HKA Angle—A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs

2020 ◽  
Author(s):  
Xu Jiang ◽  
Kai Xie ◽  
Xuequan Han ◽  
Songtao Ai ◽  
Haishan Wu ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Plateau ◽  
Preoperative Planning ◽  
Early Stage ◽  
Weight Bearing ◽  
Target Range ◽  
Tibial Osteotomy ◽  
Planning Parameter ◽  
Open Wedge Hto ◽  
Theoretical Accuracy

AbstractHigh tibial osteotomy (HTO) is a recognized treatment for early-stage medial compartment knee osteoarthritis. Preoperative planning with standing whole-leg radiographs (WLRs) is essential for ensuring optimal postoperative alignment. The primary purpose of this study is to investigate the theoretical accuracy of the wedge opening required for two different preoperative planning parameters in open-wedge HTO. The second purpose is to theoretically determine which parameter is superior. Preoperative planning for HTO was performed with standing WLRs for 39 knees with isolated medial osteoarthritis. The Miniaci preoperative planning method was applied to correct the hip-knee-ankle (HKA) angle to 3to 6 degrees of valgus and the weight-bearing line (WBL) percentage within 60 to 70% of the width of the tibial plateau. To ensure that the HKA angle was between 3 and 6 degrees of valgus, the required accuracy window for the Miniaci angle was 3.25 ± 0.03 degrees (range, 3.20–3.30°). To ensure that the WBL percentage was between 60 and 70%, the accuracy window required for the Miniaci angle was 2.35 ± 0.13 degrees (range, 2.10–2.65°). This study suggests that to correct the HKA angle and the WBL percentage within the target range on two-dimensional WLRs, the Miniaci angle must be controlled to an accuracy of ± 1.63 and ± 1.18 degrees, respectively. Theoretically, the HKA angle is highly suitable as a preoperative planning parameter for HTO with a large permissible error and a small variability in the degree of change in the Miniaci angle (ΔMiniaci).

High Tibial Osteotomy following Biologic Replacement of the Knee

2017 ◽  
Vol 30 (08) ◽  
pp. 764-768
Author(s):  
James Stannard ◽  
James Stannard
Keyword(s):  
Articular Cartilage ◽  
High Tibial Osteotomy ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Research Interest ◽  
Tibial Osteotomy ◽  
Patient Morbidity ◽  
Meniscus Transplant ◽  
Active Patients

AbstractBiologic unicondylar replacement with fresh osteoarticular allografts of the femoral condyle and tibial plateau plus a meniscus transplant provides an option for young or active patients with severe articular cartilage loss. The timing of osteotomy procedures to correct malalignment either before, concurrent, or after allograft implantation has become an area of research interest. Concurrent osteotomies and allograft transplantation have become increasingly popular due to the decreased patient morbidity from multiple surgeries that require a period of toe-touch weight bearing (TTWB) postoperatively. We discuss here our techniques for correcting malalignment, which concurrently repair major bipolar knee lesions while transplanting the meniscus. We prefer to perform a simultaneous biologic unicondylar replacement with an osteotomy, if needed. Weight bearing alignment radiographs should be obtained 6 weeks following surgery to confirm the intraoperative findings that were obtained using fluoroscopy and the alignment rod. If malalignment persists and the biologic grafts are overloaded, a staged osteotomy should be performed as soon as possible.

scholarly journals Preoperative planning using the picture archiving and communication system technique in high tibial osteotomy

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668470 ◽  
Author(s):  
Hee-June Kim ◽  
Hyun-Joo Lee ◽  
Ji-Yeon Shin ◽  
Kyeong-Hyeon Park ◽  
Seung-Gi Min ◽  
...  
Keyword(s):  
Communication System ◽  
Tibial Plateau ◽  
Weight Bearing ◽  
Clinical Results ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Open Wedge ◽  
Picture Archiving And Communication ◽  
Open Wedge Hto

Purpose: This study aimed to evaluate the accuracy of the picture archiving and communication system (PACS) method in order to select the correction angle and gap in open-wedge high tibial osteotomy (HTO) and clinical results of the patients. Material and methods: This retrospective study analyzed 27 consecutive patients (30 knees) underwent open-wedge HTO using the PACS method between April 2013 and March 2015. Full-length lower limb radiographs obtained preoperatively and at the final follow-up were used to the percentages of crossing points of the weight-bearing line and tibial plateau with respect to the medial border and mechanical femur-tibia angle. Preoperatively predicted and postoperatively measured wedge angles and gaps were compared. The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Knee Society score. Results: At the 20.5 months (12–26.5) follow-up, the weight-bearing line on the tibial plateau was corrected from 17.3% to 61.3%, and the mechanical femur-tibia angle was corrected from 7.3° varus to 3.1° valgus. No significant difference in preoperative and postoperative measured values was observed ( p = 0.440 and p = 0.505). The mean HSS score increased from 66.7 to 88.8 ( p < 0.001). The knee score and function score of Knee Society increased from 62.0 to 88.7 ( p < 0.001) and from 60.2 to 91.7 ( p < 0.001), respectively. Conclusion: In open-wedge HTO, correction of angular deformity based on the PACS method could be an accurate correction method and the good clinical results could be obtained.

