scholarly journals Rotational Changes in the Distal Tibial Fragment Relative to the Proximal Tibial Fragment at the Osteotomy Site after Open-Wedge High-Tibial Osteotomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Takahiro Sasaki ◽  
Yasushi Akamatsu ◽  
Hideo Kobayashi ◽  
Shota Mitsuhashi ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Distal Tibia ◽  
Osteotomy Site ◽  
Tibial Rotation ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Rotational Angle ◽  
Correction Angle ◽  
Wedge High Tibial Osteotomy ◽  
Flange Angle

The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of 2.9 ° ± 4.8 ° . There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle ( r = 0.42 , p < 0.05 ). Additionally, the rotational angle correlated with the flange angle ( r = − 0.41 , p < 0.05 ).

scholarly journals Does the correction angle affect hidden blood loss in HTO?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zheng Li ◽  
Yannong Wang ◽  
Guanglei Cao ◽  
Shuai An ◽  
Mingli Feng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Blood Loss ◽  
High Tibial Osteotomy ◽  
Total Blood Loss ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Total Blood ◽  
Correction Angle ◽  
Hidden Blood Loss ◽  
Wedge High Tibial Osteotomy

Abstract Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

No correction angle loss with stable plates in open-wedge high tibial osteotomy

2014 ◽  
Vol 23 (7) ◽  
pp. 1999-2006 ◽  
Author(s):  
Min Kyu Kim ◽  
Jeong Ku Ha ◽  
Dhong Won Lee ◽  
Sang Wook Nam ◽  
Jin Goo Kim ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Correction Angle ◽  
Wedge High Tibial Osteotomy

scholarly journals Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junya Itou ◽  
Umito Kuwashima ◽  
Masafumi Itoh ◽  
Koichi Kuroda ◽  
Yasuharu Yokoyama ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
High Tibial Osteotomy ◽  
Locking Plate ◽  
Fixation Method ◽  
Osteotomy Site ◽  
Osteoporotic Bone ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Distal Fixation

Abstract Background The neurovascular bundle containing the deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy (OWHTO), particularly due to drilling for bicortical fixation at distal screw holes. Therefore, monocortical fixation is recommended for distal fixation of a long locking plate as long as good stability is ensured. The purpose of this study was to analyse the biomechanical properties of monocortical fixation of distal locking screws for OWHTO. Methods Three-dimensional models of bone and fixation materials simulating OWHTO were created using computed tomographic data of patients and material data of a T-shaped long locking plate and screws. Three of the four distal screws of the locking plate were chosen for a bicortical fixation or monocortical fixation procedure. In addition, loss of correction was assessed by measuring the medial proximal tibial angle (MPTA) in patients who underwent OWHTO with two bicortical and two monocortical distal fixation screws at 1 month and 1 year after surgery. Results No significant differences in stress were observed in either the normal or osteoporotic bone model between the monocortical and bicortical fixation models, including in the area of the lateral hinge at the osteotomy site. Furthermore, there were no significant differences in MPTA between the early post-operative period and 1-year follow-up. Conclusions The monocortical fixation method for three distal screws of the locking plate did not worsen the mechanical properties of fixation for OWHTO using a long locking plate with four proximal and four distal screws. In actual surgery, the number of distal bicortical screws should be reduced based on the patient’s condition, taking into account the risk of lateral hinge fracture and unexpected surgical complications. Using at least two bicortical screws would be practical considering the various factors related to reduced fixing ability.

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.

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.

