scholarly journals Use of a Suspended and Straightened Knee Joint Position When Fixing Steel Plates Can Prevent the Increase in Postoperative Posterior Tibial Slope After Open‑wedge High Tibial Osteotomy

2021 ◽  
Author(s):  
Wenru Ma ◽  
Zengshuai Han ◽  
Shengnan Sun ◽  
Jinli Chen ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Slope ◽  
Steel Plates ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Joint Position ◽  
Radiological Assessment ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy

Abstract Background: Posterior tibial slope (PTS) increases after medial open-wedge high tibial osteotomy (OWHTO) is challenging for patients. This study aims to determine whether use of a suspended and straightened knee joint position during the fixing of steel plates can prevent an increase in the posterior tibial slope after OWHTO.Methods: This study retrospectively analyzed 112 subjects (122 knees) [34 males, 78 females; mean age 59.1±6.6 (range 48–76) years; mean body mass index (BMI) 28.06±3.61 kg/m²] who underwent OWHTO. A total of 78 knees that were suspended and extended by placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the suspended and straightened knee joint position (SSP) group, and 44 knees that were kept naturally straightened without placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the naturally straightened knee joint position (NSP) group. Patients were clinically assessed according to the visual analog pain scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. Radiological assessment was performed according to the changes in the posterior tibial slope between preoperation, 1-day postoperation, and the final follow-up periods. Ultimately, the difference in postoperative PTS changes between the two groups was statistically analyzed. The median follow-up period was 2.2 years (range 1.6–3.7 years).Results: In the final follow-up period, significant improvements were observed in the clinical VAS and WOMAC scores in both groups (P < 0.001), and no difference was found between the two groups. Radiological assessment showed that there was no statistical difference in the preoperative PTS between the two groups. The 1-day post-operative PTS and the most recent follow-up PTS were significantly greater than the preoperative PTS in the NSP group (t=-3.213, -6.406, all P < 0.001), but no significant increase was seen in the SSP group (P >0.05). The increase in PTS in the NSP group was significantly greater than that in the SSP group at the 1-day postoperative (t=2.243, P=0.030) and final follow-up periods (t=6.501, P<0.001).Conclusion: For OWHTO, the use of a suspended and straightened knee joint position rather than a naturally straightened knee joint position during the fixing of steel plates could effectively prevent the increase in postoperative PTS.Level of Evidence: Retrospective Study Level III

scholarly journals Use of a suspended and straightened knee joint position when fixing steel plates can prevent the increase in postoperative posterior tibial slope after open‑wedge high tibial osteotomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Wenru Ma ◽  
Zengshuai Han ◽  
Shengnan Sun ◽  
Jinli Chen ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Slope ◽  
Steel Plates ◽  
Tibial Osteotomy ◽  
Joint Position ◽  
Radiological Assessment ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy ◽  
And Function

Abstract Background Posterior tibial slope (PTS) increases after medial open-wedge high tibial osteotomy (OWHTO) is challenging for patients. This study aims to determine whether use of a suspended and straightened knee joint position during the fixing of steel plates can prevent an increase in the PTS after OWHTO. Methods This study retrospectively analyzed 112 subjects (122 knees) [34 males, 78 females; mean age 59.1 ± 6.6 (range 48–76) years; mean body mass index 28.06 ± 3.61 kg/m2] who underwent OWHTO. A total of 78 knees that were suspended and extended by placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the suspended and straightened knee joint position (SSP) group, and 44 knees that were kept naturally straightened without placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the naturally straightened knee joint position (NSP) group. Patients were clinically assessed according to the visual analog pain scale (VAS), the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, the Knee Society Scores (KSS) knee and function scores, the Hospital for Special Surgery (HSS) knee scores and the Lysholm knee scores. Radiological assessment was performed according to the changes in the PTS between preoperation, 1-day postoperation, and the final follow-up periods. Ultimately, the difference in postoperative PTS changes between the two groups was statistically analyzed. The median follow-up period was 2.2 years (range 1.6–3.7 years). Results In the final follow-up period, significant improvements were observed in the clinical VAS scores, WOMAC scores, KSS knee and function scores, HSS scores and the Lysholm knee scores in both groups (P < 0.001), and no difference was found between the two groups. Radiological assessment showed that there was no statistical difference in the preoperative PTS between the two groups. The 1-day postoperative PTS and the most recent follow-up PTS were significantly greater than the preoperative PTS in the NSP group (t = − 3.213, − 6.406, all P < 0.001), but no significant increase was seen in the SSP group (P > 0.05). The increase in PTS in the NSP group was significantly greater than that in the SSP group at the 1-day postoperative (t = 2.243, P = 0.030) and final follow-up periods (t = 6.501, P < 0.001). Conclusions For OWHTO, the use of a suspended and straightened knee joint position rather than a naturally straightened knee joint position during the fixing of steel plates could effectively prevent the increase in postoperative PTS. Level of Evidence: Retrospective Study Level III.

