Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy

Ishimatsu, Tetsuro; Takeuchi, Ryohei; Ishikawa, Hiroyuki; Maeyama, Akira; Osawa, Katsunari; Yamamoto, Takuya

doi:10.1007/s00402-021-03974-1

Cited by 8 publications

(4 citation statements)

References 43 publications

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“…However, no validated DLO planning method reported in the literature can be directly performed on full-length standing AP X-rays using simple measurement tools. The proposed planning method is not entirely novel but refers to the previously theoretical principles described by Miniaci and Jakob and the different planning methods and principles defined by Paley [ 12 , 20 , 24 , 34 ]. The main advantage is that the proposed planning method is based on the predicted post-operative JLO, and the correction angles at the two sides are derived from this parameter and not the reverse.…”

Section: Discussionmentioning

confidence: 99%

A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies

Capella

Sabatini

Bosco

et al. 2023

Arch Orthop Trauma Surg

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Purpose Precise preoperative planning is mandatory when a double-level osteotomy (DLO) is required to correct a severe knee deformity. Literature does not report a validated planning method regarding DLO that could be performed directly on digital radiographs using simple measurement tools. This study aims to validate a novel DLO planning method called New Mikulicz-Joint Line (NM-JL) based on essential measurement tools, in which the correction angles are induced by the predicted post-operative joint line obliquity (JLO). Methods Twenty-three patients who satisfied the inclusion criteria were enrolled. NM-JL planning method was performed using basic measurement tools to detect corrective angles and gaps. The correction was then simulated using a Virtual Segmentation Software method to obtain the osteotomy fragments. Both planning procedures were performed independently and later repeated by two orthopaedic surgeons to assess the inter and intra-observer reliability. Results The intraclass correlation coefficient (ICC) regarding corrective angles and gaps showed a significant positive correlation between the values determined using the two procedures by both raters (p < 0.05). Pearson’s correlation analysis revealed a significant correlation between the measured results of the two planning methods. (p < 0.05). Finally, the Bland–Altman analysis showed an excellent agreement (p < 0.05) for all measurements performed. Conclusions The NM-JL method showed high values of intra and inter-rater reliability. The procedure is built up starting from the predicted value of post-operative joint line obliquity, allowing to maintain this parameter fixed. Other advantages include the quickness, adaptability, and possibility to be performed on any Digital Imaging and Communication in Medicine (DICOM) viewer. Level of evidence Level IV.

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Section: Discussionmentioning

confidence: 99%

A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies

Capella

Sabatini

Bosco

et al. 2023

Arch Orthop Trauma Surg

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“…If the mLDFA was ≥ 90.0°, a simulation with distal femoral osteotomy (DFO) was performed; otherwise, when it was < 90.0°, a simulation with HTO was conducted. Subsequently, based on well‐established literature [10, 17, 18, 25, 27], the mMPTA was carefully adjusted to achieve a value of 95.0°, while the mLDFA was refined to 85.0°.…”

Section: Methodsmentioning

confidence: 99%

“…To achieve superior clinical outcomes in osteotomy of the around knee (AKO), the surgical technique selection must be predicated on the precise location of the deformity centre with due consideration of the correction angle based on joint line obliquity [2, 10, 18, 21, 23, 27]. Moreover, in the past decade, clinical performance deterioration has been observed in cases in which the mechanical medial proximal tibial angle (mMPTA) surpasses 95° post‐AKO [25].…”

Section: Introductionmentioning

confidence: 99%

Constitutional varus knee due to tibial deformity is common and represents a good indication for high tibial osteotomy in Japanese population: Consideration of 1010 knees

Abe,

Goshima,

Morinaga

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to elucidate the characteristics of varus knee deformities in the Japanese population, prevalence of various around knee osteotomy procedures and influence of femoral and tibial bowing.MethodsVarus knee deformity was defined as a weight‐bearing line ratio of <50%. A total of 1010 varus knees were selected from 1814 varus knees with weight‐bearing full‐length radiographs, obtained at two facilities, based on exclusion criteria. Various parameters were measured, and around knee osteotomy simulations based on the deformity centre were conducted using digital planning tools. Bowing of the femoral and tibial shafts was measured, with bowing defined as follows: ≤ −0.6° indicating lateral bowing and ≥ 0.6° indicating medial bowing. Statistical analysis was performed to investigate age‐related correlations and their impact on surgical techniques.ResultsThe study revealed that the proximal tibia was the centre of deformity in Japanese varus knees (42.8%), and high tibial osteotomy was frequently indicated (81.6%). Age demonstrated a mild correlation with femoral shaft bowing (r = −0.29), leading to an increase in the mechanical lateral distal femoral angle and to a decrease in the hip–knee–ankle angle and weight‐bearing line ratio (r = −0.29, 0.221, 0.219). The tibial shaft bowing was unaffected by age (r = −0.022).ConclusionA significant proportion of Japanese individuals with varus knees exhibit a deformity centre located in the proximal tibia, making them suitable candidates for high tibial osteotomy. No age‐related alterations were discerned in tibial morphology, indicating that the occurrence of constitutional varus knees is attributable to tibial deformities in the Japanese patient cohort.Level of EvidenceLevel IV.

