Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial

Lansdaal, J.R.; Mouton, Tanguy; Wascher, Daniel C.; Demey, Guillaume; Lustig, Sébastien; Neyret, Philippe; Servien, Elvire

doi:10.1007/s00167-016-4225-8

Cited by 46 publications

(30 citation statements)

References 39 publications

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“…1,2 Some authors have described full-weight bearing as early as 2 weeks post-surgery without negative impact. 3 Tomofix patients tend to resume normal activities of living soon after surgery with work-related physical activities introduced at 3-4 months and sports after approximately 6-12 months. 4,5 One reservation for allowing patients to fully weight bear early on is the perceived risk of loss of correction of the angle, although in practice this effect appears to be a rare occurrence.…”

Section: Introductionmentioning

confidence: 99%

OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method

Jonker

Fallahi

Saraswathy

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The objective was to evaluate the clinical and patient-related short- to medium-term performance of the OPTY-LINE nail device for high tibial osteotomy (HTO), comparing a case series of the said device to the established Tomofix fixed-plate device. Patients and Methods: Males with symptomatic medial compartmental osteoarthritis and no serious (co-morbid) knee pathology were followed up, five Tomofix and six OPTY-LINE patients. Patients underwent computed tomography assessment and completed Knee Injury and Osteoarthritis Outcome score (KOOS) and osteotomy surgery patient satisfaction questionnaires, 3 and 6 months post-surgery. A radiologist impression score and a quantitative digital bone density analysis were performed by two independent radiologists. Mann–Whitney U test was applied for inferential statistical tests. Results: At 6 months post-surgery, for Tomofix, the median radiologists’ healing impression score was ‘progressive healing’ versus ‘union virtually complete’ for the OPTY-LINE nail; bone healing quotient was 1.30 (standard deviation (SD) 1.74) versus 1.78 (SD 1.58), p = 0.18. The post-operative absolute surgical accuracy was a mean 12 (7.5) for Tomofix versus 4.1 (2.3) for OPTY-LINE, p = 0.052. At baseline, however, Tomofix patients had more knee symptoms, as determined by KOOS symptom sub-score, when compared to the OPTY-LINE cohort ( p = 0.009). Conclusion: This initial, non-randomized, comparative evaluation of the OPTY-LINE device for HTO has produced similar outcomes to patients treated with the established Tomofix device. In particular, the rate of post-surgical bone regeneration and surgical accuracy achieved with the OPTY-LINE device are encouraging. Large-scale randomized controlled studies with longer follow-up are indicated to further evaluate the clinical and patient-related outcome performance for OPTY-LINE.

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Section: Introductionmentioning

confidence: 99%

OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method

Jonker

Fallahi

Saraswathy

et al. 2019

J Orthop Surg (Hong Kong)

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“…Darees [18] believes that if TomoFix is used as internal fixation, knee varus does not require bone grafting within 15°, and most of the osteotomy sites can heal by themselves within 1 year. It is currently believed that bone grafting is related to the patient's bone quality, correction angle and internal fixation type [19][20][21]. In this group of studies, the patients had good bone quality and their distraction distance was less than 15mm.…”

Section: Discussionmentioning

confidence: 84%

Effect Analysis of Opening Wedge High Tibial Osteotomy (OWHTO) for the Treatment of Medial Compartment Osteoarthritis

