scholarly journals Relationship between the correction angle in medial open wedge high tibial osteotomy and the postoperative state of patellofemoral cartilage

2020 ◽  
Author(s):  
Chong-Hyuk Choi ◽  
Min Jung ◽  
Sung-Hwan Kim ◽  
Sang-Hee Kim ◽  
Tae-Hwan Yoon
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Group Versus ◽  
International Knee Documentation Committee ◽  
Cartilage Degeneration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Correction Angle ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

Abstract Background: To investigate clinical and radiologic effects of medial open wedge high tibial osteotomy (MOWHTO) on the patellofemoral joint in relation to the correction angle by comparing changes in cartilage from before to after the surgery. Methods: A total of 124 MOWHTO cases were divided into the three groups of small, moderate, and large, depending on the correction angle. Clinical and radiologic outcomes were compared at the mean follow-up time of 38.8 months. Postoperative cartilage changes were assessed during implant removal completed at two years after MOWHTO. Results: There was no significant difference evident in most clinical outcomes measured, including Lysholm score and the Knee Injury and Osteoarthritis Outcome score subscales, with the exception of postoperative Shelbourne and Trumper score between the groups (P< 0.001). International Knee Documentation Committee scale value on radiologic evaluation did not significantly differ among the groups. A progression of cartilage degeneration was noted in 40.3% of femoral trochleas and 22.6% of patellas. Cartilage degeneration was significantly progressed in the large correction angle group versus in the other two groups. Regression analysis showed that the correction angle had a significant effect on cartilage deterioration (Trochela, P=0.009; Patella, P=0.034). Conclusion: Patellofemoral joint was more adversely affected by MOWHTO in conjunction with the requirement of a larger correction angle. Thus, cases necessitating considerable correction should be forewarned of patellofemoral joint symptoms within a relatively short time after the procedure. Keywords: medial open wedge high tibial osteotomy, osteoarthritis, patellofemoral arthritis, correction angle

Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High Tibial Osteotomy With Large Alignment Correction

2020 ◽  
Vol 48 (11) ◽  
pp. 2718-2725 ◽  
Author(s):  
Sang Jun Song ◽  
Kyoung Ho Yoon ◽  
Cheol Hee Park
Keyword(s):  
High Tibial Osteotomy ◽  
Cartilage Degeneration ◽  
Pain Scale ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Factors Affecting ◽  
Correction Angle ◽  
Alignment Correction ◽  
Wedge High Tibial Osteotomy ◽  
Anterior Knee

Background: Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO). Purpose: To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO ( P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups. Results: No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group ( P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367). Conclusion: Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.

scholarly journals Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Shuhei Otsuki ◽  
Kuniaki Ikeda ◽  
Hitoshi Wakama ◽  
Nobuhiro Okuno ◽  
Yoshinori Okamoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Cartilage Degeneration ◽  
Flexion Contracture ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Progressive Degeneration ◽  
Radiographic Parameters ◽  
Wedge High Tibial Osteotomy

Abstract Purpose The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.

scholarly journals The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hyun-Soo Moon ◽  
Chong-Hyuk Choi ◽  
Min Jung ◽  
Sang-Hoon Park ◽  
Dae-Young Lee ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Cartilage Lesion ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Radiographic Parameters ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

Abstract Background Although it has been known that medial open wedge high tibial osteotomy (MOWHTO) would adversely affect the patellofemoral joint, no previous study examined the surgical outcome of MOWHTO according to the preexisting cartilage status of the patellofemoral joint. The aim of this study was to investigate the effect of MOWHTO on the patellofemoral joint with regard to objective and subjective aspects according to the preexisting cartilage status. Methods Ninety-two patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were divided into two groups according to the preexisting cartilage status of the patellofemoral joint: group 1 (International Cartilage Repair Society [ICRS] grade 2 or 3) and group 2 (ICRS grade 0 or 1). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups. Results Clinical outcomes showed overall improvement from baseline to the time of second-look operation, with no significant difference between the two groups at each time point. There were no significant differences in radiographic parameters between the two groups. Radiographic grade of patellofemoral osteoarthritis in both groups showed a tendency to progress, without statistical significance. In arthroscopic assessment, the size of the cartilage lesion on the patellofemoral joint increased with time in both groups (P = 0.003), but the degree of change over time between the two groups was not statistically significant. Consistently, there was no significant difference in the frequency of progression of cartilage lesion grade in the patellofemoral joint between the two groups. Conclusions MOWHTO would contribute to osteoarthritis progression of the patellofemoral joint regardless of the preexisting cartilage status, without an association with clinical outcomes in short-term follow-up.

scholarly journals Does the correction angle affect hidden blood loss in HTO?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zheng Li ◽  
Yannong Wang ◽  
Guanglei Cao ◽  
Shuai An ◽  
Mingli Feng ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Blood Loss ◽  
High Tibial Osteotomy ◽  
Total Blood Loss ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Total Blood ◽  
Correction Angle ◽  
Hidden Blood Loss ◽  
Wedge High Tibial Osteotomy

Abstract Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

No correction angle loss with stable plates in open-wedge high tibial osteotomy

2014 ◽  
Vol 23 (7) ◽  
pp. 1999-2006 ◽  
Author(s):  
Min Kyu Kim ◽  
Jeong Ku Ha ◽  
Dhong Won Lee ◽  
Sang Wook Nam ◽  
Jin Goo Kim ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Correction Angle ◽  
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 ).

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