High Tibial Osteotomy Procedure Research Articles

Personalised High Tibial Osteotomy Surgery Is Accurate: An Assessment Using 3D Distance Mapping

Early-stage knee osteoarthritis is often suitable for treatment with high tibial osteotomy (HTO). This is an effective joint-preserving treatment, resulting in good postoperative outcomes. To overcome the limitations of traditional HTO, the surgical technique and correction accuracy can be enhanced by personalised procedures using three-dimensional digital planning and metal additive manufacturing, The purpose of this clinical trial study was to evaluate the three-dimensional accuracy of a new personalised HTO procedure, using modern imaging techniques, 3D modelling, and distance map analysis (DMA). Twenty-five patients were treated with the personalised HTO procedure. Before surgery and after 6 months, they underwent clinical evaluation scoring, radiographic imaging, and computed-tomography scanning to generate morphological models. Specifically, preoperative tibia models were used to plan the tibia correction and the design and position of the fixation plate. Preoperative, planned, and postoperative models were imported in computer-aided and designing software (Geomagic ControlTM 2014, 3D Systems, Rock Hill, SC, USA) for DMA implementation to assess geometrical differences between model surfaces. A very good reproduction of the planned tibia morphology was achieved postoperatively (average differences between −0.9 mm and 1.4 mm). DMA values associated with fixation-plate deformation were less than 1 mm, similar to those for plate-to-tibia surface-contour matching. Overall, personalised digitally planned HTO utilising three-dimensional printed surgical guides and plates enables accurate planned correction and plate placement.

Application of image recognition-based tracker-less augmented reality navigation system in a series of sawbone trials

BackgroundThis study introduced an Augmented Reality (AR) navigation system to address limitations in conventional high tibial osteotomy (HTO). The objective was to enhance precision and efficiency in HTO procedures, overcoming challenges such as inconsistent postoperative alignment and potential neurovascular damage.MethodsThe AR-MR (Mixed Reality) navigation system, comprising HoloLens, Unity Engine, and Vuforia software, was employed for pre-clinical trials using tibial sawbone models. CT images generated 3D anatomical models, projected via HoloLens, allowing surgeons to interact through intuitive hand gestures. The critical procedure of target tracking, essential for aligning virtual and real objects, was facilitated by Vuforia’s feature detection algorithm.ResultsIn trials, the AR-MR system demonstrated significant reductions in both preoperative planning and intraoperative times compared to conventional navigation and metal 3D-printed surgical guides. The AR system, while exhibiting lower accuracy, exhibited efficiency, making it a promising option for HTO procedures. The preoperative planning time for the AR system was notably shorter (4 min) compared to conventional navigation (30.5 min) and metal guides (75.5 min). Intraoperative time for AR lasted 8.5 min, considerably faster than that of conventional navigation (31.5 min) and metal guides (10.5 min).ConclusionsThe AR navigation system presents a transformative approach to HTO, offering a trade-off between accuracy and efficiency. Ongoing improvements, such as the incorporation of two-stage registration and pointing devices, could further enhance precision. While the system may be less accurate, its efficiency renders it a potential breakthrough in orthopedic surgery, particularly for reducing unnecessary harm and streamlining surgical procedures.

Paper 31: Patient Reported and Clinical Outcomes of High Tibial Osteotomy and Distal Femoral Osteotomy in High Level Athletes

