Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

Abstract Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.

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Changes in knee joint line orientation after high tibial osteotomy are the result of adaptation of the lower limb to the new alignment

The Knee ◽

10.1016/j.knee.2020.04.018 ◽

2020 ◽

Vol 27 (3) ◽

pp. 777-786

Author(s):

Stijn Bartholomeeusen ◽

Maxim Van den Bempt ◽

Nathalie van Beek ◽

Toon Claes ◽

Steven Claes

Keyword(s):

Knee Joint ◽

High Tibial Osteotomy ◽

Lower Limb ◽

Joint Line ◽

Line Orientation ◽

Tibial Osteotomy

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Prediction of knee joint line orientation after high tibial osteotomy

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2017.05.011 ◽

2017 ◽

Vol 9 ◽

pp. 15-16

Author(s):

Chong Bum Chang ◽

Jae-Young Park ◽

Moon Jong Chang ◽

Chan Yoon ◽

Jae-Hoon Shin ◽

...

Keyword(s):

Knee Joint ◽

High Tibial Osteotomy ◽

Joint Line ◽

Line Orientation ◽

Tibial Osteotomy

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Finite element analysis of the effect of high tibial osteotomy correction angle on articular cartilage loading

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411918770706 ◽

2018 ◽

Vol 232 (6) ◽

pp. 553-564 ◽

Cited By ~ 7

Author(s):

Zahra Trad ◽

Abdelwahed Barkaoui ◽

Moez Chafra ◽

João Manuel RS Tavares

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Stress Distribution ◽

Knee Joint ◽

High Tibial Osteotomy ◽

Lateral Compartment ◽

Medial Compartment ◽

Tibial Osteotomy ◽

Element Analysis ◽

Correction Angle

Osteoarthritis is a globally common disease that imposes a considerable ongoing health and economic burden on the socioeconomic system. As more and more biomechanical factors have been explored, malalignment of the lower limb has been found to influence the load distribution across the articular surface of the knee joint substantially. In this work, a three-dimensional finite element analysis was carried out to investigate the effect of varying the high tibial osteotomy correction angle on the stress distribution in both compartments of the human knee joint. Thereafter, determine the optimal correction angle to achieve a balanced loading between these two compartments. The developed finite element model was validated against experimental and numerical results. The findings of this work suggest that by changing the correction angle from 0° to 10° valgus, high tibial osteotomy shifted the mechanical load from the affected medial compartment to the lateral compartment with intact cartilage. The Von Mises and the shear stresses decreased in the medial compartment and increased in the lateral compartment. Moreover, a balanced stress distribution between the two compartments as well as the desired alignment were achieved under a valgus hypercorrection of 4.5° that significantly unloads the medial compartment, loads the lateral compartment and arrests the progression of osteoarthritis. After comparing the achieved results against the ones of previous studies that explored the effects of the high tibial osteotomy correction angle on either clinical outcomes or biomechanical outcomes, one can conclude that the findings of this study agree well with the related clinical data and recommendations found in the literature.

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Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy

The Journal of Knee Surgery ◽

10.1055/s-0036-1571430 ◽

2016 ◽

Vol 29 (08) ◽

pp. 649-657 ◽

Cited By ~ 14

Author(s):

Kwang-Jun Oh ◽

Young Ko ◽

Ji Bae ◽

Suk Yoon ◽

Jae Kim

Keyword(s):

Knee Joint ◽

High Tibial Osteotomy ◽

Joint Line ◽

Tibial Osteotomy ◽

Joint Line Obliquity

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Change in the weight-bearing line ratio of the ankle joint and ankle joint line orientation after knee arthroplasty and high tibial osteotomy in patients with genu varum deformity

International Orthopaedics ◽

10.1007/s00264-020-04799-0 ◽

2020 ◽

Author(s):

Jae Gyoon Kim ◽

Dong Hun Suh ◽

Gi Won Choi ◽

Bong Mo Koo ◽

Sang-Gyun Kim

Keyword(s):

High Tibial Osteotomy ◽

Ankle Joint ◽

Knee Arthroplasty ◽

Weight Bearing ◽

Joint Line ◽

Line Orientation ◽

Line Ratio ◽

Tibial Osteotomy ◽

Genu Varum

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Intraoperatively accurate limb alignment after opening wedge high tibial osteotomy can be lost by large knee joint line convergence angle during surgery

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03419-1 ◽

2020 ◽

Cited By ~ 4

Author(s):

Ken Kumagai ◽

Shunsuke Yamada ◽

Tomotaka Akamatsu ◽

Shuntaro Nejima ◽

Takehiro Ogino ◽

...

