Biomechanics of the Patello-Femoral Joint. Part II: A Study of the Effect of Simulated Femoro-Tibial Varus Deformity on the Congruity of the Patello-Femoral Compartment and Movement of the Patella

1983 ◽  
Vol 12 (1) ◽  
pp. 13-21 ◽  
Author(s):  
K Fujikawa ◽  
B B Seedhom ◽  
V Wright
Keyword(s):  
High Tibial Osteotomy ◽  
Early Stage ◽  
Varus Deformity ◽  
Lateral Side ◽  
Tibial Rotation ◽  
Tibial Osteotomy ◽  
Medial Side ◽  
The Difference ◽  
Cadaveric Knee

This paper investigates the effect of different degrees of varus deformity on the pattern of contact, congruence of the patello-femoral joint, and movement of the patella. Varus deformity of 5, 10, and 15 degrees was imposed on the same cadaveric knee specimen used in the study reported in Part I (Fujikawa, Seedhom, Wright, 1983). This was done by high tibial osteotomy and the introduction of a wooden wedge of the appropriate thickness to effect the deformity. It was found that the contact gradually shifted to the medial side of the knee, and the congruence of the patello-femoral compartment was gradually destroyed as the degree of varus deformity increased to 15 degrees, although the effect of 5 degrees of varus deformity was minimal. Clinically, contact is shifted to the lateral side of the knee with varus deformity, but this is invariably associated with lateral tibial rotation. This rotation explains the difference between the results of the varus deformity imposed on cadaveric knees and those observed clinically. It is proposed that an adverse change in the congruence of the knee will occur after a sudden correction by high tibial osteotomy, just as that occurring in the normal cadaveric knee after imposing a sudden varus deformity, and therefore it may be useful to consider performing the correction at an early stage of the deformity. The effect of the varus deformity on the movement of the patella is also described.

scholarly journals Clinical Effect of Open-wedge High Tibial Osteotomy in Treatment of Kellgren-lawrence IV Knee Osteoarthritis Associated with Varus Tibial Deformity

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Yu Sha ◽  
Lei Yan
Keyword(s):  
Postoperative Complications ◽  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Tertiary Hospital ◽  
Knee Function ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy ◽  
The Difference

Objectives: The purpose of this study is to evaluate the clinical efficacy of open-wedge high tibial osteotomy (HTO) in treatment of kellgren- lawrence IV anterior medial knee osteoarthritis with varus tibia. Methods: Between 2016 and 2018, 56 patients with kellgren -lawrence IV knee osteoarthritis associated with varus tibial deformity who underwent a medial open-wedge high tibial osteotomy at a tertiary hospital were prospectively followed up. The surgical effect and postoperative complications were observed and analyzed. Meanwhile, the hospital for special surgery (HSS) scores of knee function before operation and at the last follow-up after operation was compared. Results: The median follow up was 19.8 months (range, 18 to 24 months). At the last follow-up, there was 40 excellent cases, 14 good cases, 2 fair case and 0 poor case. There were no complications such as vascular and nerve injury, internal fixation fracture and infection. The HSS score of knee function (89.6±3.9) at the last follow-up after operation was higher than (63.2±6.4) points before operation, and the difference was statistically significant ( P ＜0.05). Conclusion: Medial opening high tibial osteotomy shows remarkable therapeutic effect for patients with knee osteoarthritis associated with varus tibial deformity, and it can effectively relief the pain of knee joint with less postoperative complications.

scholarly journals The effect of plate design and fixation type on primary stability after open wedge high tibial osteotomy

2013 ◽  
Vol 60 (4) ◽  
pp. 37-41
Author(s):  
Zeljko Stepanovic ◽  
Miroslav Zivkovic ◽  
Snezana Vulovic ◽  
Srbislav Aleksandrovic ◽  
Branko Ristic
Keyword(s):  
High Tibial Osteotomy ◽  
Primary Stability ◽  
Load Resistance ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Hybrid Fixation ◽  
Initial Stiffness ◽  
Wedge High Tibial Osteotomy ◽  
The Difference ◽  
The Stability

Background: The stability of the open wedge high tibial osteotomy is dependent on an undamaged cortical hinge and design of the plate. Aims: We evaluated the primary stability of two internal fixation devices for open wedge high tibial osteotomy. Methods: Five pairs of cadaveric tibia with 10? valgus correction were stabilized with a newly designed plate with hybrid fixation and 10 mm spacer block and with conventional T plate with 10 mm spacer block. Static axial loads were applied until ultimate failure of the construct. Results: The average load at initial failure of the new plate construct was 4757.7 N compared to 3022.43 N obtained with the T plate, (p<0.01). The difference in initial stiffness of both constructs was not significant (p=0.27). The mean ultimate load at failure of the new plate construct was 5280.6 N compared to 3635.3N obtained with the T plate, (p=0.001). Conclusion: The new plate with hybrid fixation, provides substantial load resistance but similar stiffness when compared to standard T plate.