Objectives: High Tibial Osteotomy (HTO) and Distal Femoral Osteotomy (DFO) have long been utilized in the treatment of symptomatic osteoarthritis as well as malalignment with instability, meniscal deficiency or chondral defects. There remains a paucity of literature on the clinical and patient reported outcomes following HTO and DFO procedures in high level athletes. The purpose of this study is to present the outcomes in high-level athletes following HTO and DFO surgery at a large academic institution. Methods: High-level athletic patients (defined as Tegner score over 5) undergoing HTO/DFO from January 2010 to August 2023 were eligible for inclusion. Patients were excluded if they were less than 18 years old, had a Tegner score below 5 prior to symptom onset or had less than 2 years of follow-up. Demographic data including sex, age at time of surgery, and body mass index (BMI) at time of surgery was obtained from the EMR. Outcomes were assessed using follow-up questionnaires that consisted of symptom resolution, patient satisfaction, Tegner Activity Scale, IKDC, KOOS, Lysholm, and return to sports. Patients with concomitant meniscus allograft transplantation, osteochondral allograft transplantation and anterior cruciate ligament reconstruction were included. Results: There were 52 patients that met inclusion criteria, with 39 (75.0%) of patients undergoing HTO and 13 (25.0%) patients undergoing DFO. The mean age at the time of surgery was 39.5 ± 11.1 years, mean follow-up was 5.6 ± 3.1 years (2.0-12.2 years). The cohort was 71.2% male with average BMI of 26.8 ±4.1 Complete symptomatic resolution was reported by 46.2% of patients. When asked about their overall physical ability after surgery, 41.2% patients said they were “much better”, with 27.5% patients saying they were “better”. The mean VAS satisfaction score at final follow-up was 73.7 and 64.7% patients would choose to undergo the operation again if given the option. There was a significant decrease in the value of VAS pain score from the patient’s pre-operative level after knee injury versus their current pain level (73.6 vs. 29.5, p<0.0001). Furthermore, 3/51 (5.9%) patients eventually underwent total knee arthroplasty with an average time of 2.9 ± 0.2 years form HTO/DFO procedure. The mean Tegner score before injury was 6.4, before surgery was 2.7 and a significant increase to 4.3 (p<0.0001) after the procedure at follow up. Following surgery 82.7% of patients met the threshold for patient acceptable symptom state (PASS) for IKDC. 44 percent returned to sports after surgery and only 12 (25.0%) were able to return to sport to the same level from before their injury. The average time to return to sport was 47.3 ±27.0 weeks. There was a significant difference between male and female patients undergoing HTO/DFO procedures with respect to IKDC (p=0.027), KOOS symptom (p=0.048), KOOS activities of daily living (p=0.050), KOOS pain (p=0.050), KOOS QoL (p=0.039) and KOOS sports (p=0.016). Additionally, there was no significant difference in any of the clinical or patient reported outcomes studied between patients who underwent HTO/DFO procedures for degenerative joint disease versus instability aside from IKDC (72.8 vs. 61.1, p=0.046) and KOOS ADL (92.1 vs. 81.0, p=0.037). Conclusions: In high level-athletes, HTO and DFO procedures lead to high satisfaction rates and significant increases in Tegner scores following surgery compared to their symptomatic baseline, with low conversion rates to total knee arthroplasty at mid-term follow up, with male patients having better outcomes. The majority of patients did not return to sport following these procedures and even fewer were able to return to sport at their pre-injury activity level. Surgeons can use the findings from this study to educate high-level athletes that HTO/DFO procedures provide reliable improvements in clinical and patient reported outcomes with high patient satisfaction but may not allow them to return to sport at their pre-injury level.

Patient-specific cutting guides increase accuracy of medial opening wedge high tibial osteotomy procedure: A retrospective case-control study.

To compare the accuracy of patient-specific guides (PSCG) to the standard technique in medial open-wedge high tibial osteotomy (OWHTO). Secondary objectives were to evaluate factors that could influence accuracy and to compare the complication rate and operating time for both procedures. A retrospective analysis of prospective collected data was performed. Between March 2011 and May 2018, 49 patients with isolated medial knee osteoarthritis who were operated for OWHTO using PSCG and 38 patients using the standard technique were included. Preoperative and postoperative deformities were evaluated on long leg radiographs by measuring the mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, hip knee ankle angle (HKA), and joint line convergence angle. Pre- and postoperative posterior tibial slope was also evaluated. Accuracy was evaluated by analysing the difference between the preoperative planned and the actual postoperative HKA. Operating time and complication rate were also recorded in both groups. The mean preoperative HKA was 173.4° (±3.1°) in the PSCG group and 173.3° (±2.4°) in the standard group (p = 0.8416). Mean planned HKA were 182.8° (±1.1°) and 184.0° (±0°) respectively for the PSCG and the standard group. Mean postoperative HKA were 181.9° (±1.9°) and 182.6° (±3.1°) respectively for the PSCG and the standard group. An accuracy of ±2° in the HKA was achieved in 44 (90%) in the PSCG group and 24 (65%) in the standard group (p = 0.006). The probability of achieving a HKA accuracy was four times higher for patients in the PSCG group (odds ratio [OR] = 4.06, [1.1; 15.3], p = 0.038). Also, higher preoperative Ahlback grade was associated with precision, all other parameters being equal (OR = 4.2, [0.13; 0.97], p = 0.04). In this study, the PSCG technique was significantly more accurate for achieving the planned HKA in OWHTO. Complication rates and operating times were comparable between groups. Level IV, case-control study.

