scholarly journals Coronal Alignment Correction and Maintenance of Tibial Slope in Opening-Wedge Valgus High Tibial Osteotomy Using a 4-Reference Kirschner Wire Technique: A Cadaveric Study

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092360
Author(s):  
Chaiwat Chuaychoosakoon ◽  
Wachiraphan Parinyakhup ◽  
Atichart Kwanyuang ◽  
Yada Duangnumsawang ◽  
Boonsin Tangtrakulwanich ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Coronal Alignment ◽  
Opening Wedge ◽  
Gap Opening ◽  
Alignment Correction ◽  
K Wires ◽  
Correct Angle

Background: Opening-wedge valgus high tibial osteotomy (OWHTO) is a common surgical procedure used to treat symptomatic varus femorotibial malalignment in adults. Several intraoperative methods are available to determine the correct correction alignment, but achieving the desired alignment correction is difficult. Purpose/Hypothesis: The aim of this study was to assess a 4-reference K-wire technique that is relatively easy to apply and can reliably assess actual alignment correction during surgery after determination of the desired corrective angle. We hypothesized that this technique would accurately determine the coronal correction and properly maintain the tibial slope intraoperatively during OWHTO. Study Design: Descriptive laboratory study. Methods: This study was conducted using 12 fresh-frozen cadavers; 12 randomly chosen knees were corrected 5° and 12 knees were corrected 10° by use of 2 coronal and 2 sagittal K-wires. The first and second coronal K-wires were drilled at 4 cm and 1 to 2 cm below the medial joint line toward the tibiofibular joint, respectively. The angles of these 2 coronal K-wires were measured before and after the gap was opened via a modified goniometer. The difference in the angle formed by these 2 coronal K-wires from before to after opening of the gap was the alignment correction angle. In addition, 2 sagittal K-wires were drilled parallel to each other before the gap opening above and below the osteotomy site. Ensuring that these 2 sagittal K-wires remained parallel after the gap opening confirmed that the tibial slope had been maintained. The paired t test was used to compare the desired alignment corrections and the different angles measured between the pre- and postoperative radiographic alignments. Results: The mean ± SD differences in angles between the pre- and postoperative alignments of the 5° and 10° corrections were 5.04° ± 0.68° and 10.03° ± 0.68°, respectively, indicating no statistically significant differences between pre- and postoperative alignment in both groups. As well, no significant difference was noted between the pre- and postoperative medial tibial slope ( P = .54). Conclusion: The coronal alignment correction and maintenance of the tibial slope using the 4-reference K-wire technique was found to be highly accurate and reliable. Clinical Relevance: Achieving the correct angle in OWHTO is difficult, and the 4-reference K-wire technique provides an easier and more reliable way to obtain the correct angle. This technique can be used in most hospital settings, with no need for expensive equipment.

scholarly journals Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

2016 ◽  
Vol 4 (2) ◽  
pp. 232596711663074 ◽  
Author(s):  
Hiroyasu Ogawa ◽  
Kazu Matsumoto ◽  
Takahiro Ogawa ◽  
Kentaro Takeuchi ◽  
Haruhiko Akiyama
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Posterior Tibial ◽  
Insertion Angle ◽  
Wedge High Tibial Osteotomy

Usefulness of long tibial axis to measure medial tibial slope for opening wedge high tibial osteotomy

2014 ◽  
Vol 24 (11) ◽  
pp. 3661-3667 ◽  
Author(s):  
Y. Akamatsu ◽  
M. Sotozawa ◽  
H. Kobayashi ◽  
Y. Kusayama ◽  
K. Kumagai ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Medial Tibial Slope

scholarly journals The effect of wedge and tibial slope angles on knee contact pressure and kinematics following medial opening-wedge high tibial osteotomy

2018 ◽  
Vol 51 ◽  
pp. 17-25 ◽  
Author(s):  
Marianne S. Black ◽  
Agnes G. d'Entremont ◽  
Robert G. McCormack ◽  
Gregory Hansen ◽  
Derek Carr ◽  
...  
Keyword(s):  
Contact Pressure ◽  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Knee Contact Pressure

Biplane Medial Opening-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope more than Uniplane Osteotomy

2021 ◽  
Author(s):  
Dong Won Suh ◽  
Kyung Wook Nha ◽  
Seung Beom Han ◽  
Kuhoang Cheong ◽  
Bong Soo Kyung
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Womac Score ◽  
Clinical Results ◽  
Lateral View ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy

AbstractFew clinical studies have compared uniplane high tibial osteotomy (HTO) with biplane HTO. The study aim was to compare the radiological and clinical results of uniplane HTO and biplane HTO, especially in terms of the increase in the posterior tibial slope (PTS). Medial opening-wedge HTO patients' medical records and radiological results from a single institution were retrospectively reviewed. Pre- and postoperative serial radiographs, including the Rosenberg, lateral view, and standing anteroposterior view of the whole lower extremity, magnetic resonance imaging at postoperative day 2, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at postoperative 2 years were reviewed to evaluate radiological and clinical results, including the change in PTS. A total of 61 knees, including 34 for uniplane and 27 for biplane HTOs, were enrolled. There were no significant differences in the pre- and postoperative mechanical angles or incidences of the lateral hinge fractures, and all patients showed complete union at postoperative 2 years. The PTS was increased more in the biplane group than in the uniplane group (3.1 ± 2.6 in biplane vs. 0.8 ± 1.7 in uniplane, p < 0.05). The WOMAC scores were 72 ± 9.3 in the uniplane and 75 ± 5.8 in the biplane group (not significant). The increase in PTS was lower in uniplane medial opening HTO than in biplane HTO.

