Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage

Nakayama, Hiroshi; Schröter, Steffen; Yamamoto, Chie; Iseki, Tomoya; Kanto, Ryo; Kurosaka, Kenji; Kambara, Shunichiro; Yoshiya, Shinichi; Higa, Masaru

doi:10.1007/s00167-017-4680-x

Cited by 192 publications

(203 citation statements)

References 42 publications

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“…Non-anatomic knee joint obliquity can cause excessive shear force on the articular cartilage. When the obliquity angle is 5 , the shear force in the medial compartment elevate to almost twice as high as the normal knee [10]. The force value becomes even higher as the obliquity angle increases.…”

Section: Discussionmentioning

confidence: 95%

“…A positive value represented that the medial articular surface is higher than the lateral surface. A ≧ 5 KJLO was de ned as a high-degree KJLO [10]. (Fig.…”

Section: Radiological Evaluationsmentioning

confidence: 99%

“…However, this procedure inevitably changes the joint inclination in the coronal plane since the medial tibia is elevated [5][6][7][8][9]. In cases of severe varus deformity of the knee joint due to proximal tibial deformity or combined deformity of both the distal femur and proximal tibia, single-level osteotomy can result in high-degree joint obliquity because a large amount of correction is required [5][6][7], which can induce excessive shear force on the articular cartilage [10].…”

Section: Introductionmentioning

confidence: 99%

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Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

Tseng

Hsu

Wang

2020

Preprint

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Background: Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO).Methods: The correlations between postoperative KJLO and body mass index (BMI), correction amount, KAJA, mechanical lateral distal femoral angle (mLDFA), preoperative medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), KJLO and mechanical hip-knee-ankle angle (mHKA) were analyzed using Pearson correlation coefficient. The contribution of significant factors was further analyzed using multiple linear regression. The KJLO between ≦ 5。, 5。-10。And ≧ 10。KAJA groups were compared using Kruskal-Wallis test.Results: Postoperative KAJA and preoperative KJLO moderately correlated to postoperative KJLO. Preoperative MPTA, mHKA, AJLO weakly correlated to postoperative KJLO. After multiple linear regression, only postoperative KAJA, preoperative MPTA and mHKA still showed significant contribution, while preoperative KAJA made the greatest contribution. The KJLO was substantial higher in the ≧ 10。KAJA group with a high rate (68%) of high-degree KJLO.Conclusions: 10。postoperative KAJA is a critical value for decompensated KJLO. The results suggest us carefully assess the KAJA intraoperatively. Double osteotomy should be considered if ideal alignment cannot be achieved when the KAJA reach 10。.

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Section: Discussionmentioning

confidence: 95%

“…A positive value represented that the medial articular surface is higher than the lateral surface. A ≧ 5 KJLO was de ned as a high-degree KJLO [10]. (Fig.…”

Section: Radiological Evaluationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

Tseng

Hsu

Wang

2020

Preprint

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“…16,18 It is important to consider the obliquity of the joint line for the preoperative planning of HTO. 24,25 According to Schuster et al, the postoperative MPTA should be less than 95 degrees to avoid the obliquity of the joint line. 26 Our post-planning MPTAs were close to or even bigger than 95 degrees; the cause of this phenomenon is that we included patients with normal preoperative MPTA; the mean preoperative MPTA was 85.44 AE 2.55 degrees (►Tables 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

HKA Angle—A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs

et al. 2020

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High tibial osteotomy (HTO) is a recognized treatment for early-stage medial compartment knee osteoarthritis. Preoperative planning with standing whole-leg radiographs (WLRs) is essential for ensuring optimal postoperative alignment. The primary purpose of this study is to investigate the theoretical accuracy of the wedge opening required for two different preoperative planning parameters in open-wedge HTO. The second purpose is to theoretically determine which parameter is superior. Preoperative planning for HTO was performed with standing WLRs for 39 knees with isolated medial osteoarthritis. The Miniaci preoperative planning method was applied to correct the hip-knee-ankle (HKA) angle to 3to 6 degrees of valgus and the weight-bearing line (WBL) percentage within 60 to 70% of the width of the tibial plateau. To ensure that the HKA angle was between 3 and 6 degrees of valgus, the required accuracy window for the Miniaci angle was 3.25 ± 0.03 degrees (range, 3.20–3.30°). To ensure that the WBL percentage was between 60 and 70%, the accuracy window required for the Miniaci angle was 2.35 ± 0.13 degrees (range, 2.10–2.65°). This study suggests that to correct the HKA angle and the WBL percentage within the target range on two-dimensional WLRs, the Miniaci angle must be controlled to an accuracy of ± 1.63 and ± 1.18 degrees, respectively. Theoretically, the HKA angle is highly suitable as a preoperative planning parameter for HTO with a large permissible error and a small variability in the degree of change in the Miniaci angle (ΔMiniaci).

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“…The amount of metaphysical varus deformity was suggested to be a reliable prognostic factor after OWHTO. 6 Nakayama et al 21 showed that joint-line obliquity of more than 5-degree induced excessive shear stress in the tibial articular cartilage in finite element model analysis. Heijens et al 22 concluded that the MPTA reflected the static osseous component, and the JLCA, which was changed by soft tissue stretching, reflected the dynamic component as a result of realignment.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

et al. 2020

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We developed a new internal fixator: a rigid T-shaped plate with locking screws and wedge-shaped spacer block for high tibial osteotomy. The purpose of the present study was to evaluate the radiographic outcome of opening-wedge high tibial osteotomy (OWHTO) using this new internal fixator. Sixty OWHTOs were performed in patients with medial compartment osteoarthritis and varus deformity (28 males and 23 females). Patients' mean age was 60.4 years. Preoperative and postoperative radiographs were obtained. The paired t-test was used to evaluate the differences over time with respect to radiographic variables. Union of the osteotomy gap was obtained in all patients, and no implant breakage was found. On anterior–posterior radiographs, a significant difference was observed (p < 0.01) between the preoperative and postoperative mean values of femorotibial angles (179.6 ± 3.2 vs. 170.6 ± 2.5 degrees), weight-bearing line ratios (23.8 ± 13.5 vs. 60.5 ± 11.5%), anatomical medial proximal tibial angles (84.8 ± 2.5 vs. 91.0 ± 2.6 degrees), and joint line coverage angles (3.6 ± 2.0 vs. 2.4 ± 1.7 degrees). On lateral radiographs, posterior tibial slopes were 11.5 ± 3.9 degrees preoperatively and 12.2 ± 4.0 degrees postoperatively (p < 0.01), and Insall–Salvati ratios were 1.04 ± 0.12 preoperatively and 1.06 ± 0.13 postoperatively (p = 0.24). Performing OWHTO using a new internal fixator with a wedge-shaped spacer achieves adequate correction of lower limb alignment without implant-related complications. This is a Level IV, case series study.

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Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage

Cited by 192 publications

References 42 publications

Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.

HKA Angle—A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs

Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block

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