DOES OBESITY HAVE AN EFFECT ON PATIENT OUTCOMES AND PLATE SURVIVORSHIP IN HIGH TIBIAL OSTEOTOMY SURGERY? THE TOMOFIX ANATOMICAL MEDIAL HIGH TIBIAL PLATE

AbstractIntroductionSurgery in patients with high body mass index (BMI) is more technically challenging and associated with increased complications post-operatively. Inferior clinical and functional mid-term results for high BMI patients undergoing high tibial osteotomy (HTO) relative to normal weight patients have been reported. This study discusses the clinical, radiological and functional outcomes of HTO surgery in patients with a high BMI.MethodThis is a retrospective study on patients undergoing HTO surgery using the Tomofix anatomical MHT plate between 2017 and 2022, with follow-up period of up to 5 years. The cohort was divided: non-obese (BMI <30 kg/m2) and obese (BMI>30 kg/m2). Pre and post operative functional scores were collected: Oxford Knee Score (OKS), EuroQol-5D and Tegner. Complications, plate survivorship and Mikulicz point recorded.Results32 HTO procedures; 19 patients BMI <30 (average 27.0) and 14 patients BMI >30 (average 36.1). In BMI<30 cohort, one readmission for investigation of venous thromboembolism, doppler negative; two complications: hinge fracture and stitch abscess. The five year survivorship of the plate was 100%. In BMI>30 cohort, one readmission for pulmonary embolism; one complication: hinge fracture. The 5 year survivorship of the plate was 93%, 1 conversion to unicompartmental knee replacement. The average OKS improvement was 17 and 18 for BMI <30 and >30 respectively. Mikulicz point change was identical.ConclusionThe Tomofix anatomical MHT plate achieves good outcomes and minimal complications irrespective of BMI. Reduced plate survivorship, thus earlier conversion may be required in the obese, however higher cohort numbers are needed to confirm this.

MID-TERM RESULTS OF HIGH TIBIAL OSTEOTOMY USING THE ANATOMICAL TOMOFIX MEDIAL HIGH TIBIAL PLATE

AbstractIntroductionCompared to the standard Tomofix plate, the anatomical Tomofix medial high tibial (MHT) plate has been shown to improve anatomical fit and post correction tibial contour, following high tibial osteotomy (HTO). Clinical data on surgical complications, osteotomy union rates and survivorship with the anatomical Tomofix MHT plate however remain limited. This study reports mid-term results of HTO surgery, using the anatomical Tomofix MHT plate.MethodsAll patients undergoing HTO surgery using the anatomical Tomofix MHT plate between 2017 and 2022 were included in the study. Data on complications, osteotomy union rates and survivorship were collected prospectively and retrospectively analysed.Results78 HTO procedures were performed using the anatomical Tomofix plate in 68 patients. Follow-up ranged between 6 weeks and 5 years. Postoperative complications included 5 hinge fractures that united without further intervention, 1 deep vein thrombus and 1 subclinical pulmonary embolism. There were no wound problems and no returns to theatre, other than for planned removal of metalwork at 1 year. All osteotomies united with no loss of correction. Only 1 HTO was successfully revised to a partial medial knee replacement 2.5 years following osteotomy. The 5-year survivorship was 98.7%.ConclusionThe anatomical Tomofix MHT plate achieves excellent biomechanical stability and union rates in HTO surgery, with minimal complications and excellent mid-term HTO survivorship.

