Closing-wedge Group Research Articles

علاج الابهام الأروح عند البالغين: دراسة مقارنة بين نتائج خزع عظم المشط الأول بطريقة الاسفين المغلق والخزع بطريقة سكارف

Objective: The aim of this study is to evaluate the results of surgical treatments of hallux valgus by a scarf or closing wedge osteotomy of the first metatarsal. In addition to, detection complications resulting from the surgery. Patients and Methods: Descriptive comparative study was conducted for the period of one year (June2020 – June2021) at Tishreen University Hospital in Lattakia- Syria. The study included two groups of patients that were compared: group1 consisted of 19 patients (57.6%) who underwent closing wedge osteotomy, whereas group 2 consisted of 14 patients (42.4%) who underwent scarf procedure. Results: The mean hallux valgus angle (HVA) decreased from (31.43 º ±3.1) preoperatively to (9.15 º ±0.1) at postoperative in closing wedge group (group. 1), and from (29.45 º ±2.7) preoperatively to (10.10 º ±3.7) at postoperative in scarf group (group. 2), p:0.0001. The Foot and Ankle Disability Index (FADI) score increased significantly in the two groups during follow- up periods. Complications developed in the two groups, more frequently in the scarf group which included: wound healing after 8 weeks (35.7% vs 22.2%), operation site infection (21.4) % vs (11.1%), sudeck's disease (14.3% vs 5.6%), impaired wound healing (14.3% vs 5.6%) and recurrence of hallux valgus (7.1% vs 5.6%), without any case of the non- healing wound in the two groups. Satisfaction of the patients was complete in 84.8%, moderate in 9.1%, and 6.1% of the patients were unsatisfied. Conclusion: The current study demonstrated favorable results in correction deformity with two techniques, with fewer complications in closing wedge compared with the scarf method.

No Difference Between a Closing and Opening Wedge High Tibial Osteotomy: 10 Year Results of an RCT

Similar results 10 years after a closing-wedge or opening-wedge HTO in terms of clinical outcome and radiological alignment. Varus deformity increases the risk of progression of medial compartment knee osteoarthritis (OA). Patients with this condition can be treated with a valgus high tibial osteotomy (HTO) with either a closing-wedge or opening-wedge technique. Little is known about the long-term results of closing-wedge versus opening-wedge osteotomy. The aim of this study was to investigate the clinical and radiological long-term results of closing-wedge and opening-wedge HTO. From January 2001 to April 2004, ninety-two patients were randomized to receive either a closing-wedge or an opening-wedge high tibial osteotomy. The clinical outcome and radiographic results were examined preoperatively, at one year, six years, and, for the present study, at ten years postoperatively. The outcomes that we reviewed included maintenance of the achieved correction, progression of osteoarthritis (based on the Kellgren and Lawrence classification), severity of pain (as assessed on a numeric rating scalevisual [NRS]), knee function (as measured with the Hospital for Special Surgery [HSS] score and Knee injury and Osteoarthritis Outcome Score [KOOS]), walking distance, complications, and survival with conversion to a total knee arthroplasty as the end point. The results were analyzed on the basis of the intention-to-treat principle. Out of the original 92 patients included 79 completed 10-year follow-up (52 all measurements, 3 only questionnaires, and 24 TKA), 13 patients were lost to follow-up (6 deceased, 5 emigrated, and 2 unwilling to participate). Sixteen (36%) patients in the closing-wedge and eight (22%) in the opening-wedge group were converted to a TKA after ten years (p = 0.15). Ten years post-operatively, the mean hip-knee-ankle (HKA) angle was 1.5° (± 4.0° SD) of valgus after a closing-wedge HTO and 0.8° (± 5.9° SD) of varus after an opening-wedge HTO (p= 0.276). The mean difference was 2.3° (CI 95%: -0.6 – 5.1), with no statistical significant difference (p=0.12). In both groups the 10-year post-operative HKA-angles did not differ from the one- and six-year post-operative angles. No difference in severity of pain or knee function was found between the two groups. The mean NRS-pain was 2.6 (± 2.8 SD) during rest and 3.7 (± 3.1 SD) during activity in the closing-wedge group. The mean NRS-pain was 2.9 (± 3.0 SD) during rest and 4.1 (± 3.1 SD) during activity in the opening-wedge group. No difference in pain (rest or activity) was found between the groups. The mean HSS was 82.2 (± 13.6 SD) in the closing-wedge group. The mean HSS was 78.6 (± 13.0 SD) in the opening-wedge group. No difference in function was found between the groups. Of the patients who had no conversion to a TKA, no difference in clinical outcome and radiological alignment was seen 10-years post-operatively between the closing-wedge and opening-wedge HTOs. In our six-year follow-up closing-wedge HTO was associated with more conversions to a TKA. This is in contrast to the results of our new results at ten-year follow-up of the same cohort.

