Influence of hindfoot alignment on postoperative lower limb alignment in medial opening wedge high tibial osteotomy

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.

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Intraoperative Fluoroscopic Assessment of Limb Alignment is a Reliable Predictor for Postoperative Limb Alignment in Biplanar Medial Opening-Wedge High Tibial Osteotomy

The Journal of Arthroplasty ◽

10.1016/j.arth.2016.08.022 ◽

2017 ◽

Vol 32 (3) ◽

pp. 756-760 ◽

Cited By ~ 4

Author(s):

Ki-Mo Jang ◽

Jong-Hee Lee ◽

Il Youp Cho ◽

Bong-Kyung Park ◽

Seung-Beom Han

Keyword(s):

High Tibial Osteotomy ◽

Tibial Osteotomy ◽

Limb Alignment ◽

Opening Wedge ◽

Reliable Predictor ◽

Wedge High Tibial Osteotomy

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Intraoperatively accurate limb alignment after opening wedge high tibial osteotomy can be lost by large knee joint line convergence angle during surgery

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03419-1 ◽

2020 ◽

Cited By ~ 4

Author(s):

Ken Kumagai ◽

Shunsuke Yamada ◽

Tomotaka Akamatsu ◽

Shuntaro Nejima ◽

Takehiro Ogino ◽

...

Keyword(s):

Knee Joint ◽

High Tibial Osteotomy ◽

Joint Line ◽

Tibial Osteotomy ◽

Limb Alignment ◽

Opening Wedge ◽

Convergence Angle ◽

Joint Line Convergence Angle ◽

Wedge High Tibial Osteotomy

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Feasibility and 3D Planning of a Novel Patient-Specific Instrumentation Technique in Medial Opening-Wedge High Tibial Osteotomy

The Journal of Knee Surgery ◽

10.1055/s-0040-1710379 ◽

2020 ◽

Cited By ~ 1

Author(s):

Wouter Van Genechten ◽

Wouter Van Tilborg ◽

Maxim Van den Bempt ◽

Annemieke Van Haver ◽

Peter Verdonk

Keyword(s):

High Tibial Osteotomy ◽

Lower Limb ◽

Strong Correlation ◽

Intraoperative Complications ◽

Patient Specific ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Patient Specific Instrumentation ◽

Novel Approach ◽

Wedge High Tibial Osteotomy

AbstractA novel approach for opening-wedge high tibial osteotomy (OWHTO) with patient-specific instrumentation (PSI) was evaluated for its safety, feasibility, and accuracy. Next, the mechanical medial proximal tibial angle (mMPTA) was assessed as a potential planning angle by investigating the relation with the mechanical femorotibial angle (mFTA). Ten OWHTO cases were 3D planned using the mMPTA and operated with a customized 3D-printed wedge and cast which resembled the intended osteotomy opening. Patients were closely monitored for intraoperative and postoperative complications up to 1 year after surgery. Radiological assessment was conducted on full leg standing radiographs and supine lower limb computed tomography-scans preoperatively and 3 months after surgery. No intraoperative complications or logistical issues during PSI processing were observed. Absolute accuracy outcomes showed a correction error of 1.3° ± 1.1 mMPTA and 0.9° ± 0.6 mFTA with all osteotomies falling in (−2°; + 2°) mFTA around the target. The mMPTA and mFTA were found to have a strong correlation in both 3D (r = 0.842, p = 0.002) and 2D (r = 0.766, p = 0.01) imaging for effective correction. The study confirmed the development of a safe and feasible PSI technique in OWHTO with excellent accuracy outcomes. The strong correlation between the mMPTA and mFTA indicated that soft tissue changes after OWHTO are of minor significance to the final alignment in ligament-stable patients. Finally, the mMPTA was found to be a reliable planning angle in 3D software for obtaining the intended lower limb realignment and its use can therefore be recommended in modern OWHTO planning.

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