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

Background: High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are well-recognized treatments to address varus and valgus malalignment, respectively, in the setting of symptomatic unicompartmental arthritis of the tibiofemoral joint. The existing literature is limited in its ability to characterize complications after HTO or DFO procedures. Purpose: The objective of this study was to determine the rate of early (≤90 days) postoperative complications and associated variables from the 15-year experience of a single academic institution. Study Design: Case series; Level of evidence, 4. Methods: Patients treated at a single academic institution between 2008 and 2022 who underwent HTO or DFO procedures were identified. All patients with minimum 90-day follow-up were considered for inclusion in the study. Exclusion criteria were inadequate follow-up, unavailable medical records, age <14 years, and revision osteotomy. Patient demographic characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. All intraoperative complications were recorded. Results: A total of 243 knees in 232 patients met eligibility and were included in the final analysis. Three intraoperative complications (1.2%) involving fracture extension of the osteotomy occurred. There were 127 early postoperative complications (121 surgical, 6 medical) in 102 knees (68 with HTO and 34 with DFO). Medical complications included pulmonary embolus in 3 patients (1.2%), urinary tract infection in 2 patients (0.8%), and postoperative ileus requiring prolonged hospitalization in 1 patient (0.4%). The most common complications were stiffness requiring a non–standard of care intervention (17.7%), superficial wound infection or wound dehiscence (13.2%), and hemarthrosis or effusion requiring aspiration (6.6%). The rate of deep infection requiring irrigation and debridement was 4.1%. Variables associated with early postoperative complications included smoking (odds ratio [OR], 3.05; 95% CI, 1.34-6.94; P = .008), concomitant chondroplasty and/or loose body removal (OR, 2.55; 95% CI, 1.50-4.33; P = .001), and concomitant ligament reconstruction (OR, 3.97; 95% CI, 1.37-11.53; P = .011). Conclusion: These 15-year data revealed a low rate of intraoperative complications (1.2%) and a relatively high rate of early (≤90 days) postoperative complications (42.0%) after an HTO or DFO procedure. Surgeons should be aware of the increased postoperative complications associated with smoking, concomitant chondroplasty, and concomitant ligament reconstruction and should use this information to counsel patients regarding appropriate expectations in the postoperative period.

Application of a New M-shaped High Tibial Osteotomy Method: A Technical Note.

High tibial osteotomy (HTO) is used as an alternative to total knee arthroplasty in young patients with knee osteoarthritis. In the conventional HTO, if the distraction distance is large, the osteotomy section will be significantly separated, forming a large bone defect gap, which may lead to delayed healing or even nonunion. We treated a series of 10 patients with medial knee osteoarthritis by a novel M-shaped high tibial osteotomy. This helped to improve greater contact of cortical sections and rapid healing of the osteotomy break. Over a mean follow-up period of 8.5months (range, 6.0-12.0months), all patients achieved bone union. None of the patients showed complications such as nonunion or infection. The novel M-shaped HTO procedure can reduce the probability of delayed union/nonunion and avoid the complications associated with bone grafting. Hence, this technique may be an effective alternative for the HTO.

Unicompartmental knee arthroplasty vs. high tibial osteotomy for medial knee osteoarthritis (UNIKORN): a study protocol of a randomized controlled trial

BackgroundMedial knee osteoarthritis (OA) is a common health problem resulting in knee pain and limiting patients’ physical activity. After failed conservative treatment, unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are possible surgical treatment options for this condition. There is a paucity of high-quality evidence in the literature comparing objective and subjective outcomes of these procedures. Also, there is no common agreement on whether these procedures provide comparable results in late-stage medial knee OA patients.MethodsWe will perform a prospective randomized controlled trial comparing HTO and UKA in patients with late-stage medial knee OA. 100 patients with isolated medial knee OA (KL III–IV) are assigned to either UKA (n = 50) or HTO (n = 50) procedure in patients 45–65 years of age. Our primary outcome will be KOOS5 at one year postoperatively. Secondary outcomes include OARSI physical assessment, length of stay, wearable activity watch, radiographs (OA progression according to Kellgren-Lawrence classification), patient-reported outcomes (KOOS subscales, pain visual analog scale [VAS], Lysholm, and Oxford knee scores), and adverse events (conversion to total knee arthroplasty, surgery-related complications, need for revision surgery) outcomes. Our hypothesis is that neither of the interventions is superior as measured with KOOS5 at 12 months.Ethics and disseminationThe institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications.Trial registrationClinicalTrials.gov/TooloH NCT05442242. Registered on 7/1/2022.