Unintended Rotational Changes of the Distal Tibia After Biplane Medial Open-Wedge High Tibial Osteotomy

2016 ◽  
Vol 31 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Ki-Mo Jang ◽  
Jong-Hee Lee ◽  
Hyung-Jun Park ◽  
Jeong Lae Kim ◽  
Seung-Beom Han
Keyword(s):  
High Tibial Osteotomy ◽  
Distal Tibia ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals In vivo Histological Examination of the Graft Site 3 Years after Open-wedge High Tibial Osteotomy with Nanohydroxyapatite Augmentation

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Giorgio Princi ◽  
Marco Rossini ◽  
Fabio Marzilli ◽  
Riccardo Di Niccolo ◽  
Fabio Conteduca ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Histological Examination ◽  
Bone Substitute ◽  
Bone Biopsy ◽  
Osteotomy Site ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Introduction:The open-wedge high tibial osteotomy (OWHTO) is a common technique for the treatment of medial compartmental osteoarthritis of the knee. There are many options to fill the osteotomy site gap. The autologous graft donor site morbidity can be avoided using heterologous bone grafts which represent a valid alternative. Case Presentation:This case report is about a 52-year-old male with knee osteoarthritis and varus deformity. Due to stiffness, swelling, and painful limitation during daily life activities, the patient underwent OWHTO. The osteotomy gap was filled with an equine cancellous bone wedge and nanohydroxyapatite (NHA) bone paste augmentation. After 3 years, the OWTHO was converted to total knee arthroplasty and a bone biopsy of the previous graft site was performed. The histological examination presented non-viable bone areas surrounded by viable bone without inflammatory cells, suggesting the presence of residual non-viable bone from the bone substitute graft. Conclusion:The in vivo histology of the graft site after 3 years has shown that heterologous bone is a safe and valid choice as a scaffold for bone regeneration. Augmentation with NHA bone paste achieved good osteoinduction without an inflammatory reaction and good integration of the bone substitute insert. Keywords: High tibial osteotomy, histology, heterograft.

scholarly journals Association of Gap Healing With Angle of Correction After Opening-Wedge High Tibial Osteotomy Without Bone Grafting

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110022
Author(s):  
Hyung Jun Park ◽  
Seung-Baik Kang ◽  
Moon Jong Chang ◽  
Chong Bum Chang ◽  
Woon Hwa Jung ◽  
...  
Keyword(s):  
Bone Graft ◽  
High Tibial Osteotomy ◽  
Bone Grafting ◽  
Locking Plate ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Plate Removal ◽  
Correction Angle ◽  
Wedge High Tibial Osteotomy

Background: Studies have reported that opening wedge high tibial osteotomy (OWHTO) without bone grafting has outcomes that are similar to or even better than those of OWHTO with bone grafting, especially after use of a locking plate. However, a consensus on managing the gap after OWHTO has not been established. Purpose: To determine the degree of gap healing achieved without bone grafting, the factors associated with gap healing, and whether additional gap healing would be obtained after plate removal. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 73 patients who underwent OWHTO without bone grafting between 2015 and 2018. Patients in the study were divided into 2 groups based on the correction angle: small correction group (<10°; SC group) and large correction group (≥10°; LC group). The locking plate used in OWHTO was removed at a mean of 13.5 months after surgery in 65 patients. Radiographic indexes were measured: gap filling height, gap vacancy ratio (GVR), and osteotomy filling index. The acceptable gap healing was defined as an osteotomy filling index ≥3. The factors related to gap healing around the osteotomy site were selected after multicollinearity analysis. Results: Although both groups achieved acceptable gap healing regardless of the correction angle, the SC group showed higher and earlier gap healing than did the LC group (gap healing rate 81.4% in the SC group vs 41.7% in the LC group at 3 months postoperatively). The GVR was 8.6% in the SC group and 15.3% in the LC group at 12 months after surgery ( P = .005). Both the amount of time that elapsed after surgery and the correction angle were associated with gap healing ( P < .05). Additional gap healing was observed after plate removal, as the GVR decreased 2.7% more in the patients with plate removal than in patients who did not have plate removal ( P = .012). Conclusion: All patients achieved acceptable gap healing without bone graft. The degree of gap healing was higher in the SC group and increased over time. Gap healing was promoted after plate removal. Considering the results of this study, a bone graft is not necessary in routine OWHTO in terms of gap healing.

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