scholarly journals Intra- and Extra-Articular Deformity of Lower Limb: Tibial Condylar Valgus Osteotomy (TCVO) and Distal Tibial Oblique Osteotomy (DTOO) for Reconstruction of Joint Congruency

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Y. Watanabe ◽  
N. Takenaka ◽  
K. Kinugasa ◽  
T. Matsushita ◽  
T. Teramoto
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Mechanical Axis ◽  
Distal Tibia ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Valgus Osteotomy ◽  
Joint Congruency ◽  
Oblique Osteotomy ◽  
Tibial Condylar Valgus Osteotomy

Osteotomies are the established surgical procedure for the deformity of the lower limb induced by osteoarthritis (OA) of the knee and ankle. Closed-wedge (CW) and open-wedge (OW) high tibial osteotomy (HTO) are extra-articular surgery, which aim to shift the mechanical axis from medial to slightly lateral and reduce the overload in the medial compartment of the varus deformed knee by extra-articular correction. However, varus deformity of the knee with the teeter effect, which could be accompanied with subluxation and thrust due to the medial-lateral soft tissue imbalance, is not resolved only by the shift of mechanical axis. The depression of the medial tibia plateau, so-called pagoda deformity, is the intra-articular deformity, which could potentially cause the teeter effect and involves intra-articular incongruency. In such case, the osteotomy with novel concept should be developed to overcome the issues, both the imbalance of soft tissue and intra-articular deformity. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy, which improves the joint congruency of the medial-compartment knee OA with subluxation and/or intra-articular deformity and also provides better joint stability. A similar argument is raised in the treatment of the ankle OA. Low tibial osteotomy (LTO) is an extra-articular surgery to correct malalignment of lower leg. Distal tibial oblique osteotomy (DTOO) is a novel surgery to improve the bony congruency of the ankle OA. In DTOO, the distal tibia is cut obliquely from the proximal medial to the distal lateral in the coronal plane and towards the center of the tibiofibular joint to improve the bony congruency of the ankle joint. Tibial condylar valgus osteotomy (TCVO) and distal tibial oblique osteotomy (DTOO) can correct intra-articular deformity of knee and ankle, respectively. The rationale and indication of TCVO and DTOO for the treatment of the lower limb by reconstructing the joint congruency are discussed.

scholarly journals Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Peizhao Wang ◽  
Xiao Wang ◽  
Xiaotao Shi ◽  
Honglue Tan
Keyword(s):  
Lower Limb ◽  
Preoperative Planning ◽  
Mechanical Axis ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Medial Knee ◽  
Knee Oa ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

Objective. The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods. Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results. The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02 % to a postoperative value of 56.19 ± 0.10 % from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08 % at the final follow-up ( P < 0.01 ). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values ( P > 0.05 ). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63 ° to a postoperative week-one valgus of 2.37 ± 0.28 ° , and it had a valgus of 2.48 ± 0.39 ° at the final follow-up ( P < 0.01 ). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26 ° ( P > 0.05 ). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53 ° and 90.33 ± 1.52 ° , respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72 ° and the intraoperative setting value of 90.25 ± 1.67 ° ( P > 0.05 ). All corrected values were within the acceptable range of preoperative planning. Conclusion. Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.

scholarly journals Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Takashi Higuchi ◽  
Hironobu Koseki ◽  
Akihiko Yonekura ◽  
Ko Chiba ◽  
Yusuke Nakazoe ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Valgus Osteotomy ◽  
Radiological Features ◽  
Tibial Condylar Valgus Osteotomy

Novel Double Osteotomy Technique of Distal Tibia for Correction of Asymmetric Varus Osteoarthritic Ankle

2017 ◽  
Vol 38 (9) ◽  
pp. 970-981 ◽  
Author(s):  
Beat Hintermann ◽  
Roxa Ruiz ◽  
Alexej Barg
Keyword(s):  
Perioperative Complications ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Tibiotalar Joint ◽  
Joint Congruency ◽  
Supramalleolar Osteotomy ◽  
Double Osteotomy

