Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial osteotomy

Abstract Background Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO. Methods The study cohort consisted of 30 patients (15 men and 15 women) who underwent hybrid CWHTO for medial compartment osteoarthritis or spontaneous osteonecrosis of the knee. Sixteen knees were fixed with a lateral locking plate (LP group), and 17 were fixed with both a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia (LPS group). The times to bone union, radiolucency, and callus formation at the osteotomy site were evaluated radiographically. Results The mean postoperative time to radiographic confirmation of bone union was 5.5 ± 2.6 months in the LP group and 3.4 ± 1.5 months in the LPS group. Radiolucency at the osteotomy site and excess callus formation on the posterior side of the tibia were lower in the LPS group than in the LP group. Conclusions This modified hybrid CWHTO combining a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia improves the stability of the osteotomy site and shortens the period of bone union.

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Interlocking Closed-Wedge High Tibial Osteotomy Modified With Oblique Osteotomy Lines and a Locking Plate Fixation

Arthroscopy Techniques ◽

10.1016/j.eats.2020.12.005 ◽

2021 ◽

Vol 10 (4) ◽

pp. e1061-e1066

Author(s):

Ken Okazaki

Keyword(s):

High Tibial Osteotomy ◽

Locking Plate ◽

Plate Fixation ◽

Tibial Osteotomy ◽

Locking Plate Fixation ◽

Oblique Osteotomy ◽

Closed Wedge ◽

Wedge High Tibial Osteotomy

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03999-y ◽

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.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211002289 ◽

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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