scholarly journals Rotational Changes in the Distal Tibial Fragment Relative to the Proximal Tibial Fragment at the Osteotomy Site after Open-Wedge High-Tibial Osteotomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Takahiro Sasaki ◽  
Yasushi Akamatsu ◽  
Hideo Kobayashi ◽  
Shota Mitsuhashi ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Distal Tibia ◽  
Osteotomy Site ◽  
Tibial Rotation ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Rotational Angle ◽  
Correction Angle ◽  
Wedge High Tibial Osteotomy ◽  
Flange Angle

The present study is aimed at assessing the changes in tibial rotation at the osteotomy site after an open-wedge, high-tibial osteotomy (OWHTO) and analysing the factors that affect rotational changes in the distal tibial fragment relative to the proximal tibial fragment at the same site. This study involved 53 patients (60 knees; 16 males and 37 females) with medial osteoarthritis (OA) who underwent OWHTO and preoperative and 3-month postoperative computed tomography (CT) scans. Rotational angles of the distal tibia were measured using Stryker OrthoMap 3D by comparing preoperative and postoperative CTs. The mean rotational angle yielded an external rotation of 2.9 ° ± 4.8 ° . There were 17 knees with internal rotations, 37 knees with external rotations, and one knee with no rotation. The rotational angle significantly correlated with the resultant change in the femorotibial angle (correction angle) and the angle between the ascending and transverse osteotomy lines on the anterior osteotomised surface on which a flange was formed with the distal tibial osteotomised surface (flange angle). The flange angle affected the rotation, but it may have been affected by our surgical technique. The rotational angle did not significantly correlate with the change in the angle of the posterior tibial slope or body mass index. There were significant correlations between the rotational angle and correction angle ( r = 0.42 , p < 0.05 ). Additionally, the rotational angle correlated with the flange angle ( r = − 0.41 , p < 0.05 ).

scholarly journals Comparison of Radiological and Clinical Efficacy of Normal and Overcorrected Varus Deformity After Medial Open Wedge High Tibial Osteotomy: A Two-Year Follow-up Investigation

2021 ◽  
Author(s):  
Kui-shuai XU ◽  
Liang ZHANG ◽  
Rui SHEN ◽  
Jie SUN ◽  
Jian WANG ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
American Hospital ◽  
Special Surgery ◽  
Wedge High Tibial Osteotomy ◽  
The Difference ◽  
Hospital For Special Surgery

Abstract Objective To study the clinical efficacy of over-correction of varus deformity 2 years after Open wedge High tibial osteotomy (OWHTO), and by using radiographic indicators, the compensatory changes of the hip, patellofemoral, and ankle joints were observed。Methods Since February 2016, were retrospectively analyzed in August 2019 in our hospital during the period of treatment and included in the standard of 63 cases of patients with medial compartment osteoarthritis knee joint data, according to the postoperative measuring weight bearing line ratio（WBLR）, rectify all patients were divided into normal group, 52 cases (50% < WBLR < 67%) and excessive correct set of 11 cases (WBLR≥67% ),Measured at the end of the two groups of patients with preoperative and follow-up sessions Hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), joint line convergence Angle (JLCA), Posterior tibial slope (PTS) after evaluating the effect of postoperative lower limb power line correction, measurement of Hip abduction angle (HAA), tibial plafond inclination（TPI）, Talar inclination Angle (TIA),Carton index, Lateral patellar tilt(LPT), Lateral patellar shift (LPS), medial patellofemoral space, and lateral patellofemoral space were used to evaluate the postoperative compensatory changes of the adjacent joints in the two groups. The American Hospital for Special Surgery score（HSS）, The Western Ontario and McMaster University Osteoarthritis Index（WOMAC） for the patients with knee arthrosis before and at the last follow-up, and the incidence of complications in patients at the last follow-up。Results In the over-corrected group, the postoperative WBLR averaged (74.43±4.05) %, with 4 cases (36.36%) of postoperative complications, while in the normal corrected group, the postoperative WBLR averaged (55.76±4.88) %, with 6 cases (11.54%) of complications. The difference in postoperative complications between the two groups was statistically significant (P =0.041)。After OWHTO HKA compare two groups of patients at the end of the time, (7.39-1.61) ° for excessive correction group, (3.28-1.59) ° for normal correction group, difference was statistically significant (P = 0.000), compared two groups of patients at the end of the second MPTA, excessive correction group is (94.95 + 1.01) °, (91.1-2.87) ° for normal correction group, difference was statistically significant (P = 0.001), compared two groups of patients at the end of the time HAA, excessive correction group is (2.96 + 1.58) °, normal correction for (0.97 + 2.31) °,The difference was statistically significant (P=0.026), while the comparison of other imaging indicators showed no statistically significant difference. The results of surgical correction of the two groups were satisfactory, and the differences in the score of American Hospital for Special Surgery and the osteoarthritis index of The Western Ontario University and McMaster University were significant compared with those before surgery in the last follow-up (P < 0.05), and there was no statistical difference between the two groups in the last follow-up。Conclusions Overcorrection of varus deformity (postoperative WBLR≥ 67%) did not affect the clinical outcome within 2 years after OWHTO, but increased the incidence of postoperative complications and resulted in increased compensatory adduction of the hip joint。

scholarly journals Medial Wedge Opening High Tibial Osteotomy with an Extra Screw Fixation

