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Manon BDN, Ketani T, Bastard C, Rosi G, Lomani HA, Flouzat-Lachaniette CH, Dubory A, Haïat G. An Instrumented Hammer to Detect the Bone Transitions During an High Tibial Osteotomy: An Animal Study. J Biomech Eng 2025; 147:064502. [PMID: 40192639 DOI: 10.1115/1.4068372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Indexed: 05/06/2025]
Abstract
High tibial osteotomy is a common procedure for knee osteoarthritis during which the surgeon partially opens the tibia and must stop impacting when cortical bone is reached by the osteotome. Surgeons rely on their proprioception and fluoroscopy to conduct the surgery. Our group has developed an instrumented hammer to assess the mechanical properties of the material surrounding the osteotome tip. The aim of this ex vivo study is to determine whether this hammer can be used to detect the transition from cortical to trabecular bone and vice versa. Osteotomies were performed until rupture in pig tibia using the instrumented hammer. An algorithm was developed to detect both transitions based on the relative variation of an indicator derived from the time variation of the force. The detection by the algorithm of both transitions was compared with the position of the osteotome measured with a video camera and with surgeon proprioception. The difference between the detection of the video and the algorithm (respectively, the video and the surgeon; the surgeon and the algorithm) is 1.0±1.5 impacts (respectively, 0.5±0.6 impacts; 1.4±1.8 impacts), for the detection of the transition from the cortical to trabecular bone. For the transition from the trabecular to cortical bone, the difference is 3.6±2.6 impacts (respectively, 3.9±2.4 impacts; 0.8±0.9 impacts), and the detection by the algorithm was always done before the sample rupture. This ex vivo study demonstrates that this method could prevent impacts leading to hinge rupture.
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Affiliation(s)
- Bas-Dit-Nugues Manon
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, 61 Avenue du Général de Gaulle, Créteil Cedex 94010, France
- CNRS Ingénierie
| | - Teddy Ketani
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, 61 Avenue du Général de Gaulle, Créteil Cedex 94010, France
- CNRS Ingénierie
| | - Claire Bastard
- Service de Chirurgie de la Main, Service d'Orthopédie et de Traumatologique, Hôpital Saint-Antoine, Sorbonne Université, 184, rue du Faubourg-Saint-Antoine, Paris 75012, France
- CNRS Ingénierie
| | - Giuseppe Rosi
- Univ Paris Est Creteil, Univ Gustave Eiffel, CNRS, UMR 8208, MSME, 61 Avenue du Général de Gaulle, Créteil Cedex 94010, France
| | - Hugues Albini Lomani
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, 61 Avenue du Général de Gaulle, Créteil Cedex 94010, France
- CNRS Ingénierie
| | - Charles-Henri Flouzat-Lachaniette
- INSERM U955, IMRB, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94000, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94000, France
| | - Arnaud Dubory
- INSERM U955, IMRB, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94000, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94000, France
| | - Guillaume Haïat
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, 61 Avenue du Général de Gaulle, Créteil Cedex 94010, France
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Daniel AV, Wagner MJ, Levy BA. Various high tibial osteotomy techniques show high survivorship, medial opening wedge technique has risks, and patient-specific instrumentation shows promise. Arthroscopy 2025:S0749-8063(25)00358-5. [PMID: 40349805 DOI: 10.1016/j.arthro.2025.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2025] [Accepted: 05/03/2025] [Indexed: 05/14/2025]
Abstract
Valgus producing high tibial osteotomy (HTO) is a treatment for medial compartment knee osteoarthritis (OA). There has been much debate about which type of osteotomy is the "best." Many techniques, including medial opening wedge, lateral closing wedge, dome, and chevron-type osteotomies, have proven track records with survival rates free of conversion to total knee replacement (TKR) ranging from 85% to 93% at 8 years or more in some series. One of the main drawbacks to medial opening wedge HTO is effect on tibial slope and patellar height. These osteotomies tend to open more in the anterior aspect of the osteotomy resulting in an increased posterior tibial slope. This can lead to strain on the anterior cruciate ligament, so there is interest in avoiding this in the setting of ACL reconstruction. If there is a significant increase in posterior tibial slope, a "bony" flexion deformity might even occur. Another potential issue with medial opening wedge HTOs is change in patellar height leading to patella infera, which may negatively impact extensor mechanism and quadriceps function, and lead to altered patellofemoral contact pressures, and theoretically, even cause accelerated rates of patellofemoral OA. New patient-specific cutting guides developed with precise pre-operative planning, using computed tomography (CT), can guide everything from desired correction in one or multiple planes, to positioning of the hinge pin. The data is so precise, the cutting jigs can determine exact depth of the saw cut at each region of the bone, patient-specific plates can be pre-contoured to match the patient's bony anatomy after the osteotomy, and even the screw lengths for the plate can be determined. Initial data is quite encouraging; a lab study showed superior accuracy and decreased radiation exposure compared with traditional freehand technique.
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Affiliation(s)
- Adam V Daniel
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | | | - Bruce A Levy
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA.
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Hetta HF, Elsaghir A, Sijercic VC, Ahmed AK, Gad SA, Zeleke MS, Alanazi FE, Ramadan YN. Clinical Progress in Mesenchymal Stem Cell Therapy: A Focus on Rheumatic Diseases. Immun Inflamm Dis 2025; 13:e70189. [PMID: 40353645 PMCID: PMC12067559 DOI: 10.1002/iid3.70189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/10/2024] [Accepted: 03/21/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND Rheumatic diseases are chronic immune-mediated disorders affecting multiple organ systems and significantly impairing patients' quality of life. Current treatments primarily provide symptomatic relief without offering a cure. Mesenchymal stem cells (MSCs) have emerged as a promising therapeutic option due to their ability to differentiate into various cell types and their immunomodulatory, anti-inflammatory, and regenerative properties. This review aims to summarize the clinical progress of MSC therapy in rheumatic diseases, highlight key findings from preclinical and clinical studies, and discuss challenges and future directions. METHODOLOGY A comprehensive review of preclinical and clinical studies on MSC therapy in rheumatic diseases, including systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteoporosis, Sjögren's syndrome, Crohn's disease, fibromyalgia, systemic sclerosis, dermatomyositis, and polymyositis, was conducted. Emerging strategies to enhance MSC efficacy and overcome current limitations were also analyzed. RESULTS AND DISCUSSION Evidence from preclinical and clinical studies suggests that MSC therapy can reduce inflammation, modulate immune responses, and promote tissue repair in various rheumatic diseases. Clinical trials have demonstrated potential benefits, including symptom relief and disease progression delay. However, challenges such as variability in treatment response, optimal cell source and dosing, long-term safety concerns, and regulatory hurdles remain significant barriers to clinical translation. Standardized protocols and further research are required to optimize MSC application. CONCLUSION MSC therapy holds promise for managing rheumatic diseases, offering potential disease-modifying effects beyond conventional treatments. However, large-scale, well-controlled clinical trials are essential to establish efficacy, safety, and long-term therapeutic potential. Addressing current limitations through optimized treatment protocols and regulatory frameworks will be key to its successful integration into clinical practice.
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Affiliation(s)
- Helal F. Hetta
- Division of Microbiology, Immunology and Biotechnology, Department of Natural Products and Alternative Medicine, Faculty of PharmacyUniversity of TabukTabukSaudi Arabia
| | - Alaa Elsaghir
- Department of Microbiology and Immunology, Faculty of PharmacyAssiut UniversityAssiutEgypt
| | | | - Abdulrahman K. Ahmed
- Emergency Medicine Unit, Department of Anaethesia and Intensive Care, Faculty of MedicineAssiut UniversityAssiutEgypt
| | - Sayed A. Gad
- Emergency Medicine Unit, Department of Anaethesia and Intensive Care, Faculty of MedicineAssiut UniversityAssiutEgypt
| | - Mahlet S. Zeleke
- Menelik II Medical and Health Science CollegeAddis AbabaEthiopia
| | - Fawaz E. Alanazi
- Department of Pharmacology and Toxicology, Faculty of PharmacyUniversity of TabukTabukSaudi Arabia
| | - Yasmin N. Ramadan
- Department of Microbiology and Immunology, Faculty of PharmacyAssiut UniversityAssiutEgypt
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Lucidi GA, Di Paolo S, Adravanti FM, Maitan N, Dal Fabbro G, Naldi F, Grassi A, Zaffagnini S. Kinesiophobia and High-Impact Sport Activity Are Associated With a Reduced Rate of Return to Sport After High Tibial Osteotomy: A Risk Factor Analysis of a Young and Active Population. Am J Sports Med 2025; 53:1068-1076. [PMID: 40070113 DOI: 10.1177/03635465251322795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
BACKGROUND High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated. PURPOSE To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO. STUDY DESIGN Case series; Level of evidence, 4. METHODS Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if P < .05. RESULTS A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; P = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS (P = .015; coefficient = -0.13). CONCLUSION HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.
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Affiliation(s)
- Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Anatomy Center, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Di Paolo
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Nicolò Maitan
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Filippo Naldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Tsuboya T, Tada H. Exploring Subcutaneous Masses in the Elderly: Diagnostic Challenges. Intern Med 2025; 64:621-622. [PMID: 38925964 PMCID: PMC11904455 DOI: 10.2169/internalmedicine.3995-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Affiliation(s)
- Toru Tsuboya
- Tohoku University Graduate School of Dentistry, Japan
- Hayachine-no-sato, Japan
- Public Health Institute, Japan
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Chui EC, Mak KK, Ng RH, Fung EC, Chan M, Yue K, Lau LC, Chan CL, Yau EW, Zhao W, Su X, Zhang J, Xu J, Sang H, Pei G, Cheung LW, Law S, Ong MT, Yung PS. Computer-Aided High Tibial Osteotomy-A Comparative Study of Commonly Used 3D Printing Technology and Navigation Application. Orthop Surg 2025; 17:593-602. [PMID: 39711238 PMCID: PMC11787984 DOI: 10.1111/os.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/13/2024] [Accepted: 09/24/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND High tibial osteotomy (HTO) is a surgical procedure for treating certain knee conditions. Proper execution of HTO can preserve joint function and delay or avoid the need for total knee replacement. This study compared different 3D printing techniques (fused deposition modeling, selective laser sintering, and direct metal laser sintering) and a navigation system for their suitability in assisting HTO surgeries. METHODS Tibial saw-bones were used as models, and surgical guides and the navigation system were employed during the procedures. Six parameters (planning time, manufacturing time, delivery time, material cost, operation time, and accuracy) were evaluated. One-way analysis of variance (ANOVA) and t-test were used for the analysis. RESULTS The results showed that the metal surgical guides had the highest accuracy (angle differences mean, 2.4°) and operation time (mean 9.75 min), followed by plastic guides, classic guides, and the navigation system. The differences in accuracy were attributed to factors like rigidity, melting point, and errors during incisions. CONCLUSIONS The study recommended metal surgical guides as the best option for assisting HTO due to their accuracy and operation time. And the results have implications for orthopedic surgeons performing HTO surgeries, as they can use this information to improve postoperative outcomes, such as mechanical axis alignment and quality of life for HTO patients.