Huan¹,

Liu²,

Luo³

et al. 2019

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To investigate the clinical efficacy of open wedge high tibial osteotomy (OWHTO) in the treatment of medial compartment osteoarthritis of the knee.The authors used open OWHTO combined with TomoFix internal fixation to treat 46 cases (52 knees) with knee osteoarthritis with patella varus deformity from 2015.01 to 2017.10. HSS score and VAS score of Knee joint were used to evaluate the improvement of knee function and pain before and after surgery. The femorotibial angle (FTA), medial proximal tibial angle (MPTA), kneecap varus angle (KVA), and Weight-bearing line ratio of lower limbs (WBL) were measured by videography, which can evaluate the correction effect of postoperative knee varus. There were no happenings of internal fixation failure, delayed bone healing or non-union in these follow-up patients. At the follow-up of 3 months, 6 months, and 12 months, the HSS scores of the patients were significantly higher than those before the operation, and the difference was statistically significant (P<0.05). On March, June, and December after surgery, the HSS scores of patients were significantly higher than those before surgery and the difference was statistically significant (P<0.05). The VAS scores were lower than those before surgery, and the difference was statistically significant (P<0.05). These scores had no significant difference in the different follow-up time points (P>0.05). Imaging examination indexes showed that FTA, MPTA, KVA and WBL were improved after surgery and the varus deformity was corrected. Moreover, the difference was statistically significant (P<0.05). These scores had no significant difference in the different follow-up time points (P>0.05). In general, OWHTO can relieve joint pain and improve joint function by correcting lower limb line, showing good effect on medial compartment osteoarthritis of knee joint with varus.

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“…Another study by Hernigou et al (2013) 45 reported no differences in terms of hip-knee-ankle angle, tibial slope, or Caton index. Lansdaal et al 10 and Schröter et al 12 measured the mechanical tibiofemoral angle and found no difference between early and delayed weight-bearing groups. Although the verification methods used differed, most reports show that early weight-bearing does not compromise OWHTO outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies have found that immediate weight-bearing was essentially harmless. [10][11][12] Thus, the most appropriate form of postoperative management remains controversial; no consensus protocol has yet been firmly established.…”

mentioning

confidence: 99%

“…18,19 The postoperative rehabilitation protocol and osteotomy type also affected stability. [10][11][12]20 Finite element (FE) models yield local mechanical information that cannot be obtained in vivo or via experimental tests, allowing comparison of mechanical factors affecting the healing environment around various HTO implants. 21 An FE model showed that medial plate positioning was associated with poorer structural stability, and was less safe, than open-wedge osteotomy associated with anteromedial plate positioning.…”

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confidence: 99%

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Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management

Seo

Lim

Jang³

et al. 2019

J Knee Surg

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The present study was conducted to evaluate the force distribution in knee joint during daily activities after open-wedge high tibial osteotomy (OWHTO). A three-dimensional proximal tibial finite element model (FEM) was created using Mimics software to evaluate computed tomography (CT) scans of the tibia after OWHTO. The anterior and posterior gaps were 7.0 and 12.1 mm, respectively, and the target opening angle was 12 degrees. The loading ratio of the medial and lateral tibial plateaus was 6:4. To evaluate force distribution in the knee joint during activities of daily living (ADLs) after OWHTO, peak von Mises stresses (PVMSs) were analyzed at the plate and posterolateral edge region of osteotomized tibia. ADLs associated with greater knee flexion (sitting 90 degrees, standing 90 degrees, bending 90 degrees, stepping up stairs 60 degrees, and stepping downstairs 30 and 60 degrees) yielded PVMSs ranging from 195.2 to 221.5 MPa at the posterolateral edge region. In particular, stepping downstairs with knee flexion to 60 degrees produced the highest PVMS (221.5 MPa), greater than the yield strength (100–200 MPa). The highest plate PVMS was greater than 300 MPa during ADLs associated with flexion angles of approximately 90 degrees. However, these values did not exceed the yield stress (760.0 MPa). Conclusively, higher force was generated during higher flexion associated with weight-bearing and stepping downstairs produced a high force (even at lower flexion) on the posterolateral area of the tibial plateau. Therefore, a caution should be exercised when engaging in knee flexion of approximately 90 degrees and stepping downstairs in the early postoperative period when patients follow a weight-bearing rehabilitation protocol. However, this study is based on modeling; further translational studies are needed prior to clinical application.

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Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial

Abstract: II.

Cited by 46 publications

References 39 publications

OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method

OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method

Effect Analysis of Opening Wedge High Tibial Osteotomy (OWHTO) for the Treatment of Medial Compartment Osteoarthritis

Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management

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