Background: A most challenging condition for balancing a varus arthritic ankle is the presence of a defect in the medial tibial plafond. After our initial results with a medial tibial plafondplasty did not fulfill our expectations of success, we hypothesized that adding a correcting supramalleolar osteotomy of the distal tibia would move the loading force to the tibiotalar joint more medially and move the center of rotation of the talus more laterally. In this study, we analyzed midterm clinical and radiographic outcomes in patients with double tibial osteotomy. Methods: Between January 2005 and February 2010, 20 patients were treated with a medial tibial plafondplasty and a medial supramalleolar osteotomy of the distal tibia. The mean age of the patients was 44 ± 12 years (range, 17-60 years). Follow-up averaged 5.9 ± 2.1 years (range, 4-11.2 years). Weight-bearing radiographs were used to assess osteotomy union and hindfoot alignment. Results: There were no intraoperative or perioperative complications. The average VAS pain score decreased significantly from 7.9 ± 1.3 (range, 6-10) to 1.3 ± 1.6 (range, 0-7). The average AOFAS hindfoot score increased significantly from 49 ± 15 points (range, 36-68) preoperatively to 86 ± 12 points (range, 66-96) postoperatively. The varus tilt improved significantly from 19.4° ± 8.2° (range, 6°-32°) to 6.9° ± 3.9° (range, 1°-12°). Conclusion: The novel double osteotomy was found to be an efficient and successful method to restore tibiotalar joint congruency and to normalize hindfoot alignment. Level of Evidence: Level IV, prospective cohort study.

scholarly journals Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahiro Ogino ◽  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Tomotaka Akamatsu ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Tibial Osteotomy ◽  
Mechanical Axis ◽  
Tibial Osteotomy ◽  
Axis Deviation ◽  
Open Wedge ◽  
Correction Angle ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

Abstract Background The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). Methods A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. Results CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P <  0.05), and a greater soft tissue correction than OWHTO (P <  0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P <  0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. Conclusions The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.

scholarly journals Salvage of severe knee osteoarthritis: efficacy of tibial condylar valgus osteotomy versus open wedge high tibial osteotomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiaoyu Wang ◽  
Li Shi ◽  
Rui Zhang ◽  
Wenbo Wang ◽  
Lingchi Kong ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Opening Angle ◽  
Tibial Osteotomy ◽  
Valgus Osteotomy ◽  
Open Wedge ◽  
Medial Tibial Plateau ◽  
Wedge High Tibial Osteotomy ◽  
The Mean ◽  
Hss Score ◽  
Tibial Condylar Valgus Osteotomy

Abstract Introduction To compare the clinical outcomes and the radiographic features between tibial condylar valgus osteotomy (TCVO) and open wedge high tibial osteotomy (OWHTO). New insight into the indication criteria for TCVO was also clarified for achieving satisfactory results. Materials and methods Sixty-three knees with medial-compartment osteoarthritis were retrospectively studied. Thirty-four knees with subluxated lateral joint and depression of the medial tibial plateau underwent TCVO and the rest underwent OWHTO. Among the 63 knees included, 27 knees with a pre-operative femorotibial angle (FTA) ≥ 185° were defined as severe varus (subgroup S, 15 in STCVO group and 12 in SHTO group). Lower limb alignment, intra-, and extra-articular congruency were evaluated according to the radiograph obtained before and 24 months after surgery. The visual analog scale (VAS) score and Hospital for Special Surgery (HSS) score were obtained to assess the clinical results. Opening angle and distance of the opening gap in each group were measured by intra-operative fluoroscopy. Results During the 2-year follow-up period, the mean HSS score increased from 70.3 to 81.4 in HTO group and 65.9 to 87.3 in TCVO group (p < 0.05). The mean VAS score decreased from 5.9 to 2.6 and 6.0 to 2.1, respectively (p < 0.01). Pre-operative FTA was restored to 172.9° in HTO group and 171.3° in TCVO group, and percentage of mechanical axis (%MA) was improved to 59.7% and 61.2%, respectively. Joint line convergence angle (JLCA) was slightly restored and medial tibial plateau depression (MTPD) was relatively the same before and after OWHTO, while these parameters improved greatly (from 6.4° to 1.2° and − 8.0° to 5.9°, p < 0.01) in TCVO group. More undercorrected knees were observed in SHTO group than STCVO group (58.3% and 13.3%, p < 0.05). Opening angle and distance of the opening gap were larger in TCVO group (19.1° and 14.0 mm) than those in OWHTO group (9.3° and 10.1 mm, p < 0.05). Conclusion Compared to OWHTO, TCVO had priority in treating advanced knee OA with intra-articular deformity. However, TCVO had a limited capacity to correct the varus angle. Besides, TCVO might be suitable for medial-compartment OA with a pre-operative FTA ≥ 185°.