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Affiliation(s)
- Elvis Chun‐Sing Chui
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Kyle Ka‐Kwan Mak
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Randy Hin‐Ting Ng
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Ericsson Chun‐Hai Fung
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Mei‐Shuen Chan
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Kai Yue
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | | | - Clifford Long‐Fung Chan
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
- Koln 3D Technology Medical LtdHong KongChina
| | | | - Wei Zhao
- Department of OrthopaedicsSouthern University of Science and Technology HospitalShenzhenChina
| | - Xiuyun Su
- Department of OrthopaedicsSouthern University of Science and Technology HospitalShenzhenChina
| | - Jin Zhang
- Department of OrthopaedicsShenzhen Hospital of Southern Medical UniversityShenzhenChina
| | - Jianglong Xu
- Department of OrthopaedicsShenzhen Children's HospitalShenzhenChina
| | - Hongxun Sang
- Department of OrthopaedicsShenzhen Hospital of Southern Medical UniversityShenzhenChina
| | - Guoxian Pei
- Department of OrthopaedicsSouthern University of Science and Technology HospitalShenzhenChina
| | - Louis Wing‐Hoi Cheung
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Sheung‐Wai Law
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Michael Tim‐Yun Ong
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
| | - Patrick Shu‐Hang Yung
- Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongHong KongChina
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Kaibara T, Yasuda K, Kondo E, Yabuuchi K, Onodera J, Iwasaki N, Yagi T. Quantitative Technique to Precisely Fix the Tibia With a Locking Compression Plate at the Preoperatively Planned Correction Angle While Applying High Compression to the Osteotomy Site in Inverted V-Shaped High Tibial Osteotomy. Arthrosc Tech 2025; 14:103229. [PMID: 40041368 PMCID: PMC11873556 DOI: 10.1016/j.eats.2024.103229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/20/2024] [Indexed: 03/06/2025] Open
Abstract
In high tibial osteotomy (HTO) fixed with a locking compression plate (LCP), overcorrection or under-correction of knee alignment frequently occurs because the LCP applies not only proximal displacement but also valgus rotation to the distal tibia. We have developed a quantitative technique to precisely fix the tibia with the LCP at the preoperatively planned correction angle in inverted V-shaped HTO. Preoperatively, simulation of the HTO using the LCP is performed with a radiograph, and the distance of the most proximal locking screw from the articular surface is measured. During surgery, a marker wire is precisely inserted into the proximal tibia at the preoperatively planned position of the most proximal locking screw. By inserting the first screw along this marker wire, the LCP is precisely installed on the proximal tibia at the planned position. Then, a compression screw is inserted into the distal tibia through the LCP. This screw pulls the distal tibia toward the distal part of the LCP while applying proximal displacement and valgus rotation. Thus, the tibia is precisely fixed at the planned correction angle.
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Affiliation(s)
- Takuma Kaibara
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Yasuda
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Yabuuchi
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Jun Onodera
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomonori Yagi
- Knee Research Center, Yagi Orthopaedic Hospital, Sapporo, Japan
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Bayrak HC, Adiguzel IF, Demir M, Karagöz B, Ordu S. Comparative outcomes of proximal fibular osteotomy versus high tibial osteotomy in patients with medial knee osteoarthritis: A retrospective analysis. Acta Orthop Belg 2024; 90:629-638. [PMID: 39869866 DOI: 10.52628/90.4.12000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2025]
Abstract
High tibial osteotomy (HTO) is a widely used procedure for delaying knee arthroplasty, correcting alignment, and relieving symptoms in patients with knee osteoarthritis. Recently, proximal fibular osteotomy (PFO) has emerged as a less invasive and more cost-effective alternative. This study compares the outcomes of HTO and PFO to evaluate whether PFO can deliver results comparable to HTO in similar patient populations. A total of 96 patients treated between 2018 and 2022 were analyzed, with 54 patients undergoing HTO and 42 undergoing PFO. Subgroups were also created based on body mass index (BMI): non-obese HTO, obese HTO, non-obese PFO, and obese PFO. For each patient, we recorded demographic data, preoperative and 1-year postoperative Oxford Knee Scores (OKS), visual analog scale (VAS) scores, medial joint space (MJS) measurements, mechanical axis deviations (MAD), Kellgren- Lawrence grade (KL), medial proximal tibial angle (MPTA), and any complications. Both HTO and PFO led to significant improvements in OKS, VAS, MJS width, and MAD. Age, KL grade distribution, BMI, and MPTA values were comparable across the groups. Overall, HTO showed superior clinical (OKS, VAS) and radiological (MJS, MAD) outcomes, particularly in non-obese patients. Among obese patients, HTO and PFO achieved similar clinical improvements, although HTO maintained a radiological advantage. Importantly, a lower preoperative MPTA was associated with poorer clinical outcomes in the PFO group. In conclusion, while PFO can produce meaningful clinical and radiological improvements, HTO remains the more effective option in terms of both clinical and radiological outcomes in patients with a BMI below 30. For patients with a BMI over 30, HTO preserves its radiological superiority, although its clinical benefits are comparable to those of PFO. Additionally, a low preoperative MPTA is significantly linked to worse OKS scores in patients undergoing PFO.
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Hanada M, Hotta K, Matsuyama Y. Femoral trochlear groove cartilage damage after open-wedge high tibial osteotomy is associated with the change in patellar height relative to the femoral condyle. Orthop Traumatol Surg Res 2024; 110:103898. [PMID: 38663741 DOI: 10.1016/j.otsr.2024.103898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/28/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Medial open-wedge high tibial osteotomy (OWHTO) is performed for isolated medial compartment osteoarthritis or osteonecrosis of the knee and correction of varus deformity of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO. HYPOTHESIS The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes. PATIENTS AND METHODS Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices. RESULTS Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with>1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53×10-14-0.812, p=0.047). PF cartilage damage tended to progress in ΔMBI<-0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (p=0.037 and 0.038, respectively). DISCUSSION The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Higashi-ku, 431-3192, Japan.
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Higashi-ku, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Higashi-ku, 431-3192, Japan
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Debopadhaya S, Acosta E, Ortiz D. Trends and outcomes in the surgical management of young adults with knee osteoarthritis using high tibial osteotomy and unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:3995-4002. [PMID: 38771360 DOI: 10.1007/s00402-024-05362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION A significant portion of knee osteoarthritis is diagnosed in patients under the age of 55, where greater activity demands make total knee arthroplasty less desirable. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are useful alternatives, but there is little understanding of which procedure is advantageous. Hence, this study examines the utilization, complication, and reoperation rates among the HTO vs. UKA in young patients with primary osteoarthritis. METHODS A retrospective review of the National Surgical Quality Improvement Program was performed to identify 2318 patients < 55 years of age who received either a HTO or UKA for primary osteoarthritis between 2011 and 2021. Bivariate analyses compared preoperative and intraoperative characteristics among each procedure. Then, multivariate analyses examined if either procedure was associated with worse 30-day postoperative complications or need for reoperation, independent of the statistically significant pre- and intraoperative disparities. RESULTS UKAs were performed 14.2 times more commonly than HTOs, and the patients selected for HTO were more likely to be younger, have a lower BMI, have the healthiest ASA Class score, and less likely to have hypertension requiring medication (p < 0.001). HTOs took 17.5% longer to perform and had a longer average length of stay (p < 0.001), while UKAs were more likely to be performed out-patient (p < 0.001). HTOs also had higher rates of serious complications (p = 0.02), overall complications (p = 0.004), and need for reoperation (p = 0.004). Multivariate modelling demonstrated that procedure type was not a predictor of serious complications, but the use of HTO was significantly associated with any complications (odds ratio = 3.63, p = 0.001) and need for reoperation (3.21, p = 0.029). CONCLUSION Although healthier patients were selected for HTOs, UKAs were found to have a lower risk of complications and immediate reoperation. Additionally, UKAs had the advantage of lower operative burden, shorter length of stay, and a higher efficacy in outpatient settings.
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Affiliation(s)
- Shayom Debopadhaya
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA
| | - Ernesto Acosta
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA
| | - Dionisio Ortiz
- Department of Orthopaedics, Albany Medical College, 49 New Scotland Ave, Albany, NY, 12208, USA.
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Longo UG, Mazzola A, Campi S, Salvatore G, Candela V, Casciaro C, Giannarelli D, D’Hooghe M, Papalia R. Annual Trends of High Tibial Osteotomy: Analysis of an Official Registry in Italy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1168. [PMID: 39064599 PMCID: PMC11279272 DOI: 10.3390/medicina60071168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50-54, 55-59 showed the higher number of procedures. In pediatric patients (0-19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were "Varus knee" (736.42 ICD-9-CM code, 33.9%), "Osteoarthrosis, localized, primary, leg region" (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20-24 age class to the 50-54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Giuseppe Salvatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Carlo Casciaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Margaux D’Hooghe
- Department of Medicine, University of Navarra, 31008 Pamplona, Spain;
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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Edward J, Al-Shakfa F, Newman N, Lavoie F. Intrafocal injection of tranexamic acid decreases early return to hospital after high tibial osteotomy. Arch Orthop Trauma Surg 2024; 144:3017-3024. [PMID: 38940983 DOI: 10.1007/s00402-024-05411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION High tibial osteotomy (HTO) is a surgery performed to treat the symptoms and prevent the progression of medial osteoarthritis. Post-operative bleeding has led to early returns to hospital following surgery. Intrafocal injection of tranexamic acid (TXA) could reduce this bleeding complication. The objective of the study was to evaluate the effect of TXA during HTO on the incidence of post-operative complications and early returns to hospital. MATERIALS AND METHODS This retrospective study included 251 cases of HTO performed between May 2012 and October 2021, with the use of TXA introduced in May 2017. The experimental (n = 102) and control (n = 149) groups were compared as to the rate of post-operative early returns. The influence of confounding factors was evaluated, including age, sex, body mass index (BMI), tobacco use, grade of medial femorotibial osteoarthritis (MFTO), magnitude of angular correction (MAC), and surgery duration. RESULTS No statistically significant difference was found between the groups with regards to all variables except age. The experimental group was significantly older (54.4 years; σ = 7.5) than the control group (50.4 years; σ = 7.9; p < 0.001). We observed a decrease in emergency department (ED) visits in the experimental group (15.7%) compared to the control (30.2%; p = 0.008) and a decrease in early returns in the experimental group (28.4%) compared to the control (40.5%; p = 0.049). No statistically significant difference in demographic data, MFTO, or MAC was found among patients with and without an early return, in both the experimental and control groups. CONCLUSION The intrafocal injection of TXA during HTO decreases early returns to hospital.
