Factors related to the early outcome of medial open wedge high tibial osteotomy: coronal limb alignment affects more than cartilage degeneration state

2021 ◽  
Author(s):  
Sang-June Lee ◽  
Jae-Hwa Kim ◽  
Wonchul Choi
Keyword(s):  
High Tibial Osteotomy ◽  
Cartilage Degeneration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Limb Alignment ◽  
Early Outcome ◽  
Wedge High Tibial Osteotomy

Ankle and Hindfoot Symptoms after Medial Open Wedge High Tibial Osteotomy

2018 ◽  
Vol 32 (03) ◽  
pp. 269-273 ◽  
Author(s):  
Jason Roberts ◽  
Frederic Picard ◽  
Siddharth Shah
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Postoperative Change ◽  
Radiological Indices ◽  
Wedge High Tibial Osteotomy ◽  
The Mean ◽  
New Onset

AbstractMedial open wedge high tibial osteotomy (MOWHTO) is a commonly performed procedure for symptomatic medial compartment osteoarthritis (OA). However, little is known about its effects on ipsilateral ankle or hindfoot. The aim of our study was to determine the incidence of ankle or hindfoot problems after MOWHTO and examine its association with radiological indices. Thirty-five knees (32 patients) undergoing navigated MOWHTO were evaluated for the presence of new-onset ankle or hindfoot symptoms after surgery. Pre- and postoperative hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and tibial plafond inclination (TPI) were measured and compared on standing lower limb alignment radiographs. The mean postoperative change in HKA angle, MPTA, and TPI was 8.8°, 7.0°, and 8.4°, respectively. New-onset unexplained ankle or hindfoot symptoms were seen in 20% of the cases after surgery. Postoperative change in TPI was significantly greater in symptomatic patients as compared with asymptomatic ones (12.8° ± 4.9° vs. 8.1° ± 4.8°, p = 0.03). The odds ratio (OR) for developing ankle or hindfoot symptoms in cases with ≥ 10° change in TPI postoperatively was 10.8 (p = 0.04). Ankle or hindfoot symptoms were successfully managed with conservative treatment in all cases.

Limb Alignment After Open-wedge High Tibial Osteotomy and Its Effect on the Clinical Outcome

Orthopedics ◽  
2011 ◽  
Author(s):  
Hosam M. El-Azab ◽  
Mario Morgenstern ◽  
Philip Ahrens ◽  
Tibor Schuster ◽  
Andreas B. Imhoff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Limb Alignment ◽  
Wedge High Tibial Osteotomy

The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy

2018 ◽  
Vol 27 (8) ◽  
pp. 2410-2416 ◽  
Author(s):  
Mitsuaki Kubota ◽  
Ryuichi Ohno ◽  
Taisuke Sato ◽  
Junichiro Yamaguchi ◽  
Haruka Kaneko ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Limb Alignment ◽  
Medial Proximal Tibial Angle ◽  
Wedge High Tibial Osteotomy

scholarly journals Effect of Computer Navigation on Accuracy and Reliability of Limb Alignment Correction following Open-Wedge High Tibial Osteotomy: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Seung-Beom Han ◽  
Hyun Jung Kim ◽  
Dae-Hee Lee
Keyword(s):  
High Tibial Osteotomy ◽  
Meta Analysis ◽  
Computer Navigation ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Limb Alignment ◽  
Posterior Tibial ◽  
Alignment Correction ◽  
Wedge High Tibial Osteotomy

Background. It is unclear whether computer navigation can improve the accuracy and reliability of targeted lower limb alignment correction following open-wedge high tibial osteotomy (HTO). This meta-analysis was designed to compare the accuracy and reliability of limb alignment correction between computer navigated and conventional open-wedge HTOs. Methods. Studies that compared postoperative coronal alignment, including mechanical axis (MA) and weight bearing line (WBL) ratio, outliers of alignment correction, and change in tibial posterior slope, following open-wedge HTO performed using computer navigated and conventional methods were included. Results. Ten studies were included in the meta-analysis. The MA (0.93°; 95% confidence interval [CI]: 0.45–1.41°; P<0.001) and WBL ratio (1.5%; 95% CI: 0.03–2.98%; P=0.048) were significantly greater for computer navigated HTO than for conventional HTO. Outliers of alignment correction after surgery were significantly lower in patients who underwent computer navigated HTO than in those who underwent conventional HTO (odds ratio: 0.25; 95% CI: 0.08–0.79; P=0.02). Changes in posterior tibial slope from before to after surgery, however, were similar for the two approaches. Conclusion. Computer navigated HTO resulted in slightly more valgus postoperative alignment and effectively reduced outliers of alignment correction but had no effect on change in posterior tibial slope when compared with conventional HTO.

Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction

2020 ◽  
Vol 48 (11) ◽  
pp. 2718-2725 ◽  
Author(s):  
Sang Jun Song ◽  
Kyoung Ho Yoon ◽  
Cheol Hee Park
Keyword(s):  
High Tibial Osteotomy ◽  
Cartilage Degeneration ◽  
Pain Scale ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Factors Affecting ◽  
Correction Angle ◽  
Alignment Correction ◽  
Wedge High Tibial Osteotomy ◽  
Anterior Knee

Background: Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO). Purpose: To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO ( P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups. Results: No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group ( P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367). Conclusion: Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.

scholarly journals Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Shuhei Otsuki ◽  
Kuniaki Ikeda ◽  
Hitoshi Wakama ◽  
Nobuhiro Okuno ◽  
Yoshinori Okamoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Cartilage Degeneration ◽  
Flexion Contracture ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Progressive Degeneration ◽  
Radiographic Parameters ◽  
Wedge High Tibial Osteotomy

Abstract Purpose The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.

scholarly journals Relationship between the correction angle in medial open wedge high tibial osteotomy and the postoperative state of patellofemoral cartilage

2020 ◽  
Author(s):  
Chong-Hyuk Choi ◽  
Min Jung ◽  
Sung-Hwan Kim ◽  
Sang-Hee Kim ◽  
Tae-Hwan Yoon
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Group Versus ◽  
International Knee Documentation Committee ◽  
Cartilage Degeneration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Correction Angle ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

Abstract Background: To investigate clinical and radiologic effects of medial open wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint in relation to the correction angle by comparing changes in cartilage from before to after the surgery. Methods: A total of 124 MOWHTO cases were divided into the three groups of small, moderate, and large, depending on the correction angle. Clinical and radiologic outcomes were compared at the mean follow-up time of 38.8 months. Postoperative cartilage changes were assessed during implant removal completed at two years after MOWHTO. Results: There was no significant difference evident in most clinical outcomes measured, including Lysholm score and the Knee Injury and Osteoarthritis Outcome score subscales, with the exception of postoperative Shelbourne and Trumper score between the groups (P< 0.001). International Knee Documentation Committee scale value on radiologic evaluation did not significantly differ among the groups. A progression of cartilage degeneration was noted in 40.3% of femoral trochleas and 22.6% of patellas. Cartilage degeneration was significantly progressed in the large correction angle group versus in the other two groups. Regression analysis showed that the correction angle had a significant effect on cartilage deterioration (Trochela, P=0.009; Patella, P=0.034). Conclusion: Patellofemoral joint was more adversely affected by MOWHTO in conjunction with the requirement of a larger correction angle. Thus, cases necessitating considerable correction should be forewarned of patellofemoral joint symptoms within a relatively short time after the procedure. Keywords: medial open wedge high tibial osteotomy, osteoarthritis, patellofemoral arthritis, correction angle

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