Evaluation of Accuracy of a Three-Dimensional Printed Model in Open-Wedge High Tibial Osteotomy

2018 ◽  
Vol 32 (09) ◽  
pp. 841-846 ◽  
Author(s):  
Hee-June Kim ◽  
Jaeyeong Park ◽  
Kyeong-Hyeon Park ◽  
Il-Hyung Park ◽  
Jin-An Jang ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Target Angle ◽  
Wedge High Tibial Osteotomy ◽  
3D Printed ◽  
The Mean ◽  
Open Wedge Hto

AbstractThe purpose of this study was to evaluate the usefulness of a three-dimensional (3D) printed model for open-wedge high tibial osteotomy (HTO). This study retrospectively evaluated 20 patients with medial knee osteoarthritis and varus deformity. Between October 2015 and July 2016, the patients underwent open-wedge HTO using a 3D printed model. The mean age of patients was 55.2 years (range, 51–60 years). The mean preoperative mechanical femorotibial angle (mFTA) was varus 7.8 degrees (range, varus 4.7–11.6 degrees). After measuring the target angle using full-length lower limb weight-bearing radiography, the osteotomy was simulated using 3D images obtained from computed tomography (CT) with the 3D Slicer program. On the basis of the simulated osteotomy section and the target angle, the model was then designed and printed. Open-wedge HTO was then performed by applying the 3D printed model to the opening gap. The accuracy of osteotomy and the change in posterior tibial slope (PTS) angle were evaluated. The weight-bearing line on the tibial plateau was corrected from a preoperative mean of 19.5 ± 9.8% to a postoperative mean of 63.1 ± 6.1% (p < 0.001). The postoperative values were not statistically significantly different from the preoperative target points (p = 0.688). The mFTA was corrected to a postoperative mean of valgus 3.8 ± 1.4 degrees. The PTS angle showed no significant change (p = 0.256). A 3D printed model using CT may be useful for preoperative planning of open-wedge HTO. Satisfactory correction can be obtained without a change in the PTS.

Open-wedge high tibial osteotomy in patients with discoid lateral meniscus

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110173
Author(s):  
Hee-June Kim ◽  
Ji-Yeon Shin ◽  
Hyun-Joo Lee ◽  
Chul-Hee Jung ◽  
Kyeong-Hyeon Park ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Lateral Meniscus ◽  
Lateral Compartment ◽  
Clinical Results ◽  
Discoid Lateral Meniscus ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Factors Affecting ◽  
The Mean ◽  
Open Wedge Hto

Background: There are concerns about the progression of the lateral osteoarthritis (OA) should be taken into account when high tibial osteotomy (HTO) is performed in patients with discoid lateral meniscus (LM). This study evaluated the clinical results of HTO in patients with discoid LM and elucidated factors affecting the results. Methods: This study evaluated 32 female patients with varus deformity and medial OA. Patients with discoid LM (8 patients) or without discoid LM (24 patients) underwent open-wedge HTO. The mean age was 53.5 years and the mean follow-up period was 35 months. Clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), were evaluated. The progression of OA in the lateral compartment was also evaluated. Finally, we evaluated the factors affecting the clinical results and OA progression in the lateral compartment. Results: Between two groups, all clinical scores were not different (p = 0.964, 0.963, and 0.559, respectively). Three of eight patients (37.5%) in the discoid group developed OA in the lateral compartment, whereas 2 of 24 patients (8.3%) in the control group developed such; however, this was not significantly different (p = 0.085). In discoid group, patients with undercorrection has higher KS relative to patients with acceptable correction (p = 0.044). Other clinical results and OA change in the lateral compartment were not affected by evaluated factors. Conclusions: Patients who underwent open-wedge HTO showed the satisfactory clinical results and lateral OA progression regardless of the presence or absence discoid LM. However, when discoid LM was present, patients with undercorrection showed higher KS in comparison with patients with acceptable correction.

scholarly journals Arthroscopy-Assisted Computer Navigation in High Tibial Osteotomy for Varus Knee Deformity

2009 ◽  
Vol 17 (1) ◽  
pp. 51-55 ◽  
Author(s):  
WN Lo ◽  
KW Cheung ◽  
SH Yung ◽  
KH Chiu
Keyword(s):  
High Tibial Osteotomy ◽  
Computer Navigation ◽  
Mean Deviation ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Varus Knee ◽  
Knee Alignment ◽  
Knee Deformity ◽  
The Mean ◽  
Open Wedge Hto

Purpose. To assess the accuracy of knee alignment after high tibial osteotomy (HTO) for varus knee deformity using arthroscopy-assisted computer navigation. Methods. Six men and 4 women aged 47 to 53 (mean, 49) years underwent medial open wedge HTO for varus knee deformity and medial unicompartmental osteoarthritis using arthroscopy-assisted computer navigation with fluoroscopy. Patients were followed up for a mean of 23 (range, 11–32) months. Intra- and post-operative leg alignments were compared. Results. The mean postoperative coronal plane alignment was 2.7 (range, 1–4) degree valgus; the mean deviation from intra-operative computer images was one (range, 0.1–1.9) degree; 5 knees had less valgus in the postoperative radiographs than the intra-operative computer images. Conclusion. Despite being more technically demanding, time consuming, and costly, arthroscopy-assisted computer navigation is safe, accurate, and reliable for HTO.

Sign in / Sign up

Export Citation Format

Share Document