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Affiliation(s)
- Julia Edward
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada.
| | - Fidaa Al-Shakfa
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada
| | - Nicholas Newman
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada
| | - Frédéric Lavoie
- CHUM Research Centre, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, 1000, rue St- Denis, Montréal, Québec, H2X 0C1, Canada
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Olivieri R, Laso J, Pineda T, Albornoz P, Starocelsky N, Franulic N, Ugarte J. Patients aged 55 or older undergoing around the knee osteotomy have a higher rate of deep vein thrombosis but not overall early post-operative complications. J Exp Orthop 2024; 11:e70023. [PMID: 39314810 PMCID: PMC11417343 DOI: 10.1002/jeo2.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose Osteotomies around the knee have been established as an effective method for treating varus or valgus malalignment associated with other knee pathologies in young and middle-aged patients. There is limited literature regarding the risks and complications based on patient age. The purpose of this study is to determine whether age influences as a risk factor for developing intraoperative and early post-operative complications in patients undergoing osteotomies around the knee. Methods A consecutive series of patients over 18 years old who underwent distal femoral osteotomy (DFO) or high tibial osteotomy (HTO) with a minimum follow-up period of 90 days were included. Demographic characteristics, surgical technique, intraoperative and post-operative complications up to 90 days were identified. A statistical comparison based on age younger than 55 years or 55 years and older was conducted to determine if patient age acted as a risk factor in the development of complications. Results A total of 159 osteotomies were included, of which 129 were HTOs. The average age was 46.16 years, and 118 patients were younger than 55 years. Seven hinge fractures were identified as the only intraoperative complication, while the overall early post-operative complication rate was 11.32%. The most frequent was deep venous thrombosis (DVT) in 5.66% of cases, followed by deep infection with a total rate of 2.52%. When performing the subgroup analysis by age, we observed a significantly higher rate of DVT in the group aged 55 years and older (p 0.036) (odds ratio 3.96 95% confidence interval 1.009-15.533; p 0.048); however, no significant differences were observed in the overall complication rate according to the age group of the patients. Conclusions This study reveals that in patients undergoing osteotomies around the knee, the most common post-operative complication was DVT. The rate of DVT was significantly higher in patients aged 55 years and older, although no differences were observed in the overall complication rate according to the patients' age range. Level of evidence Level III (retrospective cohort study).
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Affiliation(s)
- Rodrigo Olivieri
- Department of Orthopedic SurgeryKnee Unit, Hospital del Trabajador ‐ ACHSSantiagoChile
| | - José Laso
- Department of Orthopedic SurgeryKnee Unit, Hospital del Trabajador ‐ ACHSSantiagoChile
- Hospital Barros Luco TrudeauSantiagoChile
| | - Tomás Pineda
- Department of Orthopedic SurgeryKnee Unit, Hospital del Trabajador ‐ ACHSSantiagoChile
- Hospital El CarmenSantiagoChile
| | - Pablo Albornoz
- Universidad Andres Bello, Medicina, Facultad de MedicinaSantiagoChile
| | | | - Nicolás Franulic
- Department of Orthopedic SurgeryKnee Unit, Hospital del Trabajador ‐ ACHSSantiagoChile
- Hospital Militar de SantiagoSantiagoChile
| | - Jaime Ugarte
- Department of Orthopedic SurgeryKnee Unit, Hospital del Trabajador ‐ ACHSSantiagoChile
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Miyama K, Akiyama T, Bise R, Nakamura S, Nakashima Y, Uchida S. Development of an automatic surgical planning system for high tibial osteotomy using artificial intelligence. Knee 2024; 48:128-137. [PMID: 38599029 DOI: 10.1016/j.knee.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND This study proposed an automatic surgical planning system for high tibial osteotomy (HTO) using deep learning-based artificial intelligence and validated its accuracy. The system simulates osteotomy and measures lower-limb alignment parameters in pre- and post-osteotomy simulations. METHODS A total of 107 whole-leg standing radiographs were obtained from 107 patients who underwent HTO. First, the system detected anatomical landmarks on radiographs. Then, it simulated osteotomy and automatically measured five parameters in pre- and post-osteotomy simulation (hip knee angle [HKA], weight-bearing line ratio [WBL ratio], mechanical lateral distal femoral angle [mLDFA], mechanical medial proximal tibial angle [mMPTA], and mechanical lateral distal tibial angle [mLDTA]). The accuracy of the measured parameters was validated by comparing them with the ground truth (GT) values given by two orthopaedic surgeons. RESULTS All absolute errors of the system were within 1.5° or 1.5%. All inter-rater correlation confidence (ICC) values between the system and GT showed good reliability (>0.80). Excellent reliability was observed in the HKA (0.99) and WBL ratios (>0.99) for the pre-osteotomy simulation. The intra-rater difference of the system exhibited excellent reliability with an ICC value of 1.00 for all lower-limb alignment parameters in pre- and post-osteotomy simulations. In addition, the measurement time per radiograph (0.24 s) was considerably shorter than that of an orthopaedic surgeon (118 s). CONCLUSION The proposed system is practically applicable because it can measure lower-limb alignment parameters accurately and quickly in pre- and post-osteotomy simulations. The system has potential applications in surgical planning systems.
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Affiliation(s)
- Kazuki Miyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan; Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka 819-0395, Japan; Akiyama Clinic, 2-28-39, Noke, Sawaraku, Fukuoka City, Fukuoka 814-0171, Japan.
| | - Takenori Akiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan; Akiyama Clinic, 2-28-39, Noke, Sawaraku, Fukuoka City, Fukuoka 814-0171, Japan
| | - Ryoma Bise
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
| | - Shunsuke Nakamura
- Akiyama Clinic, 2-28-39, Noke, Sawaraku, Fukuoka City, Fukuoka 814-0171, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
| | - Seiichi Uchida
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
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Mabrouk A, Risebury M, Yasen S. High survivorship and low complication rate in a single-centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow-up of 13 years. Knee Surg Sports Traumatol Arthrosc 2024; 32:736-749. [PMID: 38410856 DOI: 10.1002/ksa.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single-centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient-reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively. METHODS A prospectively maintained single-centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2 , were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow-up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score-Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ-5D, which is a standardised measure of health-related quality of life. All lower limb alignment measurements were recorded pre- and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5- and 10-year survivorship were recorded. RESULTS A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from -5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow-up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10-year survivorship was 97.2% and 91.9%, respectively. CONCLUSION MOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Michael Risebury
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Sam Yasen
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Kawde K, Pisulkar G, Salwan A, Jayasoorya A, Jadawala VH, Taywade S. A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint. Cureus 2024; 16:e56666. [PMID: 38646379 PMCID: PMC11032692 DOI: 10.7759/cureus.56666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.
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Affiliation(s)
- Kevin Kawde
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ankur Salwan
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Adarsh Jayasoorya
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vivek H Jadawala
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shounak Taywade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Weltsch D, Juels M, Chen KY, Talathi N, Silva M, Thompson RM. Closing-wedge Osteotomies: Can We Do and Teach Better? J Pediatr Orthop 2024; 44:174-178. [PMID: 38009049 DOI: 10.1097/bpo.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Wedge osteotomies are ubiquitous in pediatric orthopaedics and limb deformity surgery; however, there is no universally preferred methodology for these procedures. This study aims to determine the relative accuracy and effectiveness of several measuring and marking methods to guide best practices for wedge-shaped osteotomies in long bones. METHODS An observational cohort study was completed. Orthopaedic residents (postgraduate years 1 to 5) completed 30-degree wedge osteotomies on a sawbone (Pacific Research Lab) femur utilizing a standard oscillating saw under 3 measuring conditions: (1) no measurement tool, (2) 30-degree triangle, and (3) goniometer, in combination with 2 different marking methods: (1) marking pen or (2) pin placement. Demographic characteristics and osteotomy performance (quality, completion time, and accuracy) were assessed. Quality was ranked as perfect (1), mild step-off (2), or gross surface irregularity (3). Multivariate regressions and analysis of variance were performed comparing demographics, osteotomy performance, and measuring methods. RESULTS Twenty-four residents were included for analysis; 6 were female (25%). Female sex was independently associated with longer completion time when evaluating all combined scenarios (138 vs. 99 s, P =0.003) without differences in surface quality or angle accuracy. There were no significant associations between measuring technique and accuracy or surface quality, but use of the goniometer and the triangle both were associated with significantly longer completion time compared with no visual aid ( P =0.002 and 0.007). When controlling for measuring technique, use of the pen as a marking technique had significantly shorter completion times ( P <0.001), higher surface quality ( P <0.001), and better accuracy ( P <0.001) than guide pins. CONCLUSIONS We recommend the use of a marking pen in combination with the surgeon's preferred measuring guide to optimize trainees' performance of closing wedge osteotomies. Future research is necessary to corroborate these findings in a higher fidelity setting, such as a cadaveric study. Further, while male residents complete wedge osteotomies quicker than female residents, quality and accuracy are comparable among trainees. Slower pace should not be conflated with poor performance but rather should inform effective intraoperative teaching for diverse trainees.
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Affiliation(s)
- Daniel Weltsch
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Tel Hashomer
- UCLA David Geffen School of Medicine
| | | | | | - Nakul Talathi
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mauricio Silva
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rachel M Thompson
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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18
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Gengatharan D, Saggi SS, Bin Abd Razak HR. Pre-operative Planning of High Tibial Osteotomy With ChatGPT: Are We There Yet? Cureus 2024; 16:e54858. [PMID: 38533173 PMCID: PMC10964394 DOI: 10.7759/cureus.54858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION ChatGPT (Chat Generative Pre-trained Transformer), developed by OpenAI (San Francisco, CA, USA), has gained attention in the medical field. It has the potential to enhance and simplify tasks, such as preoperative planning in orthopedic surgery. We aimed to test ChatGPT's accuracy in measuring the angle of correction for high tibial osteotomy for cases planned and performed at a tertiary teaching hospital in Singapore. MATERIALS AND METHODS Peri-operative angular parameters from 114 consecutive patients who underwent medial opening wedge high tibial osteotomy (MOWHTO) were used to query ChatGPT 3.0. First ChatGPT 3.0 was queried on what information it required to plan a MOWHTO. Based on its response, pre-operative medial proximal tibial angle (MPTA) and joint line congruence angle (JLCA) were provided. ChatGPT 3.0 then responded with its recommended angle of correction. This was compared against the manually planned surgical correction by our fellowship-trained surgeon. A root mean square analysis was then performed to compare ChatGPT 3.0 and manual planning. RESULTS The root mean square error (RMSE) of ChatGPT 3.0 in predicting correction angle in MWHTO was 2.96, suggesting a very poor model fit. CONCLUSION Although ChatGPT 3.0 represents a significant breakthrough in large language models with extensive capabilities, it is not currently optimized to effectively perform complex pre-operative planning in orthopedic surgery, specifically in the context of MOWHTO. Further refinement and consideration of specific factors are necessary to enhance its accuracy and suitability for such applications.