scholarly journals Computer-Assisted Navigation in High Tibial Osteotomy: A Systematic Review of the Literature

2012 ◽  
Vol 6 (1) ◽  
pp. 305-312 ◽  
Author(s):  
Natasha E Picardo ◽  
Wasim Khan ◽  
David Johnstone
Keyword(s):  
Systematic Review ◽  
Body Weight ◽  
High Tibial Osteotomy ◽  
Lower Limb ◽  
Mechanical Axis ◽  
The Body ◽  
Computer Assisted ◽  
Tibial Osteotomy ◽  
Review Of The Literature ◽  
Assisted Navigation

High tibial osteotomy (HTO) is a procedure which aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success.In this article, we systematically review the computer-assisted techniques that have been used in attempts to increase the accuracy of the surgery and improve postoperative outcomes. The results of the cadaveric and clinical studies to date are presented and the benefits and pitfalls of navigation are discussed.

INFLUENCE OF LOWER-LIMB TORSION ON LONG-TERM OUTCOMES OF TIBIAL VALGUS OSTEOTOMY FOR MEDIAL COMPARTMENT KNEE OSTEOARTHRITIS

2006 ◽  
Vol 88 (11) ◽  
pp. 2439-2447 ◽  
Author(s):  
DANIEL GOUTALLIER ◽  
STÉPHANE VAN DRIESSCHE ◽  
OLIVIER MANICOM ◽  
EDY SARI ALI ◽  
JACQUES BERNAGEAU ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Lower Limb ◽  
Medial Compartment ◽  
Valgus Osteotomy ◽  
Long Term Outcomes ◽  
Tibial Valgus

Influence of Lower-Limb Torsion on Long-Term Outcomes of Tibial Valgus Osteotomy for Medial Compartment Knee Osteoarthritis

2006 ◽  
Vol 88 (11) ◽  
pp. 2439-2447 ◽  
Author(s):  
Daniel Goutallier ◽  
Stéphane Van Driessche ◽  
Olivier Manicom ◽  
Edy Sari Ali ◽  
Jacques Bernageau ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Lower Limb ◽  
Medial Compartment ◽  
Valgus Osteotomy ◽  
Long Term Outcomes ◽  
Tibial Valgus

High Tibial Osteotomy for the Correction of Varus Knee Deformity

2017 ◽  
Vol 30 (05) ◽  
pp. 409-420 ◽  
Author(s):  
Philipp Lobenhoffer ◽  
Mauricio Kfuri
Keyword(s):  
Mechanical Axis ◽  
Young Patients ◽  
Varus Deformity ◽  
Correction Method ◽  
Medial Compartment ◽  
Unicompartmental Knee Replacement ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Opening Wedge ◽  
Unicompartmental Knee

AbstractKnee varus deformity is a condition where the mechanical axis of the lower extremity is displaced medially. As a result, the medial compartment of the knee is overloaded and is prone to degenerative changes. The mechanical compromise of the medial compartment of the knee is very disabling, especially if affecting young and active individuals. Valgus-producing high tibial osteotomies (HTOs) were designed to shift the mechanical axis laterally, transferring the load to the knee compartment which is asymptomatic. HTO is a well-accepted concept for the management of medial unicompartmental knee arthritis. Medial joint line pain associated with metaphyseal varus deformity in a young patient is the essential criteria to indicate an HTO. Symptomatic young patients who do not have a bone-on-bone pathology may be benefited from HTO since for those individuals a unicompartmental knee replacement is contraindicated. Surgical technique matters in cases of HTO. Dome, lateral closing wedge, and medial opening wedge techniques have been reported with mixed results. Recent developments in fixation techniques, namely, the development of implants with angular stability, introduced safety, and reproducibility to open wedge HTOs, which became the preferred correction method for varus deformity of the knee. This article aims to cover the indications and contraindications of HTO with a focus on the unique aspects of the biplanar open wedge tibial osteotomy.

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