Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome

Abstract Purpose The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. Methods Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11–30) after MOWHTO by collecting the WOMAC score. Results Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. Conclusion This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. Level of evidence Level III.

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Biplane Medial Opening-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope more than Uniplane Osteotomy

The Journal of Knee Surgery ◽

10.1055/s-0040-1722659 ◽

2021 ◽

Author(s):

Dong Won Suh ◽

Kyung Wook Nha ◽

Seung Beom Han ◽

Kuhoang Cheong ◽

Bong Soo Kyung

Keyword(s):

High Tibial Osteotomy ◽

Tibial Slope ◽

Womac Score ◽

Clinical Results ◽

Lateral View ◽

Posterior Tibial Slope ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Posterior Tibial ◽

Wedge High Tibial Osteotomy

AbstractFew clinical studies have compared uniplane high tibial osteotomy (HTO) with biplane HTO. The study aim was to compare the radiological and clinical results of uniplane HTO and biplane HTO, especially in terms of the increase in the posterior tibial slope (PTS). Medial opening-wedge HTO patients' medical records and radiological results from a single institution were retrospectively reviewed. Pre- and postoperative serial radiographs, including the Rosenberg, lateral view, and standing anteroposterior view of the whole lower extremity, magnetic resonance imaging at postoperative day 2, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at postoperative 2 years were reviewed to evaluate radiological and clinical results, including the change in PTS. A total of 61 knees, including 34 for uniplane and 27 for biplane HTOs, were enrolled. There were no significant differences in the pre- and postoperative mechanical angles or incidences of the lateral hinge fractures, and all patients showed complete union at postoperative 2 years. The PTS was increased more in the biplane group than in the uniplane group (3.1 ± 2.6 in biplane vs. 0.8 ± 1.7 in uniplane, p < 0.05). The WOMAC scores were 72 ± 9.3 in the uniplane and 75 ± 5.8 in the biplane group (not significant). The increase in PTS was lower in uniplane medial opening HTO than in biplane HTO.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120913531 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091353 ◽

Cited By ~ 3

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.

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Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00376-5 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Shuhei Otsuki ◽

Hitoshi Wakama ◽

Kuniaki Ikeda ◽

Nobuhiro Okuno ◽

Yoshinori Okamoto ◽

...

Keyword(s):

Regression Analysis ◽

Clinical Outcome ◽

High Tibial Osteotomy ◽

Knee Extension ◽

Lysholm Score ◽

Compensatory Mechanism ◽

Tibial Osteotomy ◽

Critical Factors ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy

Abstract Purpose To evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years. Methods Our retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis. Results The preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01). Conclusion Age at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.

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