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“…OWHTO was selected for patients with correction angles <10°, and hybrid HTO was selected for patients with correction angles ≥10°, flexion contracture > 10°, or anterior knee pain. 20,21…”

Section: Subjectsmentioning

confidence: 99%

Cartilage degeneration of patellofemoral joint occurs in open wedge high tibial osteotomy, rather than in hybrid closed wedge high tibial osteotomy, during the early postoperative period: A qualitative analysis using MRI T₂ mapping

Komaki

Nakagawa

Kaihara

et al. 2023

J Orthop Surg (Hong Kong)

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Purpose After high tibial osteotomy, the patella may change position and osteoarthritis of the patellofemoral joint (PFJ) may occur. It was hypothesized that the course of PFJ degeneration would differ between open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge high tibial osteotomy (hybrid HTO). Accordingly, this study aimed to evaluate the qualitative changes in PFJ articular cartilage, during the early postoperative period after OWHTO and hybrid HTO. Methods This was a retrospective observational study of 75 knees that underwent OWHTO (N = 37) or hybrid HTO (N = 38) for medial knee osteoarthritis. OWHTO and hybrid HTO were indicated for corrections of less than 10° and more than 10°, respectively. MRI of all knees was performed before and 6 months after surgery to evaluate patellar cartilage in sagittal images for T2 mapping. Three regions of interest (medial, middle, and lateral facets) were defined in the articular cartilage, and T2 values were measured. Patellar tilting angle, lateral shift ratio, and patellar height were compared before and after surgery. Results There was no significant change in arthroscopic findings of PFJ articular cartilage between the OWHTO and hybrid HTO groups. In the OWHTO group, the mean T2 value of medial and middle facets increased significantly (lateral, 43.0 ± 3.9 to 43.7 ± 3.5; middle, 44.2 ± 3.9 to 46.2 ± 3.8; medial 41.0 ± 4.3 to 42.4 ± 4.0). Conversely, no significant change was observed in the hybrid HTO group (lateral, 41.1 ± 4.0 to 42.3 ± 4.0; middle, 43.6 ± 4.2 to 44.5 ± 4.3; medial, 40.7 ± 4.1 to 41.5 ± 4.5). Patellar height decreased and increased in the OWHTO and hybrid HTO groups, respectively, and patellar tilt decreased in the OWHTO group. Lateral shift ratio decreased significantly in both groups. Conclusions OWHTO with a small correction angle may result in qualitative changes in PFJ articular cartilage from an early stage, while hybrid HTO with a relatively large correction angle is unlikely to affect PFJ articular cartilage.

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Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy

Cited by 8 publications

References 43 publications

A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies

A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies

Constitutional varus knee due to tibial deformity is common and represents a good indication for high tibial osteotomy in Japanese population: Consideration of 1010 knees

Cartilage degeneration of patellofemoral joint occurs in open wedge high tibial osteotomy, rather than in hybrid closed wedge high tibial osteotomy, during the early postoperative period: A qualitative analysis using MRI T₂ mapping

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Femoral morphology affects postoperative alignment of the lower extremities in hybrid closed-wedge high tibial osteotomy

Cited by 8 publications

References 43 publications

A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies

A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies

Constitutional varus knee due to tibial deformity is common and represents a good indication for high tibial osteotomy in Japanese population: Consideration of 1010 knees

Cartilage degeneration of patellofemoral joint occurs in open wedge high tibial osteotomy, rather than in hybrid closed wedge high tibial osteotomy, during the early postoperative period: A qualitative analysis using MRI T2 mapping

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Cartilage degeneration of patellofemoral joint occurs in open wedge high tibial osteotomy, rather than in hybrid closed wedge high tibial osteotomy, during the early postoperative period: A qualitative analysis using MRI T₂ mapping