scholarly journals What Determines the Success of Closed-Wedge High Tibial Osteotomy: Severity of Malalignment, Obesity, Follow-up Period, or Age?

2018 ◽  
Author(s):  
Ata Can
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahiro Ogino ◽  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Tomotaka Akamatsu ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Tibial Osteotomy ◽  
Mechanical Axis ◽  
Tibial Osteotomy ◽  
Axis Deviation ◽  
Open Wedge ◽  
Correction Angle ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

Abstract Background The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). Methods A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. Results CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P <  0.05), and a greater soft tissue correction than OWHTO (P <  0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P <  0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. Conclusions The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.

scholarly journals Short-Term Results of Hybrid Closed-Wedge High Tibial Osteotomy: A Case Series with a Minimum 3-Year Follow-up

2018 ◽  
Vol 30 (4) ◽  
pp. 293-302 ◽  
Author(s):  
Hidetomo Saito ◽  
Kimio Saito ◽  
Yoichi Shimada ◽  
Toshiaki Yamamura ◽  
Shin Yamada ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Short Term ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

2021 ◽  
pp. 036354652110021
Author(s):  
Han Gyeol Choi ◽  
Joo Sung Kim ◽  
Hyun Jin Yoo ◽  
You Sun Jung ◽  
Yong Seuk Lee
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Insufficiency Fracture ◽  
Tibial Osteotomy ◽  
Pathological Feature ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Bone Marrow Lesions ◽  
Wedge High Tibial Osteotomy

Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

scholarly journals Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement

2021 ◽  
Vol 10 (13) ◽  
pp. 2743
Author(s):  
Juan Sánchez-Soler ◽  
Alex Coelho ◽  
Raúl Torres-Claramunt ◽  
Berta Gasol ◽  
Albert Fontanellas ◽  
...  
Keyword(s):  
Survival Rate ◽  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA ≤ 180°, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24–180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7° (SD 4.9) in group 1 and 179.5° (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 ± 15.9) and group 2 (84.3 ± 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA ≤ 180° (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study.

Factors associated with discrepancies between preoperatively planned and postoperative alignments in patients undergoing closed-wedge high tibial osteotomy

The Knee ◽  
2017 ◽  
Vol 24 (5) ◽  
pp. 1129-1137 ◽  
Author(s):  
Seong Hwan Kim ◽  
Du-Hyun Ro ◽  
Young-Min Lee ◽  
Yool Cho ◽  
Sahnghoon Lee ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Factors Associated ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

2021 ◽  
Vol 103-B (11) ◽  
pp. 1686-1694
Author(s):  
Hong-Yeol Yang ◽  
Woo-Kyoung Kwak ◽  
Sung Ju Kang ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Status Group ◽  
Second Look ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

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.

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