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening-wedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA. A total of 141 TKA's performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of twoyears. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment. The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p < 0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups. Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.

Patellofemoral Alignment and Anterior Knee Pain After Closing- and Opening-Wedge Valgus High Tibial Osteotomy

The purpose of this study was to compare the clinical and radiographic outcomes of opening- and closing-wedge valgus high tibial osteotomy (HTO) for the treatment of medial unicompartmental knee osteoarthritis with a minimum follow-up of 3 years, with a focus on patellofemoral alignment and anterior knee pain. We performed a retrospective comparison of 50 patients who underwent closing-wedge HTO and 50 patients who underwent opening-wedge HTO for isolated medial joint arthritis of the knee with varus deformity. All patients were evaluated and the 2 study groups were compared after a minimum follow-up of 3 years with a focus on patellofemoral alignment, patellofemoral osteoarthritis, and anterior knee pain while climbing stairs. Patellar alignment (patellar tilt and lateral patellar displacement) was not significantly different in the 2 groups either preoperatively or at follow-up. Furthermore, there were no significant differences in the extent of patellofemoral arthritis and incidence of anterior knee pain at follow-up between the 2 groups. In addition, no significant intergroup difference was found in terms of the incidence of anterior knee pain (28% in closing-wedge group and 32% in opening-wedge group at follow-up). The results of closing- and opening-wedge valgus HTO were not found to be significantly different with respect to patellar alignment, osteoarthritis of the patellofemoral joint, or anterior knee pain. Level III, retrospective comparative study.

Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: A comparative prospective multicenter study

Valgus high tibial osteotomy is considered to be an effective treatment for unicompartmental medial osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. However, the effects on posterior tibial slope of closing- or opening-wedge osteotomies remain controversial. We analyzed the modifications of tibial slope after opening- and closing-wedge high tibial osteotomies and compared the results of these two procedures. We hypothesized that there was no difference in postoperative tibial slope between opening and closing-wedge osteotomies. This prospective consecutive nonrandomized multicenter study was conducted between January 2008 and March 2009 and included 321 patients: 205 men and 116 women. A total of 224 patients underwent an opening-wedge high tibial osteotomy and 97 a closing-wedge osteotomy. The mean age was 52 years ± 9 and the mean body mass index was 28kg/m(2) ± 5. The main etiology was primary arthritis. Posterior tibial slope was measured preoperatively and at the last follow-up on a lateral radiograph in relation to the posterior tibial cortex. In the opening-wedge group, a definite 0.6° increase in tibial slope (P=0.016) was observed. In the closing-wedge group, a definite 0.7° decrease in tibial slope (P=0.02) was found. Fourteen percent of the opening-wedge osteotomies increased tibial slope by 5° or more versus only 2% of the closed-wedge osteotomies (P<0.001). Twelve percent of the closing-wedge high tibial osteotomies led to a decrease of 5° or more of the tibial slope versus 7% of the opening-wedge osteotomies (P<0.02). These results confirm what is generally reported in the literature, i.e., an increase in tibial slope in opening-wedge high tibial osteotomy and a decrease in the slope in closing-wedge osteotomies. These tibial slope changes appear to be very limited in this series, less than 1° on average. However, there was a bias since the open-wedge technique was preferred in cases with substantial varus deformity. We emphasize the importance of surgical technique to avoid alteration of the tibial slope, particularly in opening-wedge high tibial osteotomy for which we recommend a release of posterior soft tissue and a complete osteotomy of the posterior cortex of the tibia. III. Prospective consecutive nonrandomized multicenter study.

