scholarly journals Effect of the amount of correction on posterior tibial slope and patellar height in open-wedge high tibial osteotomy

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110495
Author(s):  
Keliang Wu ◽  
Jianchun Zeng ◽  
Linjing Han ◽  
Wenjun Feng ◽  
Xiaosheng Lin ◽  
...  
Keyword(s):  
Tibial Slope ◽  
Lysholm Score ◽  
Patellar Height ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Open Wedge ◽  
Correction Angle ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy ◽  
Lca Group

Objectives: To evaluate the effect of amount of correction on postoperative changes in PTS (posterior tibial slope), PH (patellar height), and clinical outcomes following biplanar OWHTO (open-wedge high tibial osteotomy). Method: This study included 79 knees (32 left and 47 right) of 79 patients (mean age 60.28 ± 4.2 years, 24 males, 55 females) with varus malalignment and symptomatic isolated medial joint osteoarthritis who underwent OWHTO. According to the amount of correction angles, all patients were divided into three groups: LCA (large correction angle) group (>14°), MCA (medium correction angle) group (10°–14°), and SCA (small correction angle) group (<10°). All patients were clinically assessed according to the Lysholm score, HSS (hospital for special surgery knee score), and KSS (knee society score) prior to and after surgery. For radiographic analysis, we measured the PTS, PH [ISI (Insall-Salvati index), and BPI (Blackburne-Peel index)]. The pre-post difference of PTS, ISI, and BPI was calculated by subtracting the post-OWHTO value to the pre-OWHTO value in three groups, respectively. The preoperative, postoperative, and difference of PTS, ISI, and BPI values were analyzed according to the correction angle. The mean follow-up period was 28.5 months (SD, 4.9; range 18–52 months). Results: Radiologically, PTS increased and PH decreased after surgery on the whole ( p < .05). The relationship between amount of correction and slope increase is significant ( p < .001). Furthermore, the pairwise difference between the LCA group and SCA group and MCA group is significant respectively ( p < .05). In terms of PH, the LCA group yielded ISI and BPI that were significantly different from baseline for the SCA group and MCA group. In addition, the pairwise difference between the SCA group and LCA group in ISI and BPI is significant ( p = .031). Clinically, significant improvements were observed in postoperative clinical scores of the Lysholm score, HSS, and KSS ( p < .05). Seventy-four patients (93.67%) reported satisfaction with surgery. However, no correlation was found between changes in PTS and PH with postoperative knee score. No severe adverse complications were observed. Conclusions: The amount of correction angle is a significant factor affecting the PTS and PH in OWHTO. With increased correction angle, the likelihood of increasing the PTS and decreasing the PH increases. Special attention should be paid to keep PTS and PH unchanged in cases where large corrections are required. Otherwise, closing wedge osteotomy or other intraoperative effective measures are supposed to be adopted.

scholarly journals Effect of the Amount of Correction on Posterior Tibial Slope and Patellar Height in Open-wedge High Tibial Osteotomy

2020 ◽  
Author(s):  
keliang wu ◽  
jianchun zeng ◽  
ke jie ◽  
wenjun feng ◽  
xiaosheng lin ◽  
...  
Keyword(s):  
Tibial Slope ◽  
Lysholm Score ◽  
Patellar Height ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Open Wedge ◽  
Correction Angle ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy ◽  
Lca Group

Abstract Objectives The effect of amount of correction on postoperative changes in the posterior tibial slope (PTS), patellar height (PH) and clinical outcomes following biplanar open-wedge high tibial osteotomy (OWHTO) were evaluated. Method This study included 64 knees (30 left, 34 right) of 64 patients (mean age 48.5±6.8 years, 20 males, 44 females) with varus malalignment and symptomatic isolated medial joint osteoarthritis who underwent OWHTO. According to the amount of correction angles, all patients were divided into three groups: large correction angle (LCA) group (>14°), medium correction angle (MCA) group（10°～14°）and small correction angle (SCA) group (<10°). All patients were clinically assessed according to the Lysholm score, hospital for special surgery knee score (HSS), and knee society score (KSS) prior to and after surgery. For radiographic analysis, we measured the PTS，PH [Insall-Salvati index (ISI), Blackbume-Peel index (BPI)]. The pre-post difference of PTS, ISI and BPI was calculated by subtracting the post-OWHTO value to the pre-OWHTO value in three groups respectively. The preoperative, postoperative, and difference of PTS, ISI and BPI values were analyzed according to the correction angle. The mean follow-up period was 27.7 months(SD, 3.9; range 12-49 months). Results Radiologically, PTS increased and PH decreased after surgery on the whole ( p ＜0.05). The relationship between amount of correction and slope increasing is significant ( p ＜0.001). Furthermore, the pairwise difference between the LCA group and SCA group, MCA group are significant respectively ( p ＜0.05). In terms of PH, the LCA group yielded ISI and BPI that were significantly different from baseline for SCA group and MCA group. In addition, the pairwise difference between the SCA group and LCA group in ISI and BPI are significant ( p =0.031). Clinically, significant improvements were observed in postoperative clinical scores of the Lysholm score, HSS, and KSS ( p <0.05). Fifty-nine patients (92.2%) reported satisfaction with surgery. However, no correlation was found between changes in PTS and PH with postoperative knee score. No severe adverse complications were observed. Conclusions The amount of correction angle is a significant factor affecting the PTS and PH in OWHTO. With increased correction angle, the likelihood of increasing the PTS and decreasing the PH increases. Special attention should be paid to keep PTS and PH unchanged in cases where large corrections are required. Otherwise, closing wedge osteotomy or other intraoperative effective measures are supposed to be adopted.