PRECLINICAL TESTING OF A CUSTOM-MADE PERSONALIZED HIGH TIBIAL OSTEOTOMY SYSTEM FOLLOWING THE ‘IDEAL’ FRAMEWORK: ACCURACY OF ANATOMICAL CORRECTION USING 3D IMAGING

High tibial osteotomy (HTO) is an effective surgical treatment for isolated medial compartment knee osteoarthritis; however, widespread adoption is limited due to difficulty in achieving the planned correction, and patient dissatisfaction due to soft tissue irritation. A new HTO system – Tailored Osteotomy Knee Alignment (TOKA®, 3D Metal Printing Ltd, Bath, UK) could potentially address these barriers having a custom titanium plate and titanium surgical guides featuring a unique mechanism for precise osteotomy opening as well as saw cutting and drilling guides. The aim of this study was to assess the accuracy of this novel HTO system using cadaveric specimens; a preclinical testing stage ahead of first-in-human surgery according to the ‘IDEAL-D’ framework for device innovation.Local ethics committee approval was obtained. The novel opening wedge HTO procedure was performed on eight cadaver leg specimens. Whole lower limb CT scans pre- and post-operatively provided geometrical assessment quantifying the discrepancy between pre-planned and post-operative measurements for key variables: the gap opening angle and the patient specific surgical instrumentation positioning and rotation - assessed using the implanted plate.The average discrepancy between the pre-operative plan and the post-operative osteotomy correction angle was: 0.0 ± 0.2°. The R2 value for the regression correlation was 0.95.The average error in implant positioning was −0.4 ± 4.3 mm, −2.6 ± 3.4 mm and 3.1 ± 1.7° vertically, horizontally, and rotationally respectively.This novel HTO surgery has greater accuracy and smaller variability in correction angle achieved compared to that reported for conventional or other patient specific methods with published data available. This system could potentially improve the accuracy and reliability of osteotomy correction angles achieved surgically.

Cartilage regeneration techniques with concomitant high tibial osteotomy (HTO), An innovative biomechanical therapy for osteoarthritis (OA) knee – Systematic review

In orthopedic surgery, a high tibial osteotomy (HTO) is a common treatment. Indications, patient selection, pre-operative planning, surgical procedure, fixation methods, and complications are all covered in detail. This research concentrated on the factors that should be examined in order to produce positive long-term results. To examine the stated hypothesis “medium- to long-term outcomes of high tibial osteotomy and therapies for cartilage healing”. A thorough search of the database like MEDLINE was done. A clinical outcome investigation employing HTO as the main technique, the usage of a sort of cartilage repair, &amp; a minimum follow-up period of 2 years were all necessary. Everything from the research layout to the patient demographics to the sorts of procedures conducted, the clinical consequences to eventual overall knee arthroplasty progression and consequences was investigated in depth. As a result of a combination of HTO and cartilage regeneration procedures, patients may avoid or delay knee arthroplasty surgery in the medium to long term.

Personalised 3D Printed high tibial osteotomy achieves a high level of accuracy: 'IDEAL' preclinical stage evaluation of a novel patient specific system.