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Affiliation(s)
| | | | - Hamid Rahmatullah Bin Abd Razak
- Musculoskeletal Sciences, Duke-Nus Medical School, Singapore, SGP
- Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
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19
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Ding H, Zhang J, Jiang C. A commentary on "Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials" [Int J Surg 60 (2018) 153-163]. Int J Surg 2024; 110:637-642. [PMID: 37889582 PMCID: PMC10871640 DOI: 10.1097/js9.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Affiliation(s)
| | | | - Chang Jiang
- Department of Orthopedic Surgery, The First People’s Hospital of Wenling, Wenzhou Medical University Affiliated Wenling Hospital, Wenling, Zhejiang, People’s Republic of China
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Oh BH, Seo KD, Heo YM, Kim TK, Choi JK, Song JH. Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4878-4885. [PMID: 37572140 DOI: 10.1007/s00167-023-07531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Changes in coronal and sagittal alignment of the knee joint after HTO have been reported in several previous studies. However, only few of them investigated the changes only on coronal alignment of the ankle joint. The purpose of this study was to investigate changes in both coronal and sagittal alignment of the ankle joint after HTO. METHODS 46 patients (49 cases) who underwent HTO were retrospectively analyzed. Preoperative and postoperative lower extremity scanogram and EOS imaging system were investigated. The hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and knee tibia plafond angle (KTPA) were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), talar tilt (TT), tibial plafond inclination (TPI), and ankle joint axis point on the weight-bearing-line (AAWBL) ratio were measured by scanogram to investigate coronal alignment of the ankle. Knee lateral ankle surface angle (KLAS) and tibial lateral surface angle (TLS) were measured by EOS to evaluate sagittal alignment of the ankle. RESULTS Varus alignment of the knee was corrected by significant change of the HKA angle (5.8 ± 3.1° vs. - 2.1 ± 2.8°, p < 0.001), MPTA (85.7 ± 2.9° vs. 91.7 ± 3.3°, p < 0.001), and KTPA (5.0 ± 3.5° vs. - 2.1 ± 4.2°, p < 0.001) after HTO. Regarding the ankle coronal alignment, there was significant change in TPI (3.9 ± 3.4° vs. - 0.9 ± 3.8°, p < 0.001) and AAWBL ratio (45.5 ± 14.7% vs. 61.6 ± 13.3%, p < 0.001). In sagittal alignment of the ankle, KLAS (4.5 ± 3.1° vs. 7.7 ± 3.7°, p < 0.001) significantly increased. Among the variables, the amount of correction in AAWBL ratio (R = 0.608, p < 0.01) showed strongest relationship with tibial correction angle. CONCLUSION Based on the present study, coronal and sagittal alignment of ankle joint was significantly affected by HTO. After HTO, AAWBL ratio increased due to lateralization of the ankle joint axis, and KLAS increased due to increased posterior tibial slope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Byung Hak Oh
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Kyung Deok Seo
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Tae Kyun Kim
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Jae Kyu Choi
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
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21
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Kazemi SM, Keyhani S, Sadighi M, Hosseininejad SM. Navigation of femoral and popliteal artery around the knee with CT angiography: implications for surgical interventions. Surg Radiol Anat 2023; 45:1515-1523. [PMID: 37733017 DOI: 10.1007/s00276-023-03241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Uncertainty about the exact position of the femoral and popliteal arteries in the medial thigh and posterior knee might increase vascular complications in surgical procedures. This study aimed to document femoral and popliteal arteries in the medial thigh and around the knee to assist surgeons in developing safer surgical approaches. METHODS The study included 120 patients-180 lower limbs-who underwent CT angiography (CTA) of the lower extremity. The distance from the femoral artery to the anterior border, midsagittal axis, and posterior border of the femur and the popliteal artery to the medial, lateral, and midpoint posterior cortex of the proximal tibia was measured in two- and three-dimensional CTA images. RESULTS The femoral artery was found to be on average 236.93 ± 29.61 mm, 195.34 ± 26.12 mm, and 146.28 ± 33.18 mm away from the adductor tubercle at the anterior, midsagittal axis, and posterior borders of the femur, correspondingly. The popliteal artery was to be located on average 5.40 ± 2.50 mm posterior to the midpoint of the plateau tibia at the joint line. CONCLUSION Considering the mentioned femoral/popliteal artery distances to the femur and proximal tibia would direct surgeons to the safe zones for more accurate surgical approaches in the medial thigh and around the knee when performing osteotomies, knee arthroplasty, arthroscopy, and trauma surgeries, to reduce possible vascular damages. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seyyed-Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Keyhani
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed-Mohsen Hosseininejad
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Joint, Bone, Connective Tissue Rheumatology Research Center (JBCRC), Golestan University of Medical Sciences, Gorgan, Iran.
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22
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Mochizuki H, Yoshioka T, Kikuchi N, Yamazaki M. Bilateral Knee Osteoarthritis Treated With Medial Open-Wedge High Tibial Osteotomy Using Two Types of β-Tricalcium Phosphate With Differing Placements in Each Knee: A Report of Two Cases. Cureus 2023; 15:e45427. [PMID: 37859897 PMCID: PMC10581886 DOI: 10.7759/cureus.45427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/21/2023] Open
Abstract
In medial open-wedge high tibial osteotomy (MOWHTO) for knee osteoarthritis, synthetic bone is commonly used as a replacement material for the opening gap. Unidirectional porous β-tricalcium phosphate (UDPTCP) and spherical porous β-tricalcium phosphate (SPTCP) have been widely used in this regard. In general, the two prostheses are placed parallel to the osteotomy opening gap. In this report, we discuss two cases involving a 63-year-old woman and a 51-year-old man who underwent MOWHTO for bilateral knee osteoarthritis. Both patients had experienced bilateral knee pain. In both patients, UDPTCP was placed anteriorly and SPTCP was placed posteriorly in one knee, with the placement reversed in the other knee. The remodeling of each type of β-TCP was evaluated using CT immediately after the surgery and one year postoperatively. The postoperative corrective loss and clinical outcomes were also evaluated. Remodeling with β-TCP was found to be faster with UDPTCP than with SPTCP, even though the anteroposterior placement differed laterally in each patient. Furthermore, there was no correction loss, and the clinical outcomes were comparable, regardless of the placement of β-TCP.
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Affiliation(s)
- Hiromi Mochizuki
- Department of Orthopaedic Surgery, Tsukuba Central Hospital, Ushiku, JPN
| | - Tomokazu Yoshioka
- Division of Regenerative Medicine for Musculoskeletal System, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Naoya Kikuchi
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
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23
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Yoo HJ, Choi JK, Heo YM, Moon SJ, Oh BH. Changes in Parameters after High Tibial Osteotomy: Comparison of EOS System and Computed Tomographic Analysis. J Clin Med 2023; 12:5638. [PMID: 37685705 PMCID: PMC10488862 DOI: 10.3390/jcm12175638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differences between the changes in lower limb alignment profiles obtained using the EOS system and CT in patients who underwent MOWHTO. We investigated whether any factors contributed to the degree of deformation. Thirty patients were prospectively enrolled between October 2019 and February 2023. Changes in femoral and tibial torsion, femorotibial rotation, and posterior tibial slope were measured using pre- and post-MOWHTO CT and EOS images. We found no significant difference in pre- and postoperative tibial torsion or posterior tibial slope between CT and EOS. No variables showed a significant correlation with changes in the tibial torsion or posterior tibial slope. This study confirmed the possibility that the EOS system could replace CT in measuring changes in several parameters pre- and postoperatively. Furthermore, we confirmed that the distal tibia tended to be internally rotated after MOWHTO; however, we found no significantly related parameters related to deformation caused by MOWHTO.
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Affiliation(s)
| | | | | | | | - Byung-Hak Oh
- Department of Orthopedic Surgery, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea; (H.-J.Y.); (J.-K.C.); (Y.-M.H.); (S.-J.M.)
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24
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Kim TW, Won JS. Anatomical Study of the Lateral Tibial Spine as a Landmark for Weight Bearing Line Assessment during High Tibial Osteotomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1571. [PMID: 37763690 PMCID: PMC10533072 DOI: 10.3390/medicina59091571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Background: Accurate pre-operative planning is essential for successful high tibial osteotomy (HTO). The lateral tibial spine is a commonly used anatomical landmark for weight-bearing line assessment. However, studies on the mediolateral (M-L) position of the lateral tibial spine on the tibial plateau and its variability are limited. Purpose: This study aimed to (1) analyze the M-L position of the lateral tibial spine on the tibial plateau and its variability, (2) investigate radiologic parameters that affect the position of the lateral tibial spine, and (3) determine whether the lateral tibial spine can be a useful anatomical landmark for weight-bearing line assessment during HTO. Materials and Methods: Radiological evaluation was performed on 200 participants (64% female, mean age 42.3 ± 13.2 years) who had standing anterior-posterior plain knee radiographs with a patellar facing forward orientation. The distances from the medial border of the tibial plateau to the lateral spine peak (dLSP) and lateral spine inflection point (dLSI) were measured using a picture archiving and communication system. The medial-lateral inter-spine distance (dISP) was also measured. All parameters were presented as percentages of the entire tibial plateau width. The relationships between the parameters were also investigated. Results: The mean value of dLSP was 56.9 ± 2.5 (52.4-64.5)%, which was 5% lower than the Fujisawa point (62%). The mean value of dLSI was 67.9 ± 2.2 (63.4-75.8)%, which was approximately 5% higher than the Fujisawa point. The values of the dLSP and dLSI were variable among patients, and the upper and lower 10% groups showed significantly higher and lower dLSP and dLSI, respectively, than the middle 10% group. The mean value of dISP was 16.5 ± 2.4%, and it was positively correlated with dLSP and dLSI. Conclusions: On average, the dLSP and dLSI were located -5% and +5% laterally from the conventional Fujisawa point, and they may be useful landmarks for correction amount adjustment during HTO. However, it should be noted that correction based on the lateral tibial spine can be affected by anatomical variations, especially in patients with small or large inter-spine distances.
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Affiliation(s)
- Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea;
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25
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Neubauer M, Reinberger EM, Dammerer D, Moser LB, Neugebauer J, Gottsauner-Wolf F, Nehrer S. Unicompartmental Knee Arthroplasty Provides Superior Clinical and Radiological Outcomes Compared to High Tibial Osteotomy at a Follow-Up of 5-8 Years. J Clin Med 2023; 12:5387. [PMID: 37629429 PMCID: PMC10455152 DOI: 10.3390/jcm12165387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Knee Osteoarthritis (OA) is a debilitating disease. Initially, the medial compartments are affected in most cases. For this pathology, joint preservation is preferable. Two surgical procedures aim to meet this goal: high-tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). The aim was to compare clinical and radiological outcomes of HTO versus UKA in patients with unicompartmental, medial OA. METHOD Retrospective case series. A total of 86 (61 UKA, 25 HTO) patients that received either treatment at a single, specialized center were assessed pre-operatively and at a single follow-up examination at 77.13 months (±8.170). The Knee Society Score (KSS), range of motion (ROM), SF36 questionnaire and the Tegner score were used. The Kellgren-Lawrence score was assessed pre- and post-surgically. Survivorship with the endpoint "revision" was assessed. RESULTS The UKA group showed significantly better improvements in KSS scores for pain (p < 0.006) and function (p < 0.001). OA progression (p < 0.02) and survivorship (p < 0.018) differed, significantly favoring UKA. ROM, SF36 and Tegner score did not differ significantly. CONCLUSIONS The presented mid-to long-term data suggest that UKA provides superior results in selected outcomes. Nevertheless, significant differences in the demographics of treatments indicate the challenge of comparing these two treatments.
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Affiliation(s)
- Markus Neubauer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Eva-Maria Reinberger
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Dietmar Dammerer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Lukas B. Moser
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Johannes Neugebauer
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Florian Gottsauner-Wolf
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
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26
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Diduch DR, Crawford DC, Ranawat AS, Victor J, Flanigan DC. Implantable Shock Absorber Provides Superior Pain Relief and Functional Improvement Compared With High Tibial Osteotomy in Patients with Mild-to-Moderate Medial Knee Osteoarthritis: A 2-Year Report. Cartilage 2023; 14:152-163. [PMID: 36823955 PMCID: PMC10416201 DOI: 10.1177/19476035231157335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Up to 10 million Americans below the age of 65 years have symptomatic knee osteoarthritis (OA) and may not yet be candidates for arthroplasty. In response, a subcutaneous implantable shock absorber (ISA) that unloads the knee has been developed. The safety and effectiveness of ISA treatment were compared against a surgical unloading control, high tibial osteotomy (HTO). DESIGN This was a prospective open-label cohort study with a historical control arm. Subjects underwent ISA placement or HTO. The primary endpoint was a composite variable combining pain, function, specific adverse events, integrity of implant or hardware, and conversion to subsequent surgery. Pain and function outcomes (Western Ontario and McMaster Universities Arthritis Index scores) were assessed through 24 months. Adverse events were tracked. RESULTS The primary endpoint demonstrated superiority of the ISA arm versus the HTO arm, with 85.6% of ISA subjects meeting all criteria compared with 65.5% of HTO subjects. In addition, all 5 secondary endpoints showed superiority of ISA over HTO. At 24 months, the proportions of subjects considered responders were 95.8% (ISA) versus 87.9% (HTO) for pain and 91.7% (ISA) versus 81.3% (HTO) for function. The ISA procedure was well tolerated, with 13.4 days to full weightbearing status versus 58.0 days for the HTO arm. CONCLUSIONS Treatment with an ISA demonstrated noninferiority and superiority versus treatment with HTO in subjects aged 25-65 years who had OA of the medial knee. Treatment with ISA has high clinical benefit and is durable through at least 24 months.
