scholarly journals Benefits of opposite screw insertion technique in medial open-wedge high tibial osteotomy: A virtual biomechanical study

2020 ◽  
Vol 20 ◽  
pp. 31-36 ◽  
Author(s):  
Jesse Chieh-Szu Yang ◽  
Cheng-Fong Chen ◽  
Oscar K. Lee
Keyword(s):  
High Tibial Osteotomy ◽  
Biomechanical Study ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Insertion Technique ◽  
Screw Insertion ◽  
Wedge High Tibial Osteotomy

scholarly journals Assessment of valgus laxity after release of the medial structure in medial open-wedge high tibial osteotomy: an in vivo biomechanical study using quantitative valgus stress radiography

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Dai Sato ◽  
Eiji Kondo ◽  
Koji Yabuuchi ◽  
Jun Onodera ◽  
Tomohiro Onodera ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Biomechanical Study ◽  
Trial Registration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Plate Removal ◽  
Wedge High Tibial Osteotomy

Abstract Background To perform medial open-wedge high tibial osteotomy (OWHTO), surgeons expose the medial-proximal tibia by releasing or cutting the superficial layer of the medial collateral ligament (sMCL). Biomechanically, the sMCL provides primary restraint against valgus forces. Therefore, any release of the sMCL can cause valgus instability of the knee joint. The purpose of this study was to assess valgus laxity after release of the medial structure of the knee during OWHTO. Methods Between 2009 and 2015, 84 consecutive patients (93 knees) who underwent OWHTO using a locking plate were enrolled in this study. All patients underwent radiological examinations before surgery, during surgery, 1 year after surgery, and after plate removal to objectively assess valgus laxity. The medial joint space (MJS) and the joint line convergence angle (JLCA) of the knee were evaluated using quantitative valgus stress radiography. Clinical evaluation was performed 2 years after surgery. Results The mean functional knee score improved significantly, from 65.5 to 91.1 points (p < 0.0001). The mechanical axis percentage shifted to pass through a point 69.7% lateral from the medial edge of the tibial plateau. The MJS and JLCA increased significantly during OWHTO surgery (11.0 mm, 7.4 °, p < 0.0001). However, no significant differences were noted in the MJS and JLCA among preoperative, 1-year postoperative periods and after plate removal. Conclusion Valgus laxity was significantly greater after release of the sMCL. However, no significant differences were noted in valgus laxity in preoperative, 1-year postoperative periods and after plate removal. Complete release of the sMCL did not cause postoperative valgus laxity after OWHTO surgery. Trial registration Trial registration number: No.012–0360.

Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study

The Knee ◽  
2008 ◽  
Vol 15 (4) ◽  
pp. 305-308 ◽  
Author(s):  
Cemal Kazımoğlu ◽  
Yaşar Akdoğan ◽  
Muhittin Şener ◽  
Ahmet Kurtulmuş ◽  
Hasan Karapınar ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Biomechanical Study ◽  
Fixation Method ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Lateral Cortex ◽  
Wedge High Tibial Osteotomy

scholarly journals A supplemental screw enhances the biomechanical stability in medial open-wedge high tibial osteotomy

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244557
Author(s):  
Jesse Chieh-Szu Yang ◽  
Philipp Lobenhoffer ◽  
Chia-Ming Chang ◽  
Cheng-Fong Chen ◽  
Hsiu-Chen Lin ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Structural Stability ◽  
Cannulated Screw ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Intact Specimen ◽  
Screw Insertion ◽  
Posterior Slope ◽  
Wedge High Tibial Osteotomy ◽  
Hinge Fracture

Background The supplemental screw technique was introduced for salvage of lateral hinge fracture in medial open-wedge high tibial osteotomy (owHTO). The efficacy of its use in protection of lateral hinge fracture and corresponding biomechanical behaviors remained unclear. The current study was aimed to clarify if a supplemental screw can provide better protection to lateral hinge in biomechanical perspective. Materials An in vitro biomechanical test was conducted. Tibial sawbones, commercial owHTO plates and a cannulated screw were utilized for preparing the intact, owHTO, and owHTO with cannulated screw insertion specimens. A “staircase” dynamic load protocol was adopted for axial compressive test with increasing load levels to determine structural strength and durability by using a material testing system, while a motion capture system was applied for determining the dynamic changes in varus angle and posterior slope of the tibia plateau with various specimen preparation conditions. Results Type II lateral hinge fracture were the major failure pattern in all specimens prepared with owHTO. The insertion of a supplemental cannulated screw in medial owHTO specimens reinforced structural stability and durability in dynamic cyclic loading tests: the compressive stiffness increased to 58.9–62.2% of an intact specimen, whereas the owHTO specimens provided only 23.7–29.2% of stiffness of an intact specimen. In view of tibial plateau alignment, the insertion of a supplemental screw improved the structural deficiency caused by owHTO, and reduced the posterior slope increase and excessive varus deformity by 81.8% and 83.2%, respectively. Conclusion The current study revealed that supplemental screw insertion is a simple and effective technique to improve the structural stability and durability in medial owHTO.

scholarly journals Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

2021 ◽  
Vol 10 (8) ◽  
pp. 1727
Author(s):  
Ta-Wei Liu ◽  
Chih-Hao Chiu ◽  
Alvin Chao-Yu Chen ◽  
Shih-Sheng Chang ◽  
Yi-Sheng Chan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Arthroscopic Surgery ◽  
Underlying Disease ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Background: Medial open wedge high tibial osteotomy (MOWHTO) is a well-established treatment for osteoarthritis of the medial tibiofemoral compartment. Surgical site infection (SSI) after MOWHTO is a devastating complication that may require further surgery. In this study, we aimed to identify the risk factors for infection after MOWHTO over 1 to 4 years of follow-up. Methods: Fifty-nine patients who underwent MOWHTO combined with knee arthroscopic surgery were included in this prospective study. Artificial bone grafts were used in all cases. Possible risk factors, including sex, age, body mass index (BMI), underlying disease, hospitalization length, correction angle, and surgery time, were recorded. Both univariate and multivariate analysis were used. Results: A total of 59 patients who underwent 61 operations were included. Eleven patients (18.0%) were reported to have SSI. Univariate analysis showed that smoking and diabetes mellitus were positively associated with SSI. Multivariate analysis showed that smoking and age were positively associated with SSI. Three patients (4.9%) were reported to suffer from deep SSI, requiring surgical debridement, all of whom were male smokers. Conclusion: Smoking, diabetes mellitus, and old age were identified to be possible risk factors of SSI after MOWHTO. These findings are common risk factors of SSI after orthopedic surgery according to the literature. Patient selection should be performed cautiously, and postoperative prognosis for MOWHTO should be carefully explained to patients who smoke.

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

2021 ◽  
pp. 036354652110021
Author(s):  
Han Gyeol Choi ◽  
Joo Sung Kim ◽  
Hyun Jin Yoo ◽  
You Sun Jung ◽  
Yong Seuk Lee
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Insufficiency Fracture ◽  
Tibial Osteotomy ◽  
Pathological Feature ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Bone Marrow Lesions ◽  
Wedge High Tibial Osteotomy

Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

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