Advantages of individualized open wedge high tibial osteotomy in treatment of medial compartment knee osteoarthritis / 中国组织工程研究

BACKGROUND: Open wedge high tibial osteotomy can achieve significant clinical efficacy for patients with medial compartment knee osteoarthritis and genu varus. However, Fujisawa point has been recognized as a reference for the correction of lower limb alignment. Can individualized orthopedics in lower limb alignment obtain better clinical efficacy? OBJECTIVE: To explore short-term efficacy of individualized orthopedics in lower limb alignment for medial compartment knee osteoarthritis through open wedge high tibial osteotomy. METHODS: Totally 46 patients with medial compartment knee osteoarthritis treated by open wedge high tibial osteotomy from June 2016 to May 2018 in Department of Orthopedics, Wuxi People's Hospital were enrolled in this study. X-ray and MRI were used to evaluate the knee and I-III degeneration grades were classified. Patients at Grade I and II were randomly divided into individualized orthopedics group and control group with 16 cases in each group. Patients at grade III were classified as Fujisawa group with 14 cases. In the individualized orthopedics group, mild grade I and moderate grade II respectively corrected lower limb alignment to 50% and 55% of lateral tibial plateau, while control group and Fujisawa group all corrected the alignment to 62.5% point. Postoperative lower limb alignment, pre- and post-operative range of motion, femoral-tibial angle and medial proximal tibial angle of the knee were measured and evaluated. The hospital for special surgery score and the Western Ontario and McMaster Universities osteoarthritis index score were followed up before operation, 3, 6 and 12 months after operation, while postoperative self-satisfaction of patients was also compared. RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months. (2) Three groups achieved satisfactory lower limb alignment. Range of motion and medial proximal tibial angle increased and femoral-tibial angle decreased at postoperative stage (P 0.05). (4) All patients were satisfied with the surgical efficacy. Postoperative self-satisfaction scores of individualized orthopedics group were superior to that of control group (P < 0.05). (5) According to the results, individualized open wedge high tibial osteotomy is benefit to obtain early functional rehabilitation of the knee through accurate correction of lower limb alignment. It can also improve patient satisfaction.

Study on lateral hinge fracture during open wedge high tibial osteotomy / 中国修复重建外科杂志

Objective: To summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. Methods: To review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. Results: The lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the "safe zone" internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. Conclusion: The intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.

Effectiveness of open wedge high tibial osteotomy on medial unicompartmental knee osteoarthritis / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of open wedge high tibial osteotomy (OWHTO) in treatment of medial unicompartmental knee osteoarthritis (MUKOA). Methods: A clinical data of 61 cases with MUKOA who were treated with OWHTO between January 2015 and January 2017 were retrospectively analyzed. There are 14 males and 47 females with an average age of 52.8 years (mean, 44-60 years). The body mass index ranged from 19.1 to 34.7 kg/m 2 (mean, 25.3 kg/m 2). Twenty-seven cases were left side and 34 cases were right side. The disease duration was 1-9 years (mean, 5.3 years). The MUKOA was rated as stage Ⅱ in 33 cases and stage Ⅲ in 28 cases. Preoperative Hospital for Special Surgery (HSS) score was 56.0±3.7. Walking visual analogue scale (VAS) score was 4.6±1.0. Results: The operation time was 49-85 minutes (mean, 66.5 minutes). The length of incision was 10-13 cm (mean, 11.0 cm). The total overt blood loss was 80-210 mL (mean, 139.1 mL). The postoperative bed-rest time was 1-10 days (mean, 4.7 days). All patients were followed up 12-24 months (mean, 17.3 months). The bearing area of tibial platform at 3 months after operation was 60.3%-66.8%, with an average of 63.4%. At 3 and 6 months after operation, the HSS score was 79.1±4.2 and 85.3±3.1 respectively, and the VAS score was 1.7±0.7 and 0.6±0.5 respectively, all showing significant differences ( P<0.05). Conclusion: OWHTO is an ideal choice for treating MUKOA with less postoperative complications. The force line could be corrected by OWHTO. However, the preoperative preparations are very important, especially that the open angle should be measured accurately.

The Effect of Hinge Direction on Posterior Tibial Slope in Medial Open-wedge High Tibial Osteotomy: A Study Based on Three-dimensional Computed Tomography Modelling / 中国运动医学杂志

Objective To explore factors affecting posterior tibial slope changes after the medial openwedge high tibial osteotomy.Methods The open-wedge high tibial osteotomy was simulated and performed on the three-dimensional proximal tibia model reconstructed based on the computed tomography (CT) scanning,and the roles of hinge axis direction and correction of genu varum in postoperative posterior tibial slope changes were analyzed separately.Results Hinge axis pointing anterolaterally was significantly associated with the increase of postoperative posterior tibial slope with regard to the axis along the anterior-posterior direction.Meanwhile,the correction of the genu varum at a larger angle was also a crucial factor for the increase of postoperative posterior tibial slopes.Conclusion Postoperative posterior tibial slope changes after open-wedge high tibial osteotomy is closely associated with the hinge axis direction and correcting angle of the genu varum.

