Factors affecting stability after medial opening wedge high tibial osteotomy using locking plate: A cadaveric study

Na, Young Gon; Kwak, Dai-Soon; Chong, Suri; Kim, Tae Kyun

doi:10.1016/j.knee.2019.07.016

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…There are several biomechanical studies analyzing the stability in OWHTO. However, the studies are focused on the stability related to the type and method of the fixation device, lateral hinge fracture, or filling the osteotomy gap with a bone substitute equivalent to the size of the opening [49]. To our knowledge, this is the first experimental model that allows a biomechanical evaluation of the stability related to the optimal position of the intersection point between the medial-lateral articular line and the corrected mechanical axis.…”

Section: Discussionmentioning

confidence: 99%

Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach

et al. 2022

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This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view.

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Section: Discussionmentioning

confidence: 99%

Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach

et al. 2022

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“…A graft material with bone healing potential, such as an autologous bone graft, will elicit better outcomes [9, 25]. Postoperatively, more careful weight‐bearing will be required to prevent correction loss [18].…”

Section: Discussionmentioning

confidence: 99%

“…Between closed‐ and open‐wedge HTOs (CWHTO and OWHTO), initial stability in CWHTO with a direct bone to bone contact can be better than in OWTHO which creates a bony gap [18]. It is well known that contact bone healing is much easier and faster than gap bone healing [19].…”

Section: Introductionmentioning

confidence: 99%

Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients

Song

Yoon²,

Kim³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the incidence of correction loss and survival rate between closed-wedge and open-wedge high tibial osteotomies (CWHTO and OWHTO, respectively) in patients with osteopenic and normal bone. Methods Retrospective review was conducted for 115 CWHTOs and 119 OWHTOs performed in osteopenic patients [− 2.5 < Bone mineral density (BMD) T scores ≤ − 1] and 136 CWHTOs and 138 OWHTOs performed in normal patients (BMD T score > − 1) from 2012 to 2019. Demographics were not diferent between CW-and OWHTOs in osteopenic and normal patients (n.s., respectively). Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated pre-and postoperatively (2 weeks after HTO). The occurrence of hinge fractures was investigated using radiographs taken on the operation day. The correction change was calculated as the last follow-up value minus postoperative MPTA. Correction loss was deined when the correction change was ≥ 3°. The survival rate (failure: correction loss) was investigated. Results There were no signiicant diferences in the pre and postoperative MA, MPTA, PTS, and value changes between CW-and OWHTOs in osteopenic and normal patients (n.s., respectively); the incidence of unstable hinge fractures also did not difer signiicantly (CWHTO vs. OWHTO = 7 vs. 7.6% in osteopenic patients; 2.9 vs. 3.6% in normal patients; n.s., respectively). The average correction change (CWHTO = − 0.6°, OWHTO = − 1.3°, p = 0.007), incidence of correction loss (CWHTO = 1.7%, OWHTO = 9.2%, p = 0.019), and 5-year survival rates (CWHTO = 98.3%, OWHTO = 90.8%, p = 0.013) difered signiicantly in osteopenic patients; there were no signiicant diferences in these results in normal patients (n.s., respectively). Conclusion CWHTO was more advantageous than OWHTO regarding the correction loss in osteopenic patients. Intra-and postoperative care that consider poor bone quality will be required when performing OWHTOs in osteopenic patients. Level of evidence III.

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“…LHF as a consequence of a MOWHTO has been a matter of discussion in recent years and is considered a critical factor that can lead to delayed union, non-union, and loss of correction ( 2 , 11 , 12 , 13 , 14 , 17 , 29 , 34 , 36 , 37 , 38 ).…”

Section: Lhf Consequencesmentioning

confidence: 99%

Lateral hinge fracture in medial opening wedge high tibial osteotomy: a narrative review

et al. 2023

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Lateral hinge fractures (LHF) are one of the most common complications of medial opening wedge high tibial osteotomy (MOWHTO), and are the leading cause of construct instability displacement, non-union, and varus recurrence after this procedure. To date, Takeuchi’s classification is the most popular classification to describe this complication, and it can help surgeons to make intra and postoperative decisions. Opening medial gap width is the most recognized factor related to LHF occurrence. Recognizing the implications of LHF in patients’ clinical and radiographic results has led many authors to propose surgical tips and the use of osteosynthesis materials such as K-wires and screws for its prevention, which should be considered when identifying risk factors for LHF during preoperative planning. The evidence for determining the optimal management of LHF is scarce and mostly supported by experts’ opinions and recommendations; therefore, studies are still needed to identify the most appropriate behavior when dealing with such a complication.

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Factors affecting stability after medial opening wedge high tibial osteotomy using locking plate: A cadaveric study

Cited by 6 publications

References 41 publications

Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach

Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach

Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients

Lateral hinge fracture in medial opening wedge high tibial osteotomy: a narrative review

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