The Effect of Lateral Cortex Disruption and Repair on the Stability of the Medial Opening Wedge High Tibial Osteotomy

2005 ◽  
Vol 33 (10) ◽  
pp. 1552-1557 ◽  
Author(s):  
Bruce S. Miller ◽  
William O. P. Dorsey ◽  
Cari R. Bryant ◽  
John C. Austin
Keyword(s):  
High Tibial Osteotomy ◽  
Torsional Stiffness ◽  
Osteotomy Site ◽  
Axial Stiffness ◽  
Control Group ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Lateral Cortex ◽  
Wedge High Tibial Osteotomy ◽  
Tibial Cortex

Background Medial opening wedge high tibial osteotomy is gaining popularity as a treatment option for medial compartment degenerative disease in the young, active patient. One of the potential technical pitfalls of this procedure is inadvertent disruption of the lateral tibial cortex during distraction at the osteotomy site. Purpose (1) To investigate the effect of lateral cortex disruption on stability during medial opening wedge high tibial osteotomy and (2) to evaluate 3 different methods of repair of the disrupted lateral cortex. Study Design Controlled laboratory study. Methods A total of 50 validated replicate tibias were evaluated in a medial opening wedge high tibial osteotomy model. Specimens were divided into 5 groups: (1) control, or intact lateral cortex (n = 10); (2) disrupted lateral cortex (n = 10); (3) lateral cortex repaired with 1 staple (n = 10); (4) lateral cortex repaired with 2 staples (n = 10); and (5) lateral cortex repaired with a periarticular plate and screws (n = 10). Specimens were placed in compression and torsion under physiologic loads, and stiffness and micromotion were calculated. Results Disruption of the lateral cortex resulted in a 58% reduction in axial stiffness and a 68% reduction in torsional stiffness compared to control specimens (P<. 05). Disruption of the lateral cortex also resulted in increased micromotion at the osteotomy site. All 3 methods of repair of the lateral cortex restored stiffness and micromotion values to those of the control group (P<. 05). Conclusions Instability at the osteotomy site may contribute to the high rate of delayed union or nonunion associated with medial opening wedge high tibial osteotomy. Repair of the lateral tibial cortex by each of these techniques restored stability to the osteotomy site in this replicate tibia model and might be effective in clinical use. However, more studies are needed to further explore the relationship between lateral cortex disruption and patient outcomes in the clinical setting before definitive conclusions can be drawn.

scholarly journals The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates

2018 ◽  
Vol 7 (12) ◽  
pp. 639-649 ◽  
Author(s):  
A. R. MacLeod ◽  
G. Serrancoli ◽  
B. J. Fregly ◽  
A. D. Toms ◽  
H. S. Gill
Keyword(s):  
Finite Element ◽  
Fracture Healing ◽  
High Tibial Osteotomy ◽  
Early Stage ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Industry Standard ◽  
Plate Design ◽  
Standard Plate

Objectives Opening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors – in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure. Materials and Methods A 10° opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of osteotomy gap healing simulating up to six weeks postoperatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (TomoFix). Results For both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared with the TomoFix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy. Conclusion We demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure. Cite this article: A. R. MacLeod, G. Serrancoli, B. J. Fregly, A. D. Toms, H. S. Gill. The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates: An experimental and finite element study. Bone Joint Res 2018;7:639–649. DOI: 10.1302/2046-3758.712.BJR-2018-0035.R1.

scholarly journals Clinical Experience Using a 3D-Printed Patient-Specific Instrument for Medial Opening Wedge High Tibial Osteotomy

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jesse Chieh-Szu Yang ◽  
Cheng-Fong Chen ◽  
Chu-An Luo ◽  
Ming-Chau Chang ◽  
Oscar K. Lee ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Weight Bearing ◽  
Ct Scanning ◽  
Tibial Slope ◽  
Patient Specific ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Time Saving ◽  
X Ray ◽  
Specific Instrument

Purpose. High tibial osteotomy (HTO) has been adopted as an effective surgery for medial degeneration of the osteoarthritis (OA) knee. However, satisfactory outcomes necessitate the precise creation and distraction of osteotomized wedges and the use of intraoperative X-ray images to continually monitor the wedge-related manipulation. Thus HTO is highly technique-demanding and has a high radiation exposure. We report a patient-specific instrument (PSI) guide for the precise creation and distraction of HTO wedge. Methods. This study first parameterized five HTO procedures to serve as a design rationale for an innovative PSI guide. Preoperative X-ray and computed tomography- (CT-) scanning images were used to design and fabricate PSI guides for clinical use. The weight-bearing line (WBL) of the ten patients was shifted to the Fujisawa’s point and instrumented using the TomoFix system. The radiological results of the PSI-guided HTO surgery were evaluated by the WBL percentage and tibial slope. Results. All patients consistently showed an increased range of motion and a decrease in pain and discomfort at about three-month follow-up. This study demonstrates the satisfactory accuracy of the WBL adjustment and tibial slope maintenance after HTO with PSI guide. For all patients, the average pre- and postoperative WBL are, respectively, 14.2% and 60.2%, while the tibial slopes are 9.9 and 10.1 degrees. The standard deviations are 2.78 and 0.36, respectively, in postoperative WBL and tibial slope. The relative errors of the pre- and postoperative WBL percentage and tibial slope averaged 4.9% and 4.1%, respectively. Conclusion. Instead of using navigator systems, this study integrated 2D and 3D preoperative planning to create a PSI guide that could most likely render the outcomes close to the planning. The PSI guide is a precise procedure that is time-saving, radiation-reducing, and relatively easy to use. Precise osteotomy and good short-term results were achieved with the PSI guide.

Sign in / Sign up

Export Citation Format

Share Document