Analysis of the Factors Affecting Bone Union after Open-Wedge High Tibial Osteotomy and Graft Material for Lateral Cortex Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze patient factors including smoking, body mass index, correction angle, graft material, presence of lateral cortex fracture, and age for the effect on bone union after open-wedge high tibial osteotomy and the effect of graft material used for lateral cortex fractures. MATERIALS AND METHODS: This retrospective study was conducted on 54 patients and 58 cases with osteoarthritic change Kallgren-Lawrence grade 2 or less from May 2012 to June 2014. Average follow-up period was 22 months (14–38 months). The patients were divided into two groups according to patient related factors and graft materials (allograft, n=6; beta-tricalcium phosphate [β-TCP], n=6) used for lateral cortex fractures and were analyzed for the relationship with bone union after open-wedge high tibial osteotomy. Radiographic and clinic analyses were performed, and van Hemert grading was used for grading bone union at 6 weeks, 3 months, 6 months, and 1 year postoperatively. RESULTS: The non-smoking group and the group without lateral cortex fracture showed significantly higher bone union rates than the control group. No significant clinical or radiological difference was observed between the two groups in 12 cases and the allograft group showed significantly higher rates of union at 6 months and 1 year postoperatively according to the van Hemert grading. CONCLUSION: Smoking and the presence of a lateral cortex fracture is a risk factor for nonunion in medial open-wedge high tibial osteotomy. The use of allograft material rather than β-TCP for lateral cortex fractures is thought to result in better bone union.

Clinical Results after Medial Opening Wedge High Tibial Osteotomy in Medial Compartment Osteoarthritis of the Knee: TomoFix(R) versus Aescula(R) Plates / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and radiologic results of medial open wedge high tibial osteotomy (HTO) using either TomoFix(R) plate (group A) or Aescula(R) plate (group B) in patients with medial compartment osteoarthritis. MATERIALS AND METHODS: Sixty-four consecutive patients who underwent HTO for medial compartmental osteoarthritis from 2008 were included. Mean follow-up duration was 37.1 months. Twenty men and 44 women with a mean age of 50 years (range, 41 to 62 years) were divided into group A (locking plate, n=20) and group B (spacer plate, n=44). Clinical results were evaluated using knee society rating system (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiological results were obtained by measuring the mechanical axis, posterior tibial slope, and medial joint space width preoperatively, 3 months postoperatively, and at the final follow-up. RESULTS: In overall patients, the mechanical axis was corrected from 7.8degrees+/-2.4degrees of varus preoperatively to 1.9degrees+/-2.2degrees of valgus 3 months after HTO. At the final follow-up, the mechanical axis was to 2.1degrees+/-3.1degrees of valgus which showed no statistical difference in group A. However, loss of correction was observed at the final follow-up, at 0.1degrees+/-3.1degrees of valgus angulation in group B. The increase of the posterior tibial slope was significantly greater in group A than group B. The joint space width in both groups was improved at last follow-up. All clinical results showed improvement after HTO, with significantly improved KSS and WOMAC scores (p<0.001). CONCLUSION: The overall clinical results after HTO for medial compartment osteoarthritis were satisfactory. A group of spacer plates needed for prolonged protective weight bearing and locking plate was effective in maintenance of correction.

The Results of Open Wedge Proximal Tibial Osteotomy According to Bone Graft and Fracture of Lateral Cortex

PURPOSE: The purposes of this study are to evaluate the clinical effect of open high tibial osteotomy for treating patients with early osteoarthritis with varus deformity and to determine the effect of a bone graft and fracture of the lateral cortex. MATERIALS AND METHODS: This study reviewed 14 patients (17 cases) who had been diagnosed with osteoarthritis with accompanying varus deformity and who were treated with open high tibial osteotomy from May 2001 to May 2007. Every patient showed less than Kallgren-Lawrence Stage II. Bone grafts were performed in 13 of the 17 cases. Clinical evaluations and radiologic evaluations were performed. We divided the patients into two groups according to a bone graft in the cases with openings of less than 10mm and preservation of the lateral cortex, and we compared them according to the clinical and radiological results, respectively. The average period of follow up was 34 months (range: 12~96 months). RESULTS: The Lysholm score improved from 59.9 preoperatively to 81.5 postoperatively and the HSS score improved from 62.9 to 85.3. The femoro-tibial angle was varus 7.8 degrees at preoperation, valgus 11.6 degrees on the immediate postoperative examination and valgus 10.5 degrees at follow up. The posterior tibial slope was 8.9 degrees at preoperation, 11.8 degrees at postoperation and 12.3 degrees at the last follow up. The Insall-Salvati ratio revealed no significant difference from 0.92 preoperatively to 0.94 postoperatively (p=0.82). There was no significant difference between the groups (p=0.47) on comparison of bone grafting or not for the patients with an opening of less than 10 mm. The group with a preserved lateral cortex showed better clinical results than the other group. However, there were no observed radiological differences (p>0.05). CONCLUSION: Open high tibial osteotomy that's performed on patients with early osteoarthritis is a useful treatment option. We can conclude that a bone graft does not significant influence the result for the case with an opening less than 10 mm, and firm fixation is mandatory when the lateral cortex is fractured.

