Medial Open Wedge High Tibial Osteotomy

Wang, Joon Ho; Bae, Ji Hoon; Lim, Hong Chul; Shon, Won Yong; Kim, Cheol Woong; Cho, Jae-Woo

doi:10.1177/0363546509341174

Cited by 87 publications

(48 citation statements)

References 21 publications

(23 reference statements)

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“…The opening gap angle and hinge position ratio in the sagittal view was correlated with an increased change in TPS. One study to 12 knees using cadavers [ 8 ] investigated whether the variable hinge position actually affected the change in TPS, and concluded that unintentional change in TPS could be avoided if a true lateral hinge position was achieved by performing a complete posterior osteotomy and inspecting the osteotomy using the gap ratio. They also stated that the osteotomy of the proximal tibia using the lateral location as a cortical hinge affected the change in TPS less than using the posterolateral location as a cortical hinge.…”

Section: Discussionmentioning

confidence: 99%

“…Two previous studies have tried to investigate the relationship between the hinge position and the change in TPS after OWHTO, but have a small number of cases, which was one study to 12 knees using cadavers [ 8 ] and another to 19 knees using three-dimensional computed tomography (3DCT) [ 9 ]. They concluded that the hinge position affected the change in TPS, and a posterolateral hinge position led to an increase in TPS after OWHTO.…”

Section: Introductionmentioning

confidence: 99%

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Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy?

Akamatsu

Kobayashi

Tsuji

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe reason why the osteotomy line in the sagittal view should be parallel to the medial tibial posterior slope in open wedge high tibial osteotomy (OWHTO) remains unclear. In addition, previous study reported that a posterolateral hinge position led to an increase in tibial posterior slope (TPS) after OWHTO. Our aims were to examine the relationships between angles among the tibial plateau and osteotomy planes or the hinge point and the change in TPS, and the location of the hinge position after OWHTO using three-dimensional computed tomography (3DCT). We hypothesized that the sagittal angle between the tibial plateau and osteotomy planes with an anterior-widening proximal tibial fragment resulted in increased TPS, and the hinge position located posterolaterally.MethodsPreoperative planning anticipated a weight-bearing line ratio of 62% on the radiograph. The anterior gap was 67% of the posterior gap in OWHTO. We identified the tibial plateau and upper and lower osteotomy planes on 3DCT of 82 patients with symptomatic medial osteoarthritic knee after OWHTO. The osteotomy plane angles between the tibial plateau and upper osteotomy planes, and opening gap angles between both osteotomy planes in the coronal and sagittal views were measured. The anteroposterior (AP) and lateral hinge position was displayed as a percentage on the upper osteotomy plane. We assessed the relationships among them.ResultsThe TPS significantly increased after OWHTO (p = 0.002). There was no significant difference between the sagittal osteotomy plane angle and the change in TPS. The sagittal opening gap angle and the AP hinge position ratio were significantly correlated with the change in the TPS (r = 0.477 p < 0.001 and r = − 0.342, p = 0.002, respectively). The hinge position was located a mean of 16.0% from the lateral and 48.6% from the posterior tibial edge in the upper osteotomy plane.ConclusionsContrary to our expectation, the osteotomy plane did not need to be parallel to the tibial plateau plane in the sagittal view. However, the osteotomy gap should be rectangular in the sagittal view. The hinge position located nearly in the center of the sagittal view.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy?

Akamatsu

Kobayashi

Tsuji

et al. 2018

BMC Musculoskelet Disord

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“…Previous studies have reported several factors related to PTSA in medial opening wedge HTO, including the triangular shape of the proximal tibia, 4 , 10 , 19 insufficient posterior osteotomy or release of posterior soft tissue, 14 , 24 anterior plate placement, 2 , 10 , 21 , 22 , 24 and posterior hinge point. 17 , 24 However, the most important cause of increased PTSA is the presence of an asymmetrical gap opening in the sagittal plane, which may be affected by the direction of wedge insertion. Song et al 23 reported that the normal tibial posterior slope can be maintained if the anterior opening gap is approximately 67% of the posterior opening gap in navigation-assisted HTO; this is consistent with our result wherein the opening gap ratio (anterior opening gap/posterior opening gap) was 0.86 ± 0.11, with a mean increase in PTSA of 4°.…”

