO). In this study, we evaluated the biomechanical strength of a spacer that we improved and determined the medial site of HTO. Methods: HTO correction angles of 15° and 20° were used in all experiments, which were performed on lower leg specimens from pigs ( n = 12). The osteotomy site was fixed by a locking plate and screws with a spacer. Compression (600 N/min until 1100 N) and extended cyclic loading (200 cycles at 1000–2000 N) were performed to compare initial displacements in HTO specimens with and without spacers. Results: The reduction ratios of displacement with and without spacers at HTO correction angles of 15° and 20° were 37% and 27%, respectively. No effect of the spacer at the correction angle of 15° was observed in the cyclic loading; however, the maximum displacement and amplitude were reduced with the spacer at the correction angle of 20°. Conclusions and clinical relevance: When the HTO correction angle is small, the effect of the spacer is uncertain. However, the spacer is effective at an HTO correction angle of 20°.

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