High tibial osteotomy (HTO) is an effective surgical treatment for isolated medial compartment knee osteoarthritis; however, widespread adoption is limited due to difficulty in achieving the planned correction, and patient dissatisfaction due to soft tissue irritation. The aim of this study was to assess the accuracy of a novel HTO system with 3D printed patient specific implants and surgical guides using cadaveric specimens. Local ethics committee approval was obtained. The novel opening wedge HTO procedure was performed on eight cadaver leg specimens. Whole lower limb CT scans pre- and post-operatively provided geometrical assessment quantifying the discrepancy between pre-planned and post-operative measurements for key variables: the gap opening angle and the patient specific surgical instrumentation positioning. The average discrepancy between the pre-operative plan and the post-operative osteotomy correction angle was: 0.0 ± 0.2° The R² value for the regression correlation was 0.95. The average error in implant positioning was -0.4 ± 4.3 mm, -2.6 ± 3.4 mm and 3.1 ± 1.7° vertically, horizontally, and rotationally respectively. This novel HTO surgery has greater accuracy in correction angle achieved compared to that reported for conventional or other patient specific methods with published data available. This system could potentially improve the accuracy of osteotomy correction angles achieved surgically.

Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System.

Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about customized devices for HTO and their correction accuracy lacks. Methods: The databases PUBMED and EMBASE were systematically screened for human and cadaveric studies about the use of customized devices for high tibial osteotomy and their outcomes concerning correction accuracy. Furthermore, a 3D-printed customized system for valgus HTO with three pilot cases at one-year follow-up was presented. Results: 28 studies were included. The most commonly used custom-made devices for HTO were found to be cutting guides. Reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3° or under. The three pilot cases that underwent personalized HTO with a new 3D-printed device presented satisfactory alignment and clinical outcomes at one-year follow-up. Conclusion: The available patient-specific devices described in the literature, including the one used in the preliminary cases of the current study, showed promising results in increasing the accuracy of correction in HTO procedure.

The influence of different hinge position on PTS during HTO: comparison between open-wedge and closed-wedge HTO

PurposeThe purpose of this study was to determine the significance of hinge position through comparison between open-wedge and closed-wedge high tibial osteotomy (HTO) and to determine the ideal hinge position to minimize the effect of HTO on the posterior tibial slope (PTS) and medial proximal tibial angle (MPTA).MethodsProcedures were performed on 32 cadaveric knees using open-wedge HTO with the standard hinge position or a low hinge position or closed-wedge HTO with the standard hinge position or a low hinge position. To define the standard hinge position in open wedge HTO, we drew a line 3-cm inferior to the medial tibial plateau toward the fibular head and located the intersection of this line with a longitudinal line 1-cm medial to fibular shaft. The low hinge position was then defined as the point 1-cm inferior to the standard position. For the standard hinge position for closed-wedge HTO, we drew a line parallel with joint line from 2-cm inferior to the lateral tibial plateau. The low hinge position was then defined as the point 1-cm inferior to the standard position.ResultsFor the open-wedge procedure, osteotomy through the low hinge position resulted in a significantly greater PTS compared to osteotomy through the standard hinge position. MPTA was also significantly greater for the low hinge position compared to standard hinge position. In the closed-wedge HTO, neither the PTS nor MPTA was significantly different for the low and standard hinge positions.ConclusionsHinge position significantly affects changes in the PTS and MPTA following open-wedge but not closed-wedge HTO. Understanding how to hinge position affects the PTS and MPTA is critical for surgeons performing open-wedge HTO procedures. Adopting an accurate hinge position is crucial for preventing complications, especially in open-wedge osteotomy, due to postoperative changes in the PTS and MPTA.

How to Perform Concomitant Medial Meniscus Pull-Out Repair With Medial Open-Wedge High Tibial Osteotomy Without Technical Failure

Varus alignment of the knee joint (varus >5°) is known as a poor prognostic factor for medial meniscus root repair, and alignment correction is recommended in patients with varus deformity and medial meniscus root tears. However, simultaneous medial meniscus pull-out repair and high tibial osteotomy are technically demanding procedures due to the long surgical time, poor visualization, and breaking of the pull-out sutures during high tibial osteotomy procedures. In the present Technical Note, we will introduce a surgical method to perform 2 procedures simultaneously without technical difficulty. The main surgical techniques are as follows. (1) Release the superficial medial collateral ligament before arthroscopic medial meniscus pull-out repair, which secures sufficient working space and visualization. Therefore, the operation time could also be reduced by performing the arthroscopic procedure with the anterior portal. (2) Protect the pull-out sutures with an ENDOBUTTON reamer, which prevents pull-out sutures from breaking during the high tibial osteotomy procedure.