Keyword(s):

Knee Joint ◽

High Tibial Osteotomy ◽

Joint Line ◽

Tibial Osteotomy ◽

Limb Alignment ◽

Opening Wedge ◽

Convergence Angle ◽

Joint Line Convergence Angle ◽

Wedge High Tibial Osteotomy

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Radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy

SICOT-J ◽

10.1051/sicotj/2019009 ◽

2019 ◽

Vol 5 ◽

pp. 12

Author(s):

Muhammad Khurram Habib ◽

Zeeshan Ali Khan

Keyword(s):

High Tibial Osteotomy ◽

Case Series ◽

Joint Line ◽

Line Orientation ◽

Medial Compartment ◽

Tibial Osteotomy ◽

Female Ratio ◽

Osteoarthritic Knee ◽

Knee Mechanics ◽

Anatomical Outcome

Objective: To determine the radiological, functional, and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy (HTO). Design of study: Descriptive case series. Study duration and settings: The present study was a descriptive case series carried out at the Orthopedic Departments of District Head Quarter Hospital Faisalabad affiliated with Faisalabad Medical University, Faisalabad from Jan 2014 to March 2018. Methodology: This study involved 40 patients of both genders, aged between 40 and 65 years having advanced degenerative disease of knee limited to medial compartment of joint. These patients were treated by medial open wedge high tibial osteotomy (OWHTO) and outcome was evaluated after 5 years of surgery in terms of radiological knee mechanics, functional outcome scores, and arthroscopic evidence of cartilage regeneration in the medial compartment. A signed written consent was taken from every patient. Findings: There was a female predominance with a male-to-female ratio of 1:4. The mean age of the patients was 53.2 ± 6.9 years. The values of the radiographic parameters significantly changed from pre-operative condition after HTO; mechanical tibiofemoral angle [MTFA, (−8.1 ± 1.2° vs. 2.5 ± 1.2°; p-value < 0.0001)], tibial plateau inclination [TPI, (5.3 ± 1.1° vs. 3.4 ± 1.1°; p-value < 0.0001)], knee joint line orientation relative to the ground [G-KJLO, (0.3 ± 0.1° vs. 4.6 ± 1.5°; p-value < 0.0001)], and ankle joint line orientation relative to the ground [G-AJLO (8.3 ± 3.2° vs. 2.3 ± 1.7°; p-value < 0.0001)]. There was significant improvement in patient’s functional status; KOOS-ADL score (45.5 ± 7.8 vs. 73.7 ± 8.6; p-value < 0.0001), International Knee Documentation Committee (IKDC) score (42.4 ± 6.9 vs. 68.5 ± 12.7; p-value < 0.0001), International Knee Society (IKS) score (149.4 ± 11.9 vs. 179.4 ± 10.2; p-value < 0.0001), Knee Society Score [KSS, (54.2 ± 5.6 vs. 69.7 ± 12.7; p-value < 0.0001)], and Hospital for Special Surgery [HSS, (50.8 ± 3.3 vs. 64.8 ± 10.7; p-value < 0.0001)]. 42.5% patients showed excellent regeneration of femoral and 30.0% patients showed excellent regeneration of tibial cartilage in the medial compartment. Conclusion: By significantly alternating the knee biomechanics, HTO was found to unload the medial compartment leading to regeneration of the articular cartilage and significant improvement in patient’s symptoms and quality of life. It is therefore recommended in the management of patients with arthritic changes limited to medial compartment only.

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