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Affiliation(s)
- David R. Diduch
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA
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Thoene M, Bejer-Olenska E, Wojtkiewicz J. The Current State of Osteoarthritis Treatment Options Using Stem Cells for Regenerative Therapy: A Review. Int J Mol Sci 2023; 24:ijms24108925. [PMID: 37240271 DOI: 10.3390/ijms24108925] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Articular cartilage has very low metabolic activity. While minor injuries may be spontaneously repaired within the joint by chondrocytes, there is very little chance of a severely impaired joint regenerating itself when damaged. Therefore, any significant joint injury has little chance of spontaneously healing without some type of therapy. This article is a review that will examine the causes of osteoarthritis, both acute and chronic, and how it may be treated using traditional methods as well as with the latest stem cell technology. The latest regenerative therapy is discussed, including the use and potential risks of mesenchymal stem cells for tissue regeneration and implantation. Applications are then discussed for the treatment of OA in humans after using canine animal models. Since the most successful research models of OA were dogs, the first applications for treatment were veterinary. However, the treatment options have now advanced to the point where patients suffering from osteoarthritis may be treated with this technology. A survey of the literature was performed in order to determine the current state of stem cell technology being used in the treatment of osteoarthritis. Then, the stem cell technology was compared with traditional treatment options.
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Affiliation(s)
- Michael Thoene
- Department of Medical Biology, School of Public Health, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland
| | - Ewa Bejer-Olenska
- Department of Pathophysiology, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
| | - Joanna Wojtkiewicz
- Department of Pathophysiology, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
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28
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Sakai M, Akasaki Y, Akiyama T, Horikawa T, Okazaki K, Hamai S, Tsushima H, Kawahara S, Kurakazu I, Kubota K, Mizu-Uchi H, Nakashima Y. Similar short-term KOOS between open-wedge high tibial osteotomy and total knee arthroplasty in patients over age 60: A propensity score-matched cohort study. Mod Rheumatol 2023; 33:623-628. [PMID: 35652607 DOI: 10.1093/mr/roac052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/28/2022] [Accepted: 05/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of the present study was to evaluate improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) after open-wedge high tibial osteotomy (HTO) in comparison with total knee arthroplasty (TKA) in cohorts over age 60 matched by pre-operative age, gender, body mass index (BMI), hip-knee-ankle angle (HKAA), KOOS sub-scores, and osteoarthritis (OA) grade. METHODS Propensity score matching was performed between 162 HTO patients and 134 TKA patients. When calculating the propensity score by multivariate logistic regression analysis, the following pre-operative confounders were included: age, gender, BMI, HKAA, KOOS sub-scores, and OA grade. Consequently, a total of 55 patients were included in each group. The Student's t-test was used to analyse differences in the post-operative KOOS sub-scores between groups. RESULTS After propensity score matching, all matched pre-operative valuables were identical, with no significant differences between the HTO and TKA groups. None of the post-operative KOOS sub-scores at 1 year after surgery showed a significant difference between the HTO and TKA groups. Both groups demonstrated significant and comparable post-operative improvement in every KOOS sub-score. CONCLUSIONS In patients over age 60, there was no significant difference in short-term pain relief and improvements in activity and quality of life between HTO and TKA after propensity score matching including pre-operative age, KOOS sub-scores, and OA grade. HTO is a joint preservation procedure that is valid for knee OA even in individuals over age 60.
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Affiliation(s)
- Mamiko Sakai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Tomohiro Horikawa
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Kumamoto Saishun Medical Center, Koshi, Kumamoto, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Ichiro Kurakazu
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Kenji Kubota
- Department of Orthopaedic Surgery, Omuta Tenryo Hospital, Omuta, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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Collins LK, Waters TL, Cole MW, Wang CX, Pontius UR, Sommi C, Sherman WF. Incidence and Trends of High Tibial Osteotomy and Unicompartmental Knee Arthroplasty Over the Past Decade: A Lost Art. Arthroplast Today 2023; 20:101121. [PMID: 36938354 PMCID: PMC10014255 DOI: 10.1016/j.artd.2023.101121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/21/2023] Open
Abstract
Background After failed nonoperative treatment, unicompartmental osteoarthritis can be treated surgically by either unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO). The purpose of this retrospective study is to analyze utilization and demographic trends of UKA and HTO relative to total knee arthroplasty (TKA) over the past decade. Methods A retrospective review was conducted using the PearlDiver database. Patients that received a UKA or HTO were identified. Trend analyses of surgical procedure utilization were performed with the Mann-Kendall trend test. Demographic data and the rates of various comorbidities were also queried. Results A total of 103,465 UKAs, 2183 HTOs, and 1,413,425 TKAs, between 2010 and 2021 quarter 1, were analyzed. Trend analyses revealed that relative to TKA utilization, UKA utilization significantly increased (P < .001) while HTO utilization significantly decreased (P < .001). The compound annual growth rate of UKA utilization relative to TKA was +5.16% from 2010 to 2017 but was -10.61% from 2018 to 2021, while that of HTO relative to TKA was -9.69% from 2010 to 2021. Demographic analyses demonstrated the UKA cohort (63.1) was significantly older than the HTO cohort (46.5) (P < .001). Additionally, there were significantly more female patients who underwent UKA than HTO (P < .001). Conclusions The present study demonstrated that relative to TKA, UKA utilization increased from 2010 to 2017, with a subsequent decrease afterward, whereas HTO utilization decreased since 2010. Demographic differences exist between the 2 operations, with HTOs more commonly performed in younger male patients, and UKAs in older female patients. Level of Evidence Level III.
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Affiliation(s)
- Lacee K. Collins
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Timothy L. Waters
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Matthew W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Cindy X. Wang
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Uwe R. Pontius
- Department of Orthopaedic Surgery, Christus Santa Rosa Health System, San Antonio, TX, USA
| | - Corrine Sommi
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Corresponding author. Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, Louisiana 70112, USA. Tel.: +1 504 982 0252.
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30
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Kim MS, Kim JJ, Kang KH, Ihm JS, In Y. Ankle Pain After Medial Opening-Wedge High Tibial Osteotomy in Patients With Knee Osteoarthritis and Concurrent Ankle Osteoarthritis. Am J Sports Med 2023; 51:494-502. [PMID: 36655729 DOI: 10.1177/03635465221143999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Medial opening-wedge high tibial osteotomy (MOWHTO) in patients with varus knee osteoarthritis (OA) causes changes to ankle and hindfoot alignment. However, the compensatory ability of the ankle and hindfoot varies according to the severity of ankle OA. PURPOSE To investigate whether the changes in ankle symptoms and ankle and hindfoot alignments differ after MOWHTO according to the severity of preoperative ankle OA. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The data of 130 patients who were followed for ≥4 years were reviewed. Patients were classified into 2 groups according to their severity of ankle OA: group 1, modified Kellgren-Lawrence grade 0 and 1; group 2, grade ≥2. Four radiographic parameters were examined to evaluate ankle alignment: tibial plafond inclination, talar tilt, talar inclination, and tibial surface angle. The hindfoot alignment was evaluated using the varus-valgus angle (VVA) of the calcaneus. A visual analog scale (VAS) was used to evaluate ankle pain. The patient-reported outcome measure of the knee joint was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. RESULTS There were 110 patients in group 1 and 20 patients in group 2. In group 2, the change in talar inclination after MOWHTO was significantly greater and the changes in tibial plafond inclination, talar tilt, and VVA were significantly smaller compared with in group 1 (all P < .05). Ankle pain VAS scores were more severe in group 2 than in group 1 pre- and postoperatively (all P < .05), and group 2 reported that ankle pain worsened postoperatively (P < .05). In both groups, knee WOMAC scores improved, and there were no differences between groups pre- or postoperatively (all P > .05). A multivariate regression analysis demonstrated that a small VVA change (odds ratio, 0.775; P = .027) and severe OA grade of the ankle joint preoperatively (Kellgren-Lawrence grades 2-4 vs 0 and 1; odds ratio, 4.241 [P = .046]) predicted increased ankle pain VAS scores after MOWHTO. CONCLUSION Although the patient-reported outcome measures for the knee joint improved irrespective of the presence of ankle OA, ankle pain worsened after MOWHTO in patients with ankle OA. Inadequate compensatory change in hindfoot alignment increased ankle pain in these patients.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Jung Kim
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Ho Kang
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Soo Ihm
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Huang Y, Lobenhoffer P, Jiang XY. Development of knee-preserving osteotomy in China. Sci Bull (Beijing) 2023; 68:125-128. [PMID: 36653214 DOI: 10.1016/j.scib.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ye Huang
- Knee Preservation Clinical and Research Center, Beiiing Jishuitan Hospital, Beijing 100035, China
| | | | - Xie-Yuan Jiang
- Traumatology Department, Beijing Jishuitan Hospital, Beijing 100035, China.
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Oshiro H, Tome Y, Tsuha Y, Aoki Y, Mizuta K, Nishida K. Packing with alpha-tricalcium phosphate followed by curettage and phenol-ethanol ablation for appendicular giant cell tumor of bone. Medicine (Baltimore) 2022; 101:e32055. [PMID: 36626415 PMCID: PMC9750708 DOI: 10.1097/md.0000000000032055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Giant cell tumor of bone (GCTB) is an intermediate and locally aggressive bone tumor. Alpha-tricalcium phosphate (alpha-TCP) is an adjustable bone substitute used to fill various sizes of bone cavities after curettage for GCTB. This study aimed to evaluate the surgical outcome of packing with alpha-TCP followed by curettage and phenol-ethanol ablation. We retrospectively reviewed data of 16 patients with GCTB who underwent primary surgery in our institute between January 2009 and April 2021. Data of Campanacci grading system; number of local recurrences and distant metastases; local recurrence-free survival rate using the Kaplan-Meier method; oncological outcomes; and complications after surgery (secondary osteoarthritis and postoperative fracture) were evaluated in this study. Regarding the Campanacci grading system, 2 patients were classified as grade I, 14 as grade II, and none as grade III. The 5-year local recurrence-free survival rate was 77.8% in all cases. Lung metastasis was not detected in this study. Oncological outcomes were: continuous disease free, 13 patients; alive with disease, 3 patients; and no evidence of disease or death of disease, none of the patients. Secondary osteoarthritis after surgery was not detected in the present study. Packing with alpha-TCP followed by curettage and phenol-ethanol ablation for appendicular GCTB may be safe and effective in suppressing the risk of secondary osteoarthritis.