Efficacy and safety of intravenous combined with topical administration of tranexamic acid in reducing blood loss in opening wedge high tibial osteotomy procedure: A retrospective case-control study.

This study aimed to evaluate the efficacy and safety of intravenous combined with topical application of tranexamic acid (TXA) in reducing blood loss in opening wedge high tibial osteotomy (OWHTO). A total of 60 patients who underwent unilateral OWHTO between May 2018 and May 2019 were retrospectively reviewed. All the patients were then divided into one of the two groups (30 per group): the TXA group, patients receiving intravenous combined with topical application of TXA, and the control group, patients receiving no TXA. Outcome measures were drain volume, total blood loss, hidden blood loss, transfusion requirements, and incidence of complications. The mean follow-up of TXA group was 14.2 2.3 months (range, 13-16 months) and the mean follow-up for the control group was 14.4 2.1 months (range, 13-17 months). No significant difference was found for the follow-up of two groups (P=0.829). Drainage volume (143.3 65.4 ml vs 307.8 51.4 mL, P < 0.001), hidden blood loss (156.7 63.8 mL vs 286.4 79.1 mL, P < 0.001) and knee swelling (3.2 0.9 vs 6.5 2.1, P < 0.001) in the TXA group was clearly less than that in the control group, and there was no statistical significance with regard to hospitalization time (P=0.746), transfusion requirements (P=1.000), wound complications (P=0.386), deep venous thrombosis (P=1.000), postoperative Lysholm knee score (P=0.681) and Knee Injury and Osteoarthritis Outcome subscales pain (P=0.752), symptoms (P=0.673), activities of daily living (P=0.871), sport/recreation function (P=0.816), and knee-related quality of life (P=0.576) at 6 months postoperatively. This study has shown that administration of intravenous combined with topical TXA in OWHTO can effectively reduce perioperative blood loss without increasing the incidence of postoperative complications. Level III, Therapeutic Study.

Tibial Condylar Valgus Osteotomy Combined With Medial Open-Wedge Distal Tuberosity Tibial Osteotomy

Severe varus deformity in osteoarthritic knees is attributed not only to bony deformity but also to intra-articular deformity as a result of medial joint space narrowing with lateral joint space widening (increased joint line convergence angle). In such knees, correction of bony deformity by high tibial osteotomy (HTO) alone may not be capable of restoring physiological joint geometry and biomechanics. Tibial condylar valgus osteotomy (TCVO), an L-shaped osteotomy in the medial tibial condyle, has been proposed to improve articular stability and congruity by elevating the medial tibial joint line and addressing the articular component of the deformity; however, its surgical efficacy for correction of the valgus deformity is limited. Therefore a procedure combining HTO and TCVO can be a reasonable option to achieve restoration of the knee joint physiology in such situations. In our current practice, medial open-wedge distal tuberosity tibial osteotomy (MOW-DTO) has been the procedure of primary option among the HTO procedures to avoid patellofemoral overload which could be an inherent problem in medial open-wedge HTO. In this article, the surgical rationale and the combined procedure of TCVO and MOW-DTO are described.

Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors.

BACKGROUND:An important aim of high tibial osteotomy (HTO) is to prevent or delay the need for total knee replacement (TKR). We sought to estimate the frequency and timing of conversion from HTO to TKR and the factors associated with it.METHODS:We prospectively evaluated patients with osteoarthritis (OA) of the knee who underwent medial opening wedge HTO from 2002 to 2014 and analyzed the cumulative incidence of TKR in July 2019. The presence or absence of TKR on the HTO limb was identified from the orthopedic surgery reports and knee radiographs contained in the electronic medical records for each patient at London Health Sciences Centre. We used cumulative incidence curves to evaluate the primary outcome of time to TKR. We used multivariable Cox proportional hazards analysis to assess potential preoperative predictors including radiographic disease severity, malalignment, correction size, pain, sex, age, body mass index (BMI) and year of surgery.RESULTS:Among 556 patients who underwent 643 HTO procedures, the cumulative incidence of TKR was 5% (95% confidence interval [CI] 3%–7%) at 5 years and 21% (95% CI 17%–26%) at 10 years. With the Cox proportional hazards multivariable model, the following preoperative factors were significantly associated with an increased rate of conversion: radiographic OA severity (adjusted hazard ratio [HR] 1.96, 95% CI 1.12–3.45), pain (adjusted HR 0.85, 95% CI 0.75–0.96)], female sex (adjusted HR 1.67, 95% CI 1.08–2.58), age (adjusted HR 1.50 per 10 yr, 95% CI 1.17–1.93) and BMI (adjusted HR 1.31 per 5 kng/m2, 95% CI 1.12–1.53).INTERPRETATION:We found that 79% of knees did not undergo TKR within 10 years after undergoing medial opening wedge HTO. The strongest predictor of conversion to TKR is greater radiographic disease at the time of HTO.