The Effect of Medial Opening and Lateral Closing High Tibial Osteotomy on Leg Length

Background: High tibial osteotomy (HTO) is a common treatment for medial compartment arthritis of the knee in younger, more active patients. An HTO also potentially affects leg length. Mathematical models predict that the osteotomy type (medial opening-wedge vs lateral closing-wedge) and the magnitude of the correction determine the change in leg length, but no in vivo studies have been published. Purpose: This study was undertaken to quantify and compare leg-length change after opening-wedge and closing-wedge HTO. Study Design: Cohort study; Level of evidence, 3. Methods: Thirty-two medial opening-wedge and 32 lateral closing-wedge HTOs were selected from patients treated at the authors’ institution. Preoperative and postoperative coronal plane alignment and leg length were measured and surgical details were collected. Results: The 64 osteotomies were performed at an average age of 57 years. The mean opening wedge was 9.3 mm and the mean closing wedge was 8.0 mm. Mean knee alignment changed from 174° preoperatively to 183° postoperatively in both groups. In the medial opening-wedge group, entire leg length changed from 836.3 ± 63.5 mm to 841.8 ± 64.1 mm, an increase of 5.5 ± 4.4 mm (P < .0001). Tibia length changed from 368 ± 30.9 mm to 372.3 ± 31.2 mm, an increase of 4.3 ± 2.3 mm (P < .0001). In the lateral closing-wedge group, entire leg length changed from 840.6 ± 51.5 mm preoperatively to 837.9 ± 52.0 mm postoperatively, a decrease of 2.7 ± 4.0 mm (P = .0008). Tibia length changed from 365.1 ± 23.2 mm to 361 ± 22.9 mm, a decrease of 4.1 ± 2.9 mm (P < .0001). The difference in mean leg-length change between opening-wedge and closing-wedge osteotomies was 8.2 ± 5.9 mm (P < .0001). Conclusion: Both medial opening-wedge and lateral closing-wedge HTO can result in significant leg-length change, but changes are generally less than mathematical models predict.

Early Complications After High Tibial Osteotomy –A Comparison of Two Techniques

This prospective cohort study compared opening wedge high tibial osteotomy with use of the Puddu plate and the Vitoss synthetic cancellous bone versus closing wedge high tibial osteotomy with use of the AO/ASIF L-plate, focusing on complications (nonunions, infections, loss of correction, reoperations) and patient satisfaction (visual linear analog scale). During a 10-month period, we performed high tibial osteotomy for 40 patients experiencing medial knee osteoarthritis and a varus deformity. The average follow-up was 11 months. The complication rate in patients treated with the opening wedge technique was significantly higher regarding tibial nonunion, loss of correction, and material failure. Patients in the closing wedge group were more satisfied with the postoperative result. This study found that the Puddu plate, despite 6 weeks of non-weight bearing facilitating the osseous consolidation with Vitoss cement, was not able to maintain the correction during the time required for bone healing.

Lateral Closing-Wedge Osteotomy Achieved More Accurate Correction Than Medial Opening-Wedge Osteotomy