Control of Posterior Tibial Slope and Patellar Height in Open-Wedge Valgus High Tibial Osteotomy

2011 ◽  
Vol 39 (4) ◽  
pp. 851-856 ◽  
Author(s):  
Stefan Hinterwimmer ◽  
Knut Beitzel ◽  
Jochen Paul ◽  
Chlodwig Kirchhoff ◽  
Martin Sauerschnig ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Patellar Height ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Posterior Tibial

The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy

2017 ◽  
Vol 26 (6) ◽  
pp. 1851-1858 ◽  
Author(s):  
Ho-Seung Jo ◽  
Jin-Sung Park ◽  
June-Ho Byun ◽  
Young-Bok Lee ◽  
Young-Lac Choi ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy

scholarly journals Is it possible to avoid posterior tibial slope increase in open-wedge high tibial osteotomy?

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0005
Author(s):  
Hüseyin Kaya ◽  
Elcil Kayabiçer ◽  
Ali Engin Daştan ◽  
Emin Taşkıran
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Statistical Analyses ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
X Rays ◽  
Open Wedge ◽  
P Values ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy

Aim: Posterior tibial slope has shown to be increased with open-wedge high tibial osteotomy (OWHTO) which may lead to an increase in loading of the anterior cruciate ligament and causing patellofemoral problems in return. In this case series, patients with an OWHTO performed posteromedial to the medial collateral ligament (MCL), keeping it intact was investigated. The aim of this study was to evaluate the influence of this technique on the posterior tibial slope. Methods: Thirty knees (15 right, 15 left) of 28 patients (22 women, 6 men) with a mean age of 53.57±5.9 years who had an OWHTO between January 2014 and February 2016 were included in this study. Surgical technique: A proximal tibial osteotomy is performed posteromedial to MCL keeping it intact. Following the osteotomy, distraction is also performed from the posteromedial aspect of tibia. Fixation is achieved utilizing TomoFix plate. Radiological evaluation: Preoperative and postoperative mechanical axes (MA) were measured on standard weight bearing long axis x-rays. Preoperative and postoperative posterior tibial slope angles were measured on lateral x-rays using three different Methods: the angles between medial tibial plateau and (1) posterior tibial cortex, (2) tibial proximal anatomical axis, and (3) posterior fibular cortex were measured. The correlations of three different measurement methods were analyzed. Patients were grouped according to preoperative MA deviations and postoperative MA changes (either <10º or >=10º). The posterior tibial slope changes were compared between groups. Statistical analyses: All statistical analyses were performed utilizing SPSS 18.0. Results: Mean preoperative and postoperative MA deviations were 9.81°±4.94° and -2.72°± 2.69° respectively. The mean correction angle of MA of lower extremity was 12.62°±4.58°. The three methods used to measure the posterior tibial slope angles were found to be highly correlated with each other ((1) and (2) r=0.961; (1) and (3) 0.906; (2) and (3) 0.934; p values <0.0001). Preoperative mean posterior tibial slope angles were 9.50º±4.47°, 11.51º± 4.50°, and 10.80º±4.58°; postoperative angles were 6.10º±4.23°, 8.78º±4.57° and 8.11º±4.55°, respectively. Posterior tibial slope angle was significantly decreased postoperatively with respect to all three methods (p <0.0001). The changes in the posterior tibial slope was not statistically significant between the groups with preoperative <10º and >=10º deformities (p values 0.861, 0.723, 0.727, respectively). Conclusions: Posterior tibial slope was found to be decreased with this posteromedial OWHTO technique. This technique offered the advantage of preserving the posterior tibial slopes postoperatively even in highly deformed knees which necessitated higher degrees of corrections in the mechanical axes.

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