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Affiliation(s)
- Hiromichi Oshiro
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- * Correspondence: Yasunori Tome, Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0125, Japan (e-mail: )
| | - Yuichi Tsuha
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Aoki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kohei Mizuta
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Central Sensitization Is Associated with Inferior Patient-Reported Outcomes and Increased Osteotomy Site Pain in Patients Undergoing Medial Opening-Wedge High Tibial Osteotomy. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121752. [PMID: 36556954 PMCID: PMC9783071 DOI: 10.3390/medicina58121752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Studies have shown that centrally sensitized patients have worse clinical outcomes following total knee arthroplasty (TKA) than non-centrally sensitized patients. It is unclear whether central sensitization (CS) affects patient-reported outcomes (PROs) and/or level of osteotomy site pain in patients undergoing medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether CS is associated with PROs and osteotomy site pain following MOWHTO. Materials and Methods: A retrospective evaluation was conducted on 140 patients with varus knee osteoarthritis (OA) who were treated with MOWHTO and monitored for two years. Before surgery, the Central Sensitization Inventory (CSI) was used to assess CS status, and a CSI of 40 or higher was considered indicative of CS. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and pain visual analogue scale (VAS) were used to assess PROs. The minimal clinically important difference (MCID) for the WOMAC was set as 4.2 for the pain subscore, 1.9 for the stiffness subscore, 10.1 for the function subscore, and 16.1 for the total based on the results of a previous study. The WOMAC score, pain VAS score of the osteotomy site, and the achievement rates of WOMAC MCID were compared between the CS and non-CS groups. Results: Thirty-seven patients were assigned to the CS group, whereas 84 were assigned to the non-CS group. Before surgery, the CS group showed a higher WOMAC score than the non-CS group (58.7 vs. 49.4, p < 0.05). While there was a statistically significant improvement in WOMAC subscores (pain, stiffness, function, and total) for both groups at two years after surgery (all p < 0.05), the CS group had a higher WOMAC score than the non-CS group (37.1 vs. 21.8, p < 0.05). The CS group showed significantly inferior results in pre- and postoperative changes of WOMAC subscores (pain, function, and total) relative to the non-CS group (all p < 0.05). In addition, pain at the osteotomy site was more severe in the CS group than in the non-CS group at two years after surgery (4.8 vs. 2.2, p < 0.05). Patients with CS had worse MCID achievement rates across the board for WOMAC pain, function, and total scores (all p < 0.05) compared to the non-CS group. Conclusions: Centrally sensitized patients following MOWHTO had worse PROs and more severe osteotomy site pain compared to non-centrally sensitized patients. Furthermore, the WOMAC MCID achievement rate of patients with CS was lower than that of patients without CS. Therefore, appropriate preoperative counseling and perioperative pain management are necessary for patients with CS undergoing MOWHTO. Level of Evidence: Level III, case-control study.
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Grünwald L, Schröter S, Dickschas J, Harrer J, Minzlaff P, Hinterwimmer S, Saier T, Pattappa G, Angele P. Patient response to osteotomy around the knee joint at one year post-operation-fulfilment of expectations and current health status. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04660-6. [PMID: 36344785 DOI: 10.1007/s00402-022-04660-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The aim of this study was to investigate patient satisfaction and fulfilment of expectations after osteotomy around the knee at one year postoperatively, using patient-related outcome measures. MATERIALS AND METHODS From the initial sample of 264 patients, a total of 132 patients (age 48y ± 11) were enrolled in this prospective study (response rate 49.3%). Data were collected using the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES), items for satisfaction and the Knee injury and Osteoarthritis Outcome Score (KOOS) measures. At one year postoperative follow-up, an individualized questionnaire asked whether the specific person-related expectations had been fulfilled. RESULTS Satisfaction was high with 83.2% of all participants at one year after surgery. A total of 78% of patients stated they would decide to do the surgery again. This decision was significantly associated with satisfaction, younger age and better KOOS scores scales before surgery for pain, activity and sports. We found high correlations between satisfaction and fulfilment of expectations for the HFES-KSES. Fulfilment of expectations one year after surgery was significantly associated with significant improvements in KOOS scales at one year post-operation. Expectations (1) "to get the knee back to normal status", (2) "improve ability to squat", (3) "improve ability to run", (4) "improve ability to kneel" had been fulfilled worst. A multiple linear regression model for satisfaction had an R2 = 0.797 of the variance. The most influential was the variable fulfilment of "maintain health" that had 70.7% of variance. CONCLUSIONS The fulfilled expectation concerning an improvement of the ability to maintain health was the most influential parameter for satisfaction at one year post-osteotomy. Patients with better health status of the knee and younger age rated the surgery to be more positive and were also more likely to do the surgery again. This provides an indication for an earlier intervention, before the knee and overall health status becomes more detrimental. LEVEL OF EVIDENCE Level II (Therapeutic study).
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Affiliation(s)
- Leonard Grünwald
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Tübingen, Germany.
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany.
| | - Steffen Schröter
- Department of Orthopedics and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
| | - Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany
- Klinik für Unfallchirugie und Orthopädische Chirurgie, Universitätsklinikum Erlangen, Friedrich Alexander Universität Erlange, Maximilianspl. 2, 91054, Erlangen, Germany
| | - Jörg Harrer
- Department of Orthopedics and Traumatology, Helmut-G.-Walther Klinikum, Prof.-Arneth-Straße 2B, 96215, Lichtenfels, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
| | - Philipp Minzlaff
- Orthoclinic Agatharied, Krankenhaus Agatharied GmbH, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | | | - Tim Saier
- Berufsgenossenschaftliche Unfallklinik Murnau, Prof-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Girish Pattappa
- Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Peter Angele
- Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Sporthopaedicum Regensburg, Hildegard-Von Bingen-Str. 1, 93053, Regensburg, Germany
- Klinik für Trauma und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
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Sung YG, Yoon H, Park DC, Kim MS, In Y. Clinical Usefulness of SPECT/CT for Assessing Postoperative Outcomes After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2022; 10:23259671221121083. [PMID: 36250032 PMCID: PMC9561658 DOI: 10.1177/23259671221121083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Qualitative studies have explored changes in Tc-99m hydroxymethylene
diphosphonate (HDP) uptake on single-photon emission computed tomography and
computed tomography (SPECT/CT) as a result of offloading after medial
opening-wedge high tibial osteotomy (MOWHTO) in patients with medial
compartment knee osteoarthritis. However, whether changes in the Tc-99m HDP
uptake on SPECT/CT reflect the degree of clinical improvement in
postoperative outcomes, especially when using minimal clinically important
differences (MCIDs), has not been investigated. Purpose: To investigate the association between changes in Tc-99m HDP uptake on
SPECT/CT and MCID-based improvement on the Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC) score in patients who underwent
MOWHTO. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study included 35 knees in 31 patients who underwent MOWHTO. SPECT/CT was
performed preoperatively and 3 years postoperatively with clinical and
radiological assessments. On SPECT/CT, the knee joint was divided into 10
regions, and the radiotracer uptake amount of each region was divided by the
uptake amount of the reference zone. Patients were divided into 2 groups
based on whether they achieved the MCID of 16.1 points on the WOMAC at 3
years postoperatively, and changes in uptake amount on SPECT/CT were
compared between the groups. Results: At 3 years postoperatively, 22 patients achieved the MCID on the WOMAC
(62.9%; above-MCID group) and 13 patients did not (37.1%; below-MCID group).
In the above-MCID group, significant improvement was observed in the WOMAC
after MOWHTO (from 55.8 to 19.6; P < .05); however,
significant improvement was not observed in the below-MCID group (from 38.8
to 32.3; P = .100). Based on mean change of uptake on
SPECT/CT in each region, the above-MCID group showed significantly greater
reduction of uptake on SPECT/CT than the below-MCID group in the femoral
anteromedial compartment (P = .004), tibial anteromedial
compartment (P = .009), and tibial anterolateral
compartment (P = .031). Conclusion: Reduction in radiotracer uptake on SPECT/CT of the knee joint reflected
clinical improvement in patient-reported outcomes following MOWHTO.
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Affiliation(s)
- Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyukjin Yoon
- Division of Nuclear Medicine, Department of Radiology, St Vincent’s
Hospital, College of Medicine, The Catholic University of Korea, Suwon-si, Republic
of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Yong In, MD, PhD, Department of Orthopaedic Surgery, Seoul St
Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222,
Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (
)
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Wei C, Xie W, Zhang W, Tang N, Su Y, Jiang B, Walschot LH, Xu H, Li Y, Huang T. New insight into the current study of high tibial osteotomy: A bibliometric analysis. Medicine (Baltimore) 2022; 101:e30357. [PMID: 36123859 PMCID: PMC9478324 DOI: 10.1097/md.0000000000030357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To analyze global trends in focus and funding of research related to high tibial osteotomy (HTO) and to identify the 100 most cited articles in this field. METHODS A Web of Science search was used to identify HTO publications in English-language scientific journals from January 1967 till February 3th, 2021. Results were filtered to the 100 most cited articles by reading the abstract or full-text paper. Information of these articles was recorded for further analysis. The 10 top-cited articles during the last 5 years and the 10 top-cited articles about HTO ranked by average citations per year were selected to predict research trends. RESULTS In all, 48 out of the 100 top-cited articles were published between 2000 and 2010. The United States of America was the primary contributor (n = 29) followed by Germany (n = 17) and Japan (n = 11). The total number of citations per article ranged from 65 to 563, median 108, mean 135 (standard deviation = 84). The American Journal of Bone and Joint Surgery accounted for 23 out of the 100 top-cited articles. Koshino T was the most cited author (603 citations). The most frequently highlighted study theme was prognostic research. Patient-based clinical research was the dominant study design (85%). The majority of articles (48 out of 100) were level IV evidence with a mean of 141 (standard deviation = 97) citations. Top-cited articles in the last 5 years focused on open wedge osteotomy. CONCLUSION Technical optimization of open wedge osteotomy has emerged as the main area of research in HTO. More specifically, recent publications focus on the surgical technology, cartilage repair and new fixation devices. Besides, papers with a high level of evidence are needed for the development of HTO.
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Affiliation(s)
- Cong Wei
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenqing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wenchao Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ning Tang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Su
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Buchan Jiang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lucas H. Walschot
- Department of Orthopaedics, AZ St Maarten Hospital, Mechelen, Belgium
| | - Haijun Xu
- Department of Orthopedics, Wuhan Forth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Tianlong Huang, Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China (e-mail: ) or Yusheng Li, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China (e-mail: )
| | - Tianlong Huang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Tianlong Huang, Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China (e-mail: ) or Yusheng Li, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China (e-mail: )
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Cazor A, Schmidt A, Shatrov J, Alqahtani T, Neyret P, Sappey-Marinier E, Batailler C, Lustig S, Servien E. Less risk of conversion to total knee arthroplasty without significant clinical and survivorship difference for opening-wedge high tibial osteotomies in varus knee deformities at 10-year minimum follow-up compared to closing-wedge high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2022; 31:1603-1613. [PMID: 36038667 DOI: 10.1007/s00167-022-07122-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO). METHODS This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point. RESULTS At the time of HTO, mean age was 55 years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3 years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3 years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate. CONCLUSION At mean follow-up of 13 years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA. LEVEL OF EVIDENCE Retrospective case series, IV.