2019 ◽  
Vol 6 (01) ◽  
pp. 45-48
Author(s):  
Ahmed A. Khalifa ◽  
Amr A. Fadle ◽  
Mohammad Ali Alzohiry ◽  
Mohamed Eslam Elsherif ◽  
Omar Refai
Keyword(s):  
High Tibial Osteotomy ◽  
Screw Fixation ◽  
Rotational Stability ◽  
Osteotomy Site ◽  
Lateral Side ◽  
Tibial Osteotomy ◽  
Varus Malalignment ◽  
Tibia Vara

AbstractMedial wedge opening high tibial osteotomy (MWOHTO) is effective for managing a variety of knee conditions, varus malalignment of the knee, either secondary to osteoarthritis or residual adolescent tibia vara, are among the indications, fixation may be done using different methods (Stables, T-plate, Budu plate, and TomoFix). We are describing our technique of performing (MWOHTO) fixed with titanium T plate supplemented with an extra screw from the lateral side which we call “extra-focal” screw to obtain biplanar fixation which may add to the rotational stability at the osteotomy site.

Effect of Slope and Varus Correction High Tibial Osteotomy in the ACL-Deficient and ACL-Reconstructed Knee on Kinematics and ACL Graft Force: A Biomechanical Analysis

2020 ◽  
pp. 036354652097614
Author(s):  
Florian B. Imhoff ◽  
Brendan Comer ◽  
Elifho Obopilwe ◽  
Knut Beitzel ◽  
Robert A. Arciero ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Knee Kinematics ◽  
Tibial Rotation ◽  
Tibial Osteotomy ◽  
Correction Osteotomy ◽  
Acl Graft ◽  
Slope Correction ◽  
Internal Tibial Rotation ◽  
Reconstructed Knee ◽  
Acl Deficient

Background: Correction of high posterior tibial slope is an important treatment option for revision of anterior cruciate ligament (ACL) failure as seen in clinical and biomechanical studies. In cases with moderate to severe medial compartment arthritis, an additional varus correction osteotomy may be added to improve alignment. Purpose: To investigate the influence of coronal and sagittal correction high tibial osteotomy in ACL-deficient and ACL-reconstructed knees on knee kinematics and ACL graft load. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were selected according to previous computed tomography measurements with increased native slope and slight varus tibial alignment (mean ± SD): slope, 9.9°± 1.4°; medial proximal tibia angle, 86.5°± 2.1°; age, 47.7 ± 5.8 years. A 10° anterior closing-wedge osteotomy, as well as an additional 5° of simulated varus correction osteotomy, were created and fixed using an external fixator. Four alignment conditions—native, varus correction, slope correction, and combined varus and slope correction—were randomly tested in 2 states: ACL-deficient and ACL-reconstructed. Compressive axial loads were applied to the tibia while mounted on a free-moving X-Y table and free-rotating tibia in a knee testing fixture. Three-dimensional motion tracking captured anterior tibial translation (ATT) and internal tibial rotation. Change of tensile forces on the reconstructed ACL graft were recorded. Results: In the ACL-deficient knee, an isolated varus correction led to a significant increase of ATT by 4.3 ± 4.0 mm ( P = .04). Isolated slope reduction resulted in the greatest decrease of ATT by 6.2 ± 4.3 mm ( P < .001). In the ACL-reconstructed knee, ATT showed comparable changes, while combined varus and slope correction led to lower ATT by 3.7 ± 2.6 mm ( P = .01) than ATT in the native alignment. Internal tibial rotation was not significantly altered by varus correction but significantly increased after isolated slope correction by 4.0°± 4.1° ( P < .01). Each isolated or combined osteotomy showed decreased forces on the graft as compared with the native state. The combined varus and slope osteotomy led to a mean decrease of ACL graft force by 33% at 200 N and by 58% at 400 N as compared with the native condition ( P < .001). Conclusion: A combined varus and slope correction led to a relevant decrease of ATT in the ACL-deficient and ACL-reconstructed cadaveric knee. ACL graft forces were significantly decreased after combined varus and slope correction. Thus, our biomechanical findings support the treatment goal of a perpendicular-aligned tibial plateau for ACL insufficiencies, especially in cases of revision surgery. Clinical Relevance: This study shows the beneficial knee kinematics and reduced forces on the ACL graft after combined varus and slope correction.

scholarly journals Inverted V–Shaped High Tibial Osteotomy for Medial Osteoarthritic Knees With Severe Varus Deformity

2018 ◽  
Vol 7 (10) ◽  
pp. e999-e1012 ◽  
Author(s):  
Eiji Kondo ◽  
Kazunori Yasuda ◽  
Koji Yabuuchi ◽  
Yoshimitsu Aoki ◽  
Masayuki Inoue ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Varus Deformity ◽  
Tibial Osteotomy

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.

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