The effect of the sagittal plane osteotomy inclination on the posterior tibial slope in medial open wedge HTO: experimental study with a square column model

BackgroundMedial open-wedge high tibial osteotomy (HTO) is an effective and safe treatment method for medial osteoarthritis of the knee. However, unintended changes in the posterior tibial slope (PTS) may occur. Several factors cause PTS alterations after medial open-wedge HTO; however, research on sagittal-plane osteotomy inclination (SPOI) in relation to the PTS is sparse. The purpose of this study was to evaluate whether the SPOI affects changes in the PTS after medial open-wedge HTO. The hypothesis was that an SPOI parallel to the PTS causes no change in the PTS after medial open-wedge HTO.MethodsA square column model with a 10° posterior slope was produced using two three-dimensional (3D) programs and a 3D printer. Then, a series of medial open-wedge HTO procedures was performed on the square column model through virtual simulation using the two 3D programs, and an actual simulation was conducted using a 3D printer, a testing machine and a measurement system. The SPOI was divided into four types: ① SPOI 20° (posterior-inclined 10° osteotomy), ② SPOI 10° (osteotomy parallel to posterior slope), ③ SPOI 0° (anterior-inclined 10° osteotomy), and ④ SPOI − 10° (anterior-inclined 20° osteotomy). The correction angle was increased at intervals of 5° from 0° to 30°. The change in posterior slope was measured in the sagittal plane.ResultsThe posterior slope was increased in SPOI 20° (posterior-inclined 10° osteotomy), maintained in SPOI 10° (osteotomy parallel to posterior slope), and decreased in SPOI 0° (anterior-inclined 10° osteotomy) and SPOI − 10° (anterior-inclined 20° osteotomy) based on the correction angle.ConclusionsIn this study using a square column model, the SPOI affected the change in the PTS, and an SPOI parallel to the PTS caused no change in the PTS after medial open-wedge HTO.

Radiographic evaluation of patellar ligament length after tibial plateau leveling osteotomy in dogs

To radiographically compare patellar ligament length (PLL) in dogs undergoing tibial plateau leveling osteotomy (TPLO) for unilateral cranial cruciate ligament rupture at preoperative, postoperative, and follow-up evaluations. 105 dogs that underwent TPLO for unilateral cranial cruciate ligament rupture at a referral veterinary hospital from October 1, 2008, through November 30, 2017. Medical records were reviewed to obtain information on dog signalment, surgical procedure, and radiographically measured PLL at preoperative, postoperative, and follow-up evaluations. Dogs undergoing TPLO had a shorter PLL at the postoperative and follow-up evaluations, compared with the PLL at the preoperative evaluation. Mean ± SD overall unadjusted PLL decreased significantly by 2.3 ± 3.4% between the preoperative and postoperative evaluation and by 2.8 ± 3.9% between the preoperative and follow-up evaluation. The PLL did not differ significantly between the postoperative and follow-up evaluation; mean PLL decreased by 0.4 ± 3.8% between the postoperative and follow-up evaluation. The PLL was shorter after TPLO in dogs, which was similar to changes observed for humans after high tibial osteotomy procedures. Further evaluation of clinical assessments, joint mobility, ultrasonographic assessments, and kinematic results are needed to determine the relevance of the PLL and whether a decrease in ligament length results in decreased mobility and persistent lameness in dogs, as has been reported for humans.