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Affiliation(s)
- A Cazor
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - A Schmidt
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
| | - J Shatrov
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia Orthopaedic Research Institute, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - T Alqahtani
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - P Neyret
- Infirmerie Protestante, 3 rue Penthod, 69300, Lyon, France
| | - Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - C Batailler
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - S Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, 25 Avenue François Mitterand, Lyon, France
| | - E Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 29 Boulevard du 11 Novembre 1918, Lyon, France
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Hayatbakhsh Z, Farahmand F, Karimpour M. Is a Complete Anatomical Fit of the Tomofix Plate Biomechanically Favorable? A Parametric Study Using the Finite Element Method. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:712-720. [PMID: 36258741 PMCID: PMC9569138 DOI: 10.22038/abjs.2022.60928.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/23/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The opening wedge high tibial osteotomy (HTO) fixation using the Tomofix system is at the risk of mechanical failure due to unstable fixation, lateral hinge fracture, and hardware breakage. This study aimed to investigate the effect of the level of anatomical fit (LOF) of the plate on the failure mechanisms of fixation. METHODS A finite element model of the HTO with a correction angle of 12 degrees was developed. The LOF of the TomoFix plate was changed parametrically by altering the curvature of the plate in the sagittal plane. The effect of the LOF on the fixation performance was studied in terms of the factor of safety (FOS) against failure mechanisms. The FOSs were found by 1) dividing the actual stiffness of the plate-bone construct by the minimum allowable one for unstable fixation, 2) dividing the compressive strength of the cortical bone by the actual maximum pressure at the lateral hinge for the lateral hinge fracture, and 3) the Soderberg criterion for fatigue fracture of the plate and screws. RESULTS The increase of the LOF by applying a larger bent to the plate changed the fixation stiffness slightly. However, it reduced the lateral hinge pressure substantially (from 182 MPa to 71 MPa) and increased the maximum equivalent stresses in screws considerably (from 187 MPa to 258 MPa). Based on the FOS-LOF diagram, a gap smaller than 2.3 mm was safe, with the highest biomechanical performance associated with a 0.5 mm gap size. CONCLUSION Although a high LOF is necessary for the Tomofix plate fixation to avoid mechanical failure, a gap size of 0.5mm is favored biomechanically over complete anatomical fit.
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Affiliation(s)
- Zahra Hayatbakhsh
- Department of Biomedical Engineering, Science and Research branch, Islamic Azad University, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, University of Tehran, Tehran, Iran
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Key S, Demir S, Aydın O, Say Y, Erten M. A biomechanical study: Comparison of three different implant options in high Tibial osteotomy. Clin Biomech (Bristol, Avon) 2022; 98:105722. [PMID: 35863144 DOI: 10.1016/j.clinbiomech.2022.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many implant options could be preferable for fixation after osteotomy in varus knee medial compartment arthrosis. Due to usage characteristics, it is important to compare the biomechanical properties of them. For this purpose, we aimed to examine three different implant types biomechanically in our study. METHODS Ovine tibiae undergoing medial open-wedge high tibial osteotomy were fixed in vitro with three different implants using an angular wedge plate, a metal block plate and an external fixator system. The fixed ovine tibiae were subjected to axial tensile, axial loading and three-point bending tests in a test machine. All biomechanical tests were repeated five times, the maximum and minimum values were ignored, and the average values of the remaining three test results were taken into account. The test results were interpreted after converted into force-elongation curves in Trapezium-X software. FINDINGS Biomechanical test results revealed some differences between implant types. While the metal block plate had the highest axial tensile strength value, it was the fixation group showing the lowest strength in axial load tests. The used fixator system was the highest strength in axial load tests and the lowest strength in axial tensile tests. INTERPRETATION Considering the clinically significant forces related to the biomechanical stability of the three different implants used for high tibial osteotomy, the fixator system would appear to be slightly superior, although it should be noted that torsional forces, as well as parameters that could change in living tissue, might affect the results.
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Affiliation(s)
- Sefa Key
- Department of Orthopedics and Traumatology, Bingöl State Hospital, Bingöl, Turkey
| | - Sukru Demir
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University, 23190 Elazig, Turkey
| | - Oğuz Aydın
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University, 23190 Elazig, Turkey
| | - Yakup Say
- Department of Metallurgy and Materials Engineering, College of Engineering, Munzur University, Tunceli, Turkey
| | - Mehmet Erten
- Department of Medical Biochemistry, Public Health Lab, Malatya, Turkey.
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Seth I, Bulloch G, Seth N, Gibson D, Rastogi A, Lower K, Rodwell A, Bruce W. High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Indian J Orthop 2022; 56:973-982. [PMID: 35669023 PMCID: PMC9123137 DOI: 10.1007/s43465-022-00620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Purpose High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are commonly performed procedures for the treatment of compartmental knee osteoarthritis; however, the optimal procedure remains controversial. We conducted this systematic review and meta-analysis to compare the functional outcomes and assess complications and revision rates between the two techniques. Methods We searched electronic databases for relevant studies comparing HTO versus UKA for unicompartmental knee osteoarthritis. Continuous data as visual analogue scale (VAS), range of motion, and free walking speed were pooled as mean differences (MDs). Dichotomous data as functional knee outcomes, complications, and revision were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software for windows. Results Twenty-five studies involving 8185 patients were included. Meta-analysis showed that HTO was associated with higher risk of complications (OR = 2.47, 95% CI [1.52, 4.04]), poorer functional results (excellent/good) (OR = 0.32, 95% CI [0.21, 0.49]), and greater range of motion (MD = 7.05, 95% CI [2.41, 11.68]) compared to UKA. No significant differences were found between the compared groups in terms of VAS (MD = 0.14, 95% CI [- 0.08, 0.36]), revision rates (OR = 1.30, 95% CI [0.65, 2.60]), and free walking speed (MD = - 0.05, 95% CI [- 0.11, 0.00]). Conclusion This study showed that UKA achieved fewer complications, better functional outcomes, and less range of motion compared to HTO. No significant differences were detected between HTO and UKA in terms of VAS and revision rate. Treatment options should be personalized to each patient considering factors such as their age, activities of daily living, their body mass index, and severity of osteoarthritis. Level of evidence II. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00620-9.
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Affiliation(s)
- Ishith Seth
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
- Department of Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC 3550 Australia
| | - Gabriella Bulloch
- grid.1623.60000 0004 0432 511XDepartment of Orthopaedic Surgery, The Alfred Hospital, Melbourne, VIC 3004 Australia
| | - Nimish Seth
- grid.1008.90000 0001 2179 088XFaculty of Science, Medicine and Health, University of Melbourne, Melbourne, VIC 3010 Australia
| | - Damien Gibson
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Anish Rastogi
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Kirk Lower
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Aaron Rodwell
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Warwick Bruce
- grid.414685.a0000 0004 0392 3935Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW 2139 Australia
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Vaishya R, Vaish A, Ansari AH, Suryant S. Bilateral genu varum deformity correction in an adult by medial opening-wedge high tibial osteotomy without internal fixation. BMJ Case Rep 2022; 15:e250044. [PMID: 35649623 PMCID: PMC9161078 DOI: 10.1136/bcr-2022-250044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
A young adult man in 20s presented with bow leg deformity of both the knees, since childhood and bilateral knee pain for the last 4 years. Plain radiographs of both the knees confirmed bilateral genu varum deformity, more on the right side (16.2°) as compared with left (12.3°). He was managed surgically by a single-stage bilateral medial opening wedge high tibial osteotomy, using a synthetic bone substitute of a tri calcium phosphate. After the healing of osteotomies at 3 months, the patient was pain free and walked comfortably with normal lower limb alignment.
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Affiliation(s)
- Raju Vaishya
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Abhishek Vaish
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Aabid Husain Ansari
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Sumit Suryant
- Orthopaedics and Joint Replcement Surgery, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
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Van fraeyenhove B, Oussedik S. Navigation Guided Corrective Osteotomy (based on surgical technique). OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Laven IEWG, Schröder FF, de Graaff F, Rompen JC, Hoogeslag RAG, van Houten AH. Accuracy, inter- and intrarater reliability, and user-experience of high tibial osteotomy angle measurements for preoperative planning: manual planning PACS versus semi-automatic software programs. J Exp Orthop 2022; 9:44. [PMID: 35581416 PMCID: PMC9114281 DOI: 10.1186/s40634-022-00475-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare the accuracy, inter- and intrarater reliability, and user-experience of manual and semi-automatic preoperative leg-alignment measurement planning software for high tibial osteotomy (HTO). Methods Thirty patients (31 lower limbs) who underwent a medial opening wedge HTO between 2017 and 2019 were retrospectively included. The mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and planned correction angle were measured on preoperative long-leg full weight-bearing radiographs utilising PACS Jivex Review® v5.2 manual and TraumaCad® v2.4 semi-automatic planning software. Independent measurements were performed by four raters. Two raters repeated the measurements. Accuracy in the standard error of measurement (SEM), inter- and intrarater reliability, and user-experience were analysed. Additionally, measurements errors of more than 3° were remeasured and reanalysed. Results The SEMs of all measured varus malalignment angles and planned correction angle were within 0.8° of accuracy for both software programs. Measurements utilising the manual software demonstrated moderate interrater intraclass correlation coefficient (ICC)-values for the mLDFA and mMPTA, and an excellent interrater ICC-value for the correction angle (0.810, 0.779, and 0.981, respectively). Measurements utilising the semi-automatic software indicated excellent interrater ICC-values for the mLDFA, mMPTA, and correction angle (0.980, 0.909, and 0.989, respectively). The intrarater reliability varied substantially per angle, presenting excellent intrarater agreements by both raters (ICC > 0.900) for the correction angle in each software program as well as poor-to-excellent ICC-values for the mLDFA (0.282–0.951 and 0.316–0.926) and mMPTA (0.893–0.934 and 0.594–0.941) in both the manual planning and semi-automatic software. Regarding user-experience, semi-automatic software was preferred by two raters, while the other two raters had no distinctive preference. After remeasurement of five outliers, excellent interrater ICC-values were found for the mLDFA (0.913) and mMPTA (0.957). Conclusions Semi-automatic software outperforms the manual software when user-experience and outliers are considered. However, both software programs provide similar performance after remeasurement of the human-related erroneous outliers. For clinical practice, both programs can be utilised for HTO planning. Level of evidence Diagnostic study, Level III. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00475-x.
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Affiliation(s)
- Iris E W G Laven
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, 7550 AM, The Netherlands.,Techmed Centre, Faculty of Science and Technology (S&T), University of Twente, Enschede, 7522 NB, The Netherlands
| | - Femke F Schröder
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, 7550 AM, The Netherlands.,Techmed Centre, Faculty of Science and Technology (S&T), University of Twente, Enschede, 7522 NB, The Netherlands
| | - Feike de Graaff
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, 7550 AM, The Netherlands.
| | - J Christiaan Rompen
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, 7550 AM, The Netherlands
| | - Roy A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, 7550 AM, The Netherlands
| | - Albert H van Houten
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, 7550 AM, The Netherlands
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Ma X, Hu Y, Wang K, The Chinese Hospital Association Clinical Medical Technology Application Committee, The Joint Surgery Branch of the Chinese Orthopaedic Association, The Subspecialty Group of Osteoarthritis, Chinese Association of Orthopaedic Surgeons. Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy. Orthop Surg 2022; 14:789-806. [PMID: 35509153 PMCID: PMC9087466 DOI: 10.1111/os.13281] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1-5 are indications and contraindications for PKO for lower extremity alignment correction, items 6-21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23-25 address the perioperative period, follow-up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction.