Counteracting Knee Flexors Strength Could Effectively Prevent the Increase in Post-operative Posterior Tibial Slope in Patients Undergoing Open‑wedge High Tibial Osteotomy

2021 ◽  
Author(s):  
Wenru Ma ◽  
Zengshuai Han ◽  
Shengnan Sun ◽  
Jinli Chen ◽  
Tengbo Yu ◽  
...  
Keyword(s):  
Tibial Slope ◽  
Steel Plates ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Radiological Assessment ◽  
Open Wedge ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy ◽  
Knee Flexors

Abstract Background A difficult-solved problem is that the posterior tibial slope (PTS) increases after medial open-wedge high tibial osteotomy (OWHTO).Purpose To evaluate effects from knee flexors on changes in the posterior tibial slope after OWHTO and to determine whether counteracting the strength of knee flexors could prevent increase in post-operative PTS.Methods The study retrospectively analyzed 112 subjects (122 knees) [34 males, 78 females; mean age 59.1±6.6 (range 48–76) years; mean body mass index (BMI) 28.06±3.61 kg/m²] who underwent OWHTO. During fixing steel plates, 78 knees keeping suspended and extended to counteract the strength of knee flexors by gravity are comprised the no-flexor group and 44 knees in natural posture without counteracting knee flexors are comprised the flexor group. Patients were clinically assessed according to the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and a visual analogue pain scale (VAS). Radiological assessment was made according to the changes in the posterior tibial slope between preoperative, 1-day post-operative and final follow-up periods. Ultimately, difference in post-operative PTS changes between the two groups was statistically analyzed. The median follow-up period was 2.2 years (range 1.6–3.7 years).Results In the final follow-up period, significant improvements were observed in the clinical scores of the VAS and WOMAC in both groups (P < 0.001), and no difference was found between the two groups. Radiological assessment showed that the final follow-up PTS was significantly greater than preoperative PTS in the flexor group (t=-6.406, P < 0.001), but no significant increase was seen in the no-flexor group (P =0.482). Increase of PTS in the flexor group was significantly greater than that in the no-flexor group at 1-day postoperative (t=2.243, P=0.030) and final follow-up periods (t=6.501, P<0.001).Conclusion For OWHTO, knee flexors would aggravate the increase in post-operative PTS. Using gravity to counteract the strength of knee flexors when fixing steel plates could effectively prevent the increase in post-operative PTS.

scholarly journals BIPLANAR OPEN WEDGE HIGH TIBIAL OSTEOTOMY IN THE MEDIAL COMPARTMENT OSTEOARTHRITIS OF THE KNEE JOINT: COMPARISON BETWEEN THE AESCULAAND TOMOFIX PLATE AT ORTHOPAEDICS DEPARTMENT OF JLNMCH, BHAGALPUR, BIHAR.

2020 ◽  
pp. 68-70
Author(s):  
Rakesh Ramdayal Singh ◽  
Yogesh Kumar ◽  
Maseeh Azam ◽  
D. K. Singh ◽  
Debarshi Jana
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy ◽  
Group A ◽  
Tomofix Plate

Background: The purpose of this study was to compare the results of Aescula and TomoFix plates used for biplanar open wedgehigh tibial osteotomy in medial osteoarthritis of the knee joint with varus deformity. Methods: A consecutive series of 50 cases of biplanar open wedge high tibial osteotomy were evaluated retrospectively. GroupA contained 25 cases treated by using the Aescula plate, and group T contained 25 cases treated by using the TomoFix plate. Full weight-bearing was permitted at 6 weeks after surgery in group A and at 2 weeks in group T. Clinical evaluations were performed at the final follow-up by using postoperative knee scores and functional scores. Radiographic analysis included postoperative mechanical femur-tibia angle, change in posterior tibial slope angle, and complications related to implants. The mean follow-up periods were 30 months in group A and 26 months in group T. Results: The knee and functional scores were improved at the final follow-up in both groups (p< 0.05), but no differences wereobserved between the two groups (p> 0.05). An acceptable correction angle was obtained in 52% of group A and in 84% of group T (p = 0.015). Change in posterior tibial slope angle was larger in group A than in group T (p< 0.001), showing better maintenance of posterior tibial slope in group T. In group A, there were 3 cases of screw loosening and 4 cases of delayed union. In addition, there were residual varus deformities in 7 cases (6 in group A and 1 in group T). Conclusions: This study shows that firm fixation using a TomoFix plate for open wedge high tibial osteotomy produces better radiologic results and a low complication rate than those of the Aescula spacer plate.

scholarly journals Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

2016 ◽  
Vol 4 (2) ◽  
pp. 232596711663074 ◽  
Author(s):  
Hiroyasu Ogawa ◽  
Kazu Matsumoto ◽  
Takahiro Ogawa ◽  
Kentaro Takeuchi ◽  
Haruhiko Akiyama
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Posterior Tibial ◽  
Insertion Angle ◽  
Wedge High Tibial Osteotomy

Biplane Medial Opening-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope more than Uniplane Osteotomy

2021 ◽  
Author(s):  
Dong Won Suh ◽  
Kyung Wook Nha ◽  
Seung Beom Han ◽  
Kuhoang Cheong ◽  
Bong Soo Kyung
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Slope ◽  
Womac Score ◽  
Clinical Results ◽  
Lateral View ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy

AbstractFew clinical studies have compared uniplane high tibial osteotomy (HTO) with biplane HTO. The study aim was to compare the radiological and clinical results of uniplane HTO and biplane HTO, especially in terms of the increase in the posterior tibial slope (PTS). Medial opening-wedge HTO patients' medical records and radiological results from a single institution were retrospectively reviewed. Pre- and postoperative serial radiographs, including the Rosenberg, lateral view, and standing anteroposterior view of the whole lower extremity, magnetic resonance imaging at postoperative day 2, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at postoperative 2 years were reviewed to evaluate radiological and clinical results, including the change in PTS. A total of 61 knees, including 34 for uniplane and 27 for biplane HTOs, were enrolled. There were no significant differences in the pre- and postoperative mechanical angles or incidences of the lateral hinge fractures, and all patients showed complete union at postoperative 2 years. The PTS was increased more in the biplane group than in the uniplane group (3.1 ± 2.6 in biplane vs. 0.8 ± 1.7 in uniplane, p < 0.05). The WOMAC scores were 72 ± 9.3 in the uniplane and 75 ± 5.8 in the biplane group (not significant). The increase in PTS was lower in uniplane medial opening HTO than in biplane HTO.

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