Section: Discussionmentioning

confidence: 99%

Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

Ogawa

Matsumoto

Ogawa

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Medial opening wedge high tibial osteotomy (HTO) is a well-established surgery for medial compartment knee osteoarthritis (OA) wherein the lower extremity is realigned to shift the load distribution from the medial compartment of the knee to the lateral compartment. However, this surgery is known to affect the posterior tibial slope angle (PTSA), which could lead to abnormal knee kinematics and instability, and eventually to knee OA. Although PTSA control is as important as coronal realignment, few appropriate measurements for this parameter have been reported. The placement of a wedge spacer might have an effect on PTSA.Purpose:To elucidate the relationship between the PTSA and the direction of insertion of a wedge spacer.Study Design:Case series; Level of evidence, 4.Methods:This study assessed 43 knees from 34 patients who underwent medial opening wedge HTO for knee OA. Pre- and postoperative lateral radiographs of the knee as well as postoperative computed tomography scans were performed to evaluate the relationship among PTSA, wedge insertion angle (WIA), and opening gap ratio (distance of the anterior opening gap/distance of the posterior opening gap at the osteotomy site).Results:The PTSA significantly increased from 9.0° ± 2.8° preoperatively to 13.2° ± 4.1° postoperatively (P < .001), resulting in a mean ΔPTSA of 4.7° ± 4.5°. The mean opening gap ratio was 0.86 ± 0.11, and the mean WIA was 25.9° ± 8.4°. The WIA and opening gap ratio were both highly correlated with ΔPTSA (r = 0.71 and 0.72, respectively), implying that a smaller WIA or smaller gap ratio leads to less increase in posterior slope.Conclusion:The direction of wedge insertion is highly correlated with PTSA increase, which suggests that the PTSA can be controlled for by adjusting the direction of wedge insertion during surgery.Clinical Relevance:Study results suggest that it is possible to adjust the PTSA by controlling the WIA during surgery. Proper attention to WIA can avoid an iatrogenic increase in posterior tibial slope.

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Section: Discussionmentioning

confidence: 99%

“…64 A study in human alcoholics showed an increase in glutamate–glutamine and GABA labeling in heavy compared with light drinkers. 64 In our study, we found many alcohol-metabolizing enzymes that were upregulated by alcohol consumption, in agreement with a previous study. 65 Furthermore, alcohol-responsive glutamate and GABA mRNAs were detected in SNs (GABA-related mRNAs were associated with the upregulated alcohol-responsive mRNAs, see Table 5).…”

Section: Discussionmentioning

confidence: 99%

The synaptoneurosome transcriptome: a model for profiling the emolecular effects of alcohol

et al. 2014

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Chronic alcohol consumption changes gene expression, likely causing persistent remodeling of synaptic structures via altered translation of mRNAs within synaptic compartments of the cell. We profiled the transcriptome from synaptoneurosomes (SNs) and paired total homogenates (THs) from mouse amygdala following chronic voluntary alcohol consumption. In SN, both the number of alcohol-responsive mRNAs and the magnitude of fold-change were greater than in THs, including many GABA-related mRNAs upregulated in SNs. Furthermore, SN gene co-expression analysis revealed a highly connected network, demonstrating coordinated patterns of gene expression and highlighting alcohol-responsive biological pathways, such as long-term potentiation, long-term depression, glutamate signaling, RNA processing and upregulation of alcohol-responsive genes within neuroimmune modules. Alterations in these pathways have also been observed in the amygdala of human alcoholics. SNs offer an ideal model for detecting intricate networks of coordinated synaptic gene expression and may provide a unique system for investigating therapeutic targets for the treatment of alcoholism.

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Medial Open Wedge High Tibial Osteotomy

Abstract: To prevent the unintentional increase of the posterior tibial slope, special attention should be paid to locate the intact cortical hinge on the lateral, not the posterolateral, side of the tibia.

Cited by 87 publications

References 21 publications

Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy?

Should sagittal osteotomy line be parallel to tibial posterior slope in high tibial osteotomy?

Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

The synaptoneurosome transcriptome: a model for profiling the emolecular effects of alcohol

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