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Affiliation(s)
- Xin‐long Ma
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Yong‐cheng Hu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Kun‐zheng Wang
- Department of Orthopaedic SurgeryThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'an ShaanxiChina
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Ruggeri M, Gill HS, Leardini A, Zaffagnini S, MacLeod A, Ortolani M, Faccia F, Grassi A, Fabbro GD, Durante S, Belvedere C. Superimposition of ground reaction force on tibial-plateau supporting diagnostics and post-operative evaluations in high-tibial osteotomy. A novel methodology. Gait Posture 2022; 94:144-152. [PMID: 35334334 DOI: 10.1016/j.gaitpost.2022.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A fully personalised combination of Gait Analysis (GA), including Ground Reaction Force (GRF), and patient-specific knee joint morphology has not yet been reported. This can provide valuable biomechanical insight in normal and pathological conditions. Abnormal knee varus results in medial knee condylar hyper-compression and osteoarthritis, which can be prevented by restoring proper condylar load distribution via High Tibial Osteotomy (HTO). RESEARCH QUESTION This study was aimed at reporting on an original methodology, merging GA, GRF and Computer-Tomography (CT) to depict a patient-specific representation of the knee mechanical condition during locomotion. It was hypothesised that HTO results in a lateralized pattern of GRF with respect to the tibial plateau. METHODS Four patients selected for HTO received clinical, radiological and instrumental examinations, pre- and post-operatively at 6-month follow-up. GA was performed during level walking and more demanding motor tasks using a 9-camera motion-capture system, combined with two force platforms, and an established protocol. Additional skin markers were positioned around the tibial-plateau rim. Weight-bearing CT scans of the knee were collected while still wearing these markers. Proximal tibial and marker morphological models were reconstructed. The markers from CT reconstruction were then registered to the corresponding trajectories as tracked by GA data. Resulting registration matrices were used to report GRF vectors on the plane best matching the tibial-plateau model and the intersection paths were calculated. RESULTS AND SIGNIFICANCE The registration procedure was successfully executed, with a max registration error of about 3 mm. GRF intersection paths were found medially to the tibial plateau pre-op, and lateralized post-op, thus much closer to the knee centre, as expected after HTO. The exploitation of the present methodology offers personalised quantification of the original mechanical misalignment and of the effect of surgical correction which could enhance diagnostics and planning of HTO as well as other knee treatments.
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Affiliation(s)
- Miriana Ruggeri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Harinderjit Singh Gill
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alisdair MacLeod
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Faccia
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Natori S, Itokawa K, Inaba Y. The range of the required anterolateral cortex osteotomy distance varied widely in biplanar open wedge high tibial osteotomy. BMC Musculoskelet Disord 2022; 23:327. [PMID: 35387626 PMCID: PMC8985367 DOI: 10.1186/s12891-022-05283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background To evaluate the anterolateral cortex distance between the lateral edge of the flange and hinge point in surgical simulations of biplanar open wedge high tibial osteotomy (OWHTO) using computed tomography (CT) images. Methods A total of 110 knees treated with OWHTO for medial knee osteoarthritis with varus malalignment were enrolled. Surgical simulations of biplanar OWHTO, including the transverse and ascending cuts, were performed in the standard manner using preoperative CT images. The distance between the lateral edge of the flange and the hinge point was measured. In addition, another plane of the ascending cut was defined through the hinge point. The angle between these two planes of the ascending cut was measured in the axial plane. Results The mean anterolateral cortex distance was 9.4 ± 4.6 mm (range, − 1.5 mm – 20.3 mm). In 3 knees, osteotomy of the anterolateral cortex was not needed. The mean value of the angle between the two ascending cut planes was 8.4 ± 3.6° (range, − 2.1° – 14.8°), which meant that osteotomy of anterolateral cortex was not needed when the ascending cut was performed at this angle. Moreover, these two values increased when the flange thickness was changed from one-third to one-fourth of the anteroposterior tibial diameter or the angle between the transverse and ascending cuts was changed from 110° to 120°. Conclusions In biplanar OWHTO, anterolateral cortex osteotomy would be required. However, the range of the required anterolateral cortex osteotomy distance varied widely and the required anterolateral cortex osteotomy distance depended on the flange thickness and the angle between the transverse and ascending cuts. In addition, change of the ascending cut plane can change the necessity of anterolateral cortex osteotomy.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shuhei Natori
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kei Itokawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Song IS, Kwon J. Analysis of changes in tibial torsion angle on open-wedge high tibial osteotomy depending on the osteotomy level. Knee Surg Relat Res 2022; 34:17. [PMID: 35346394 PMCID: PMC8962052 DOI: 10.1186/s43019-021-00127-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study evaluated the tibial torsional angle changes of 72 knees before and after open-wedge high tibial osteotomy (OWHTO) and compared the results according to the osteotomy level. MATERIALS AND METHODS Seventy patients (72 knees) with Kellgren-Lawrence grade 3 underwent OWHTO. Demographic data, operation procedures, and measurement of mechanical tibiofemoral angle (mTFA), anatomical tibiofemoral angle (aTFA), tibial torsional angle (TTA), and pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. The authors analyzed TTA changes between 30 knees with high-level osteotomy (group A) and 42 knees with low-level osteotomy (group B). RESULTS The changes of TTAs in the subjects of 72 knees went from 29.26 ± 5.6° preoperative mean to 25.36 ± 6.4° postoperative mean (p = 0.032). The postoperative TTAs of group A (mean 27.4 ± 4.8°) and B (mean 25.7 ± 4.9°) were statistically significant (p < 0.01). Preoperative Lysholm and IKDC scores of 72 knees had means of 49.1 ± 3.5 and 49.0 ± 15.2, respectively, and postoperative means of 85.7 ± 8.56 and 78.0 ± 17.6, respectively, which were statistically significant (p < 0.01). CONCLUSIONS Changes of TTA with internal rotation of distal tibia were observed following OWHTO. High-level osteotomy on the proximal tibia's lateral cortex had less internal rotation of the distal tibia than low-level osteotomy.
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Affiliation(s)
- In-Soo Song
- Department of Orthopedic Surgery, Daejeon Sun Hospital, 29, Mokjung-ro, Jung-gu, Daejeon, Republic of Korea.
| | - Junhan Kwon
- Department of Orthopedic Surgery, Daejeon Sun Hospital, 29, Mokjung-ro, Jung-gu, Daejeon, Republic of Korea
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Kim SJ, Nguyen LT, Seo YJ, Jung D, Shin YS, Kim J, Choi JY, Song SY. Bone healing on serial plain radiographs occurs slowly but adequately after medial opening wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc 2022; 30:993-1000. [PMID: 33646369 DOI: 10.1007/s00167-021-06506-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to prospectively investigate osteotomy gap filling rates on serial plain radiographs, and to evaluate whether alignment correction is maintained after medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate without bone graft. METHODS Between March 2014 and June 2017, MOWHTO was performed without bone graft regardless of gap size. Radiographs were taken preoperatively, postoperatively, at 1, 3, 6, 12, 18, and 24 months after surgery. Radiographic examinations included a weight bearing long-standing anteroposterior (AP) view of the whole lower extremity, as well as, the AP, lateral, and both oblique views of the knee. Bone healing was measured on the medial oblique view of the knee. The postoperative alignment correction and its maintenance were assessed using the three radiologic parameters of the weight-bearing line (WBL) ratio, the hip-knee-ankle angle (HKAA), and the medial proximal tibial angle (MPTA) on the weight-bearing long-standing AP view of the lower extremity. RESULTS Fifty-two consecutive patients underwent MOWHTO, but three patients failed to follow-up for more than 24 months. A total of 49 patients were assessed in this study. The median opening gap height was 10.0 mm (IQR, 8.0-12.0; range, 7-20). On immediate post-operative radiographs, the mean gap filling was 31.4 ± 3.6%. After 1, 3, 6, 12, 18, and 24 months, the mean gap filling rates increased to 38.7 ± 4.4%, 51.4 ± 6.6%, 66.5 ± 5.1%, 84.8 ± 7.0%, 92.4 ± 5.6%, and 97.8 ± 2.3%, respectively. Statistical differences were observed between all the follow-up evaluations (P < 0.001). Statistical differences in the WBL ratio, HKAA, and MPTA were observed between preoperatively and 1 month after surgery (P < 0.001). The mean PTSA increased significantly from preoperatively to postoperatively (P < 0.001). However, no statistical differences were found between the post-operative follow-up radiographs performed for these four values. CONCLUSION MOWHTO using a locking plate without bone graft achieved at least 90% bone healing and had no loss in correction at 2 years postoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sung Jae Kim
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, Republic of Korea
| | - Lich Thi Nguyen
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, Republic of Korea
| | - Dawoon Jung
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, Republic of Korea
| | - Young-Soo Shin
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Jeehyoung Kim
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea
| | - Jae-Young Choi
- School of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Si Young Song
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, Gyeonggi-do, 18450, Republic of Korea.
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Kanakamedala AC, Hurley ET, Manjunath AK, Jazrawi LM, Alaia MJ, Strauss EJ. High Tibial Osteotomies for the Treatment of Osteoarthritis of the Knee. JBJS Rev 2022; 10:01874474-202201000-00002. [PMID: 35020711 DOI: 10.2106/jbjs.rvw.21.00127] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» A high tibial osteotomy (HTO) is a joint-preserving procedure that can be used to treat symptomatic unicompartmental cartilage disorders in the presence of limb malalignment. » Appropriate patient selection and careful preoperative planning are vital for optimizing outcomes. » Based on past literature, correction of varus malalignment to 3° to 8° of valgus appears to lead to favorable results. Recently, there has been growing awareness that it is important to consider soft-tissue laxity during preoperative planning. » Although there has been a recent trend toward performing opening-wedge rather than closing-wedge or dome HTOs for unicompartmental osteoarthritis, current data suggest that all 3 are acceptable techniques with varying complication profiles. » Based on current evidence, an HTO provides pain relief, functional improvement, and a high rate of return to sport, with reported survivorship ranging from 74.7% to 97.6% and 66.0% to 90.4% at 10 and 15 years, respectively.
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Affiliation(s)
- Ajay C Kanakamedala
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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50
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Fortier LM, Gursoy S, Knapik DM, Chahla J. Three-Dimensional Patient Specific Instrumentation and Cutting Guide for Medial Closing Wedge High Tibial Osteotomy to Correct Valgus Malalignment. Arthrosc Tech 2022; 11:e13-e23. [PMID: 35127424 PMCID: PMC8807722 DOI: 10.1016/j.eats.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023] Open
Abstract
Achievement of appropriate mechanical knee alignment is crucial to ensure optimal clinical outcomes following osteotomy procedures about the knee. The use of patient-specific instrumentation (PSI) to assist in preoperative planning and intraoperative realignment has gained increasing popularity. The purpose of this article is to describe a surgical technique involving a medial closing wedge high tibial osteotomy performed using three-dimensional (3D) PSI and cutting guide to revise residual valgus deformity following failed distal femoral osteotomy. The correction angle, 3D position of the hinge and wedge, as well as final plate and screw position are planned preoperatively using virtual software and computed tomography imaging to allow precise surgical execution.
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Affiliation(s)
- Luc M. Fortier
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
| | - Safa Gursoy
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
| | | | - Jorge Chahla
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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