Question: In patients having high tibial osteotomy, how do lateral closing-wedge and medial opening-wedge techniques compare with regard to achievement and maintenance of correction? Design: Randomized (allocation concealed)*, un-blinded, controlled trial with 1-year follow-up. Setting: A university medical center in Rotterdam, The Netherlands. Patients: 92 patients (mean age 50 y, 64% men) with radiographic evidence of medial compartment osteoarthritis of the knee with medial joint pain and varus malalignment. Patients with symptomatic osteoarthritis of the lateral compartment, rheumatoid arthritis, range of movement of 10° were excluded. Patients in whom both knees were symptomatic had only the first knee included. 91 patients (99%) completed the study. Intervention: 47 patients were allocated to closing-wedge high tibial osteotomy and a plaster cylinder cast for 6 weeks after surgery, and 45 patients were allocated to opening-wedge osteotomy fixed with use of a Puddu plate (Arthrex, Naples, Florida). The closing-wedge technique was performed with use of the Allopro (Zimmer, Winterthur, Switzerland) calibrated osteotomy guide to resect the bone. The common peroneal nerve was exposed and retracted, and the anterior part of the fibular head was resected. The osteotomy was fixed with 2 staples. A fasciotomy of the anterior compartment was done to prevent compartment syndrome. For the opening-wedge technique, the extent of the opening wedge was calculated preoperatively with use of the goniometric formula table in the Arthrex instruction manual. During the procedure, the degree of correction was controlled by fluoroscopic assistance. If the opening-wedge was >7.5 mm, the open gap was filled with bone harvested from the ipsilateral iliac crest. Patients in the opening-wedge group were also randomized to receive a plaster cast (n = 22) or no cast (n = 23) after the osteotomy. Main outcome measures: Achievement of an overcorrection of the hip-knee-ankle angle by 4° ofvalgus (difference between the achieved valgus correction and the objective of 4° ofovercorrection). A dichotomous outcome of the proportion ofpatients achieving a valgus alignment between 0° and 6° was also measured. Secondary outcomes were measures of pain (visual analog scale [VAS]), walking distance, and knee function (Hospital for Special Surgery [HSS] score). The HSS score measured pain, function, range of movement, muscle strength, flexion deformity, and instability and involved a questionnaire and a physical examination. Main results: Analysis was by intention to treat. At 1 year, the hip-knee-ankle angle was greater in the closing-wedge group than in the opening-wedge group (3.4° vs 1.3°, respectively, with an adjusted mean difference of 2.12° [95% confidence interval, 0.38 to 3.86]). The mean deviation from valgus alignment of 4° was less in the closing-wedge group than in the opening-wedge group (2.7° vs 4°, respectively, with an adjusted mean difference of 1.67° [95% confidence interval, 0.42 to 2.92]). A valgus alignment within 0° to 6° was achieved in more patients in the closing-wedge group than in the opening-wedge group (Table).

Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate

A prospective, randomised, controlled trial compared two different techniques of high tibial osteotomy with a lateral closing wedge or a medial opening wedge, stabilised by a Puddu plate. The clinical outcome and radiological results were examined at one year. The primary outcome measure was the achievement of an overcorrection of valgus of 4 degrees . Secondary outcome measures were the severity of pain (visual analogue scale), knee function (Hospital for Special Surgery score), and walking distance. Between January 2001 and April 2004, 92 patients were randomised to one or other of the techniques. At follow-up at one year the post-operative hip-knee-ankle angle was 3.4 degrees (+/- 3.6 degrees SD) valgus after a closing wedge and 1.3 degrees (+/- 4.7 degrees SD) of valgus after an opening wedge. The adjusted mean difference of 2.1 degrees was significant (p = 0.02). The deviation from 4 degrees of valgus alignment was 2.7 degrees (+/- 2.4 degrees SD) in the closing wedge and 4.0 degrees (+/- 3.6 degrees sd) in the opening-wedge groups. The adjusted mean difference of 1.67 degrees was also significant (p = 0.01). The severity of pain, knee score and walking ability improved in both groups, but the difference was not significant. Because of pain, the staples required removal in 11 (23%) patients in the closing-wedge group and a Puddu plate was removed in 27 (60%) patients in the opening-wedge group. This difference was significant (p < 0.001). We conclude that closing-wedge osteotomy achieves a more accurate correction with less morbidity, although both techniques had improved the function of the knee at one year after the procedure.

Inverted V-shaped high tibial osteotomy compared with closing-wedge high tibial osteotomy for osteoarthritis of the knee

We compared the results ten years after an inverted V-shaped high tibial osteotomy with those of a historical series of conventional closing-wedge osteotomies. The closing-wedge series consisted of 56 knees in 51 patients with a mean follow-up of 11 years (10 to 15). The inverted V-shaped osteotomy was evaluated in 48 knees in 43 patients at a mean follow-up of 14 years (10 to 19). All the patients were scored using the Japanese Orthopaedic Association rating scale for osteoarthritis of the knee and radiological assessment. The pre-operative grade of osteoarthritis was similar in both groups. Post-operatively, the knee function score was graded as satisfactory in 63% (35) of the closing-wedge group but in 89% (43) of the inverted V-shaped osteotomy group. Post-operative radiological examination showed that delayed union and loss of correction occurred more often after a closing-wedge osteotomy than after an inverted V-shaped procedure. Our study suggests that the inverted V-shaped osteotomy may offer more dependable long-term results than traditional closing-wedge osteotomy.