One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical and radiological results of one-staged open-wedge high tibial osteotomy (HTO) and arthroscopic anterior cruciate ligament (ACL) reconstruction for patients with complete rupture of the ACL and concomitant varus malalignment of the lower limb. MATERIALS AND METHODS: Twenty-five patients were prospectively assessed before and 1 year after their simultaneous operation as a single procedure. The clinical assessment included the Lysholm score, the Tegner activity level scale and a physical examination. The radiological data was used to calculate the mechanical axis, the joint space, the tibial slope and the arthrometric stress test. The postoperative complications were also assessed. RESULTS: The Lysholm knee score and the Tegner activity level scale improved from a mean of 72.1 to 93.8 and from 1.45 to 4.65, respectively (p0.05). The severity and rate of the postoperative complications were both low. CONCLUSION: One-staged open-wedge HTO and ACL reconstruction produced satisfactory correction of the mechanical axis alignment and, it improved knee function. Further, the procedure had a low complication rate. It is also cost effective due to, reducing the frequency of operation and avoiding overlap of rehabilitation.

Open Wedge High Tibial Osteotomy with Aescula(R) Plate / 대한정형외과학회잡지

PURPOSE: This study is to evaluate chinical and radiological results of open wedge high tibial osteotomy using Aescula(R) plate. MATERIALS AND METHODS: Ninity one patients who have unicompartmental osteoarthritis with varus deformity were treated by open wedge high tibial osteotomy with Aescula(R) plate and followed up at least 2 years. Clinically, visual analogue scale (VAS), range of motion (ROM) and hospital for special surgery (HSS) score were evaluated. Radiologically, tibio-femoral angle, mechanical axis, medial proximal tibia angle and posterior slope were measured. All complications were also evaluated. RESULTS: During the follow-up VAS improved from 8.3 to 2.1, ROM were checked preoperatively from 1.3degrees to 137degrees and from 1.8degrees to 136.1degrees at last follow up. And HSS score improved from 76.8 to 91. Preoperative tibio-femoral angle was 0.4degrees of varus, mechanical axis 6.4degrees of varus, medial proximal tibia angle 84.4degrees and posterior slope 9.3degrees. Radiologic results at last follow up revealed significant improvements by 8.3degrees of valgus for tibio-femoral angle, 1.8degrees of valgus for mechanical axis and 90.1degrees for medial proximal tibia angle. Mean posterior slope was 10.4degrees which increased 1.1degrees compared with preoperative one. And there was one fixation failure that needed re-operation. CONCLUSION: Open wedge high tibial osteotomy using Aescula(R) provided excellent clinical and radiological results at 2 years follow-up.

Navigation versus Radiographic Measurements in the Open-Wedge High Tibial Osteotomy using Computer Assisted Surgery (CAS) / 대한정형외과학회잡지

PURPOSE: To compare the measurements using a navigation system and radiographic measurement in an open wedge high tibial osteotomy under navigation control. MATERIALS AND METHODS: From July, 2005 to January, 2007, 32 open wedge high tibial osteotomies were performed using a navigation system for osteoarthritis of the knee. The postoperative mechanical axis % (MA%), which is planned on the navigation system, were 62%. The mechanical axis (MA) and MA% were measured on the navigation system. The preoperative and postoperative MA and MA% were measured on the radiographs. The angles measured with the navigation system and radiographs were compared. RESULTS: On the navigation system, the mean MA before osteotomy was varus 8.8degrees. The mean MA and MA% after fixation were valgus 2.9degrees and 57.7%. On the radiographs, the mean MA was varus 9.7degrees preoperatively and valgus 4.0degrees postoperatively. The mean MA% was 10.2% preoperatively and valgus 64.4% postoperatively. There were positive correlations between the values measured with the navigation system and the radiographs (r>0.5, p<0.001). CONCLUSION: There were significant correlations between the values measured with the navigation system and radiographs in an open wedge high tibial osteotomy using a navigation system. The correction angle from the navigation system is reliable, predictable and controllable during surgery.