scholarly journals Opening Wedge High Tibial Osteotomy Using Tricalcium Phosphate Wedge

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Sinan Zehir ◽  
Murat Çalbıyık ◽  
Ercan Şahin ◽  
Mahmut Kalem ◽  
Murat Songür ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tricalcium Phosphate ◽  
Tibial Slope ◽  
Joint Space ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Beta Tricalcium Phosphate ◽  
One Year

Objectives: High tibial osteotomy is a standard procedure indicated for early medial sided osteoarthritis in varus knees. In this study, we present the early results of high tibial open wedge osteotomy cases using beta-tricalcium phosphate as a graft substitute and Otis-c plate. Methods: Between years 2010 and 2013, 47 cases of (34F, 13 M) medial compartmental gonarthrosis with genu varum deformity treated with high tibial osteotomy, were evaluated with at least one year follow-up, preoperatively both clinically and radiologically. Clinical evaluation involved functional assessment and pain evaluation using Lysholm and visual analog scale (VAS) scores, including knee range-of-motion. Radiological evaluation included medial joint space measurements on weight bearing knee radiographs with measurements of varus angle and posterior tibial slope. Surgical procedure included standard arthroscopy followed by medial sided opening wedge osteotomy with correction of the varus deformity using β- tricalcium phosphate graft substitute and fixation of the osteotomy site using Otis-C plate and locking screws. All patients were evaluated at the end of minimum one-year follow-up period. Results: Mean age of the patients was 56,7 (50- 65) years and mean follow-up period was 24,5 (12- 44) months. Mean duration of surgery was 47,4±10.2 minutes. No case of nonunion, delayed union, neurovascular injury or iatrogenic fracture was encountered. Two cases developed deep vein thrombosis and one case developed superficial wound infection managed successfully by local debridement with retention of implants and antibiotics. Mean duration of union was 13,4±2.7 weeks. Mean preoperative and follow-up range-of-motion were measured as 131±8.9 and 129±9.1 respectively with no statistical difference. Preoperative and follow-up VAS scores showed significant difference as 7.6±1.76 and 2.3±1.08 respectively (p=0.001). Also Lysholm scores improved significantly at the end of the follow-up period (43.23±4.01 vs. 76.3±3.7 p<0,001). Radiological evaluation revealed mean correction angle of 10.84±2.70 degrees at follow-up. Mean posterior tibial slope was measured relatively unchanged (8.6±1.70° degrees preoperatively versus 8.2±2.30° follow-up). Medial joint space width measurements showed a significant increase (pre-op 3.7±1.6 mm. versus 4.6±1.32 mm. at the follow-up (p<0.001)). Conclusion: Medial opening wedge osteotomy for treatment of early medial compartment gonarthrosis in varus knees is still a valuable option. Our short term preliminary results using beta-tricalcium phosphate wedge graft substitute and Otis-c plate-screw osteosynthesis revealed satisfactory short term clinical and radiological results with acceptable complication rates.

Clinical Outcomes of Closing- and Opening-Wedge High Tibial Osteotomy for Treatment of Anteromedial Unicompartmental Knee Osteoarthritis

2018 ◽  
Vol 32 (08) ◽  
pp. 758-763 ◽  
Author(s):  
Jiangfeng Lu ◽  
Shiyu Tang ◽  
Yanru Wang ◽  
Yao Li ◽  
Chang Liu ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Functional Outcomes ◽  
Tibial Slope ◽  
Joint Space ◽  
Posterior Tibial Slope ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Posterior Tibial

AbstractThis article compares the long-term outcomes of closing-wedge osteotomy (CWO) and opening-wedge osteotomy (OWO) in the treatment of unicompartmental medial osteoarthritis with varus deformity. This study included 79 patients who underwent high tibial osteotomy (HTO) between 2002 and 2008. Pre- and postoperative radiography and computed tomography were used to evaluate the posterior tibial slope, the patellar height, the tibiofemoral angle, and the lateral and medial tibiofemoral joint space. Pre- and postoperative severity of arthritis was assessed with the Kellgren–Lawrence grading system. Pre- and postoperative American Knee Society (AKS) score and Lysholm Knee Score (LKS) were determined to evaluate functional outcomes. The duration of follow-up was 86.1 ± 6.2 months. Postoperatively, at the most recent follow-up, there was a slight increase in the size of the medial tibiofemoral joint space after CWO and OWO, which reflected a decrease in stress on the medial compartment and manifested as a significant improvement in the AKS knee and function scores and the LKS. OWO increased the posterior tibial slope as compared with the preoperative value, while CWO reduced the posterior tibial slope. CWO and OWO for HTO resulted in similar functional outcomes. OWO was associated with patella infera and more severe patellofemoral arthritis, while CWO was associated with a greater severity of lateral tibiofemoral arthritis.

Structural allograft impaction enables fast rehabilitation in opening-wedge high tibial osteotomy: a consecutive case series with one year follow-up

2019 ◽  
Vol 28 (12) ◽  
pp. 3747-3757 ◽  
Author(s):  
Wouter Van Genechten ◽  
Maxim Van den Bempt ◽  
Wouter Van Tilborg ◽  
Stijn Bartholomeeusen ◽  
Gert Van Den Bogaert ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Consecutive Case ◽  
Opening Wedge ◽  
Structural Allograft ◽  
Wedge High Tibial Osteotomy ◽  
One Year

scholarly journals Opening-wedge high tibial osteotomy: a seven - to twelve-year study

Joints ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 006-011 ◽  
Author(s):  
Gennaro Pipino ◽  
Pier Indelli ◽  
Domenico Tigani ◽  
Giuseppe Maffei ◽  
Davide Vaccarisi
Keyword(s):  
High Tibial Osteotomy ◽  
Healing Process ◽  
Surgical Techniques ◽  
Long Term Results ◽  
Wedge Osteotomy ◽  
Consecutive Series ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

Purpose: medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory midterm results when accurate patient selection and precise surgical techniques were applied. This study was conducted to investigate the clinical and radiographic seven- to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. Methods: we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. Results: good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. Conclusions: medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid- to long-term results. Level of evidence: Level IV, therapeutic cases series.

Lateral hinge fracture delays healing of the osteotomy gap in opening wedge high tibial osteotomy with a beta-tricalcium phosphate block

The Knee ◽  
2020 ◽  
Vol 27 (1) ◽  
pp. 192-197 ◽  
Author(s):  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Shuntaro Nejima ◽  
Shuntaro Muramatsu ◽  
Yasushi Akamatsu ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tricalcium Phosphate ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Beta Tricalcium Phosphate ◽  
Wedge High Tibial Osteotomy ◽  
Hinge Fracture

Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

2021 ◽  
Vol 103-B (11) ◽  
pp. 1686-1694
Author(s):  
Hong-Yeol Yang ◽  
Woo-Kyoung Kwak ◽  
Sung Ju Kang ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Status Group ◽  
Second Look ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

scholarly journals Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Carola Pilone ◽  
Federico Verdone ◽  
Roberto Rossi ◽  
Davide Bonasia ◽  
Federica Rosso
Keyword(s):  
Prognostic Factors ◽  
Regression Model ◽  
High Tibial Osteotomy ◽  
Womac Score ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Inclusion Criteria ◽  
Opening Wedge

Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]

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