scholarly journals In vivo Histological Examination of the Graft Site 3 Years after Open-wedge High Tibial Osteotomy with Nanohydroxyapatite Augmentation

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Giorgio Princi ◽  
Marco Rossini ◽  
Fabio Marzilli ◽  
Riccardo Di Niccolo ◽  
Fabio Conteduca ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Histological Examination ◽  
Bone Substitute ◽  
Bone Biopsy ◽  
Osteotomy Site ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Introduction:The open-wedge high tibial osteotomy (OWHTO) is a common technique for the treatment of medial compartmental osteoarthritis of the knee. There are many options to fill the osteotomy site gap. The autologous graft donor site morbidity can be avoided using heterologous bone grafts which represent a valid alternative. Case Presentation:This case report is about a 52-year-old male with knee osteoarthritis and varus deformity. Due to stiffness, swelling, and painful limitation during daily life activities, the patient underwent OWHTO. The osteotomy gap was filled with an equine cancellous bone wedge and nanohydroxyapatite (NHA) bone paste augmentation. After 3 years, the OWTHO was converted to total knee arthroplasty and a bone biopsy of the previous graft site was performed. The histological examination presented non-viable bone areas surrounded by viable bone without inflammatory cells, suggesting the presence of residual non-viable bone from the bone substitute graft. Conclusion:The in vivo histology of the graft site after 3 years has shown that heterologous bone is a safe and valid choice as a scaffold for bone regeneration. Augmentation with NHA bone paste achieved good osteoinduction without an inflammatory reaction and good integration of the bone substitute insert. Keywords: High tibial osteotomy, histology, heterograft.

scholarly journals Open wedge high tibial osteotomy for the treatment of osteoarthritis of both knee and ankle in the same leg: A report of two cases

2021 ◽  
Author(s):  
Ji-Hoon Baek ◽  
Su Chan Lee ◽  
Hosun Jin ◽  
Hye Sun Ahn ◽  
Chang Hyun Nam
Keyword(s):  
High Tibial Osteotomy ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

We report two cases of patients with concurrent osteoarthritis of the knee and the ipsilateral ankle. Patients were treated with high tibial osteotomy (HTO). In well-planned and selected cases, HTO may be effective in treating not only the knee but also the ankle in patients with ipsilateral double-joint osteoarthritis.

Primary stability of different plate positions and the role of bone substitute in open wedge high tibial osteotomy

The Knee ◽  
2017 ◽  
Vol 24 (6) ◽  
pp. 1299-1306 ◽  
Author(s):  
Ryohei Takeuchi ◽  
Jung Woon-Hwa ◽  
Hiroyuki Ishikawa ◽  
Yuichiro Yamaguchi ◽  
Katsunari Osawa ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Bone Substitute ◽  
Primary Stability ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

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

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.

scholarly journals Novel unidirectional porous hydroxyapatite used as a bone substitute for open wedge high tibial osteotomy

2014 ◽  
Vol 25 (11) ◽  
pp. 2541-2547 ◽  
Author(s):  
Kenta Uemura ◽  
Akihiro Kanamori ◽  
Katsuya Aoto ◽  
Masashi Yamazaki ◽  
Masataka Sakane
Keyword(s):  
High Tibial Osteotomy ◽  
Bone Substitute ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Porous Hydroxyapatite ◽  
Wedge High Tibial Osteotomy

scholarly journals Medial Opening Wedge High Tibial Osteotomy Fixation with Short Plate without any Graft, Synthetic Material or Spacer

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0016
Author(s):  
Faik Türkmen ◽  
Cem Sever ◽  
Burkay Kutluhan Kacıra ◽  
Mehmet Demirayak ◽  
Mehmet Ali Acar ◽  
...  
Keyword(s):  
Bone Graft ◽  
High Tibial Osteotomy ◽  
Varus Deformity ◽  
Bone Grafts ◽  
Osteotomy Site ◽  
Osteoarthritis Of The Knee ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Synthetic Materials ◽  
Wedge High Tibial Osteotomy

Objectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer.

scholarly journals Assessment of valgus laxity after release of the medial structure in medial open-wedge high tibial osteotomy: an in vivo biomechanical study using quantitative valgus stress radiography

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Dai Sato ◽  
Eiji Kondo ◽  
Koji Yabuuchi ◽  
Jun Onodera ◽  
Tomohiro Onodera ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Biomechanical Study ◽  
Trial Registration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Plate Removal ◽  
Wedge High Tibial Osteotomy

Abstract Background To perform medial open-wedge high tibial osteotomy (OWHTO), surgeons expose the medial-proximal tibia by releasing or cutting the superficial layer of the medial collateral ligament (sMCL). Biomechanically, the sMCL provides primary restraint against valgus forces. Therefore, any release of the sMCL can cause valgus instability of the knee joint. The purpose of this study was to assess valgus laxity after release of the medial structure of the knee during OWHTO. Methods Between 2009 and 2015, 84 consecutive patients (93 knees) who underwent OWHTO using a locking plate were enrolled in this study. All patients underwent radiological examinations before surgery, during surgery, 1 year after surgery, and after plate removal to objectively assess valgus laxity. The medial joint space (MJS) and the joint line convergence angle (JLCA) of the knee were evaluated using quantitative valgus stress radiography. Clinical evaluation was performed 2 years after surgery. Results The mean functional knee score improved significantly, from 65.5 to 91.1 points (p < 0.0001). The mechanical axis percentage shifted to pass through a point 69.7% lateral from the medial edge of the tibial plateau. The MJS and JLCA increased significantly during OWHTO surgery (11.0 mm, 7.4 °, p < 0.0001). However, no significant differences were noted in the MJS and JLCA among preoperative, 1-year postoperative periods and after plate removal. Conclusion Valgus laxity was significantly greater after release of the sMCL. However, no significant differences were noted in valgus laxity in preoperative, 1-year postoperative periods and after plate removal. Complete release of the sMCL did not cause postoperative valgus laxity after OWHTO surgery. Trial registration Trial registration number: No.012–0360.

Sign in / Sign up

Export Citation Format

Share Document