Opening- or closing-wedged high tibial osteotomy: A meta-analysis of clinical and radiological outcomes

Smith, Toby; Sexton, Debbie; Mitchell, Philip; Hing, Caroline B.

doi:10.1016/j.knee.2010.10.001

Cited by 119 publications

(90 citation statements)

References 44 publications

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“…We did not use entire lower extremities from the hip to the foot as described by Kim et al [14]. The average age of the donors of specimens in our study was 71.4 years, substantially older than patients usually undergoing osteotomies around the knee [10,32]. Even if we excluded severely arthritic knees, the age of the specimens may have led to the inclusion of knees with lowgrade osteoarthritis, which may have affected the results of our study because the relationship between the proximal tibia and popliteal artery can differ in arthritic knees [7]; however, this difference is reported to be minimal (1 mm) and its clinical implications questionable [16].…”

Section: Discussionmentioning

confidence: 99%

“…For younger patients, a realignment osteotomy may be performed as a distal femoral or proximal tibial osteotomy, or both, depending on the deformity of the lower limb. Distal femoral and proximal tibial osteotomies have been performed on either the medial or lateral side, with satisfactory clinical postoperative results [32,36,38]. In most cases, a medial opening-wedge proximal tibial osteotomy (in a varus knee), or a lateral opening-wedge distal femoral osteotomy (in a valgus knee) is indicated, but other options, such as a lateral closing-wedge proximal tibial osteotomy or medial closing-wedge distal femoral osteotomy may be appropriate in individual cases since each type of osteotomy has its specific advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

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Injury Risk to Extraosseous Knee Vasculature During Osteotomies: A Cadaveric Study With CT and Dissection Analysis

Bisicchia

Rosso²,

Pizzimenti

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Realignment osteotomies about the knee may be performed as distal femoral or proximal tibial osteotomies; both may be performed either on the medial or lateral sides of the knee, in closing-or opening-wedge fashion. Although rare, injury to neurovascular structures may occur, and the proximity of the vascular structures to the osteotomy saw cuts has been incompletely characterized. Questions/purposes We performed a cadaver study to assess the risk of vascular injury in patients undergoing realignment osteotomies by (1) quantifying the distances between osteotomy saw cuts and blood vessels using threedimensional CT reconstruction after distal femoral and proximal tibial osteotomies; and (2) qualitatively describing the small-and medium-sized vasculature around the knee, to provide the link between the CT analysis and wedge incision measures, and better show the potential extraosseous supply to the regions investigated. Methods Twelve human cadaveric knees were injected with a latex and barium sulfate suspension into the superficial femoral artery. Each specimen underwent CT to evaluate vascular perfusion and was randomized to either a lateral opening-wedge distal femoral osteotomy and medial opening-wedge proximal tibial osteotomy group, or a medial closing-wedge distal femoral osteotomy and lateral closing-wedge proximal tibial osteotomy group. Postoperatively, knees underwent CT in extension to measure the shortest distance between the osteotomies and the popliteal artery, anterior and posterior tibial arteries, and genicular arteries. Vessels between 5 mm and 10 mm from the osteotomy cut were considered in a zone of moderate risk for damage, while vessels less than 5 mm from the cut were considered in a zone of high risk for damage. Vessels more than 10 mm from the cut were not considered to be at risk. Subsequently, knees underwent dissection and chemical débridement to qualitatively describe the smaller One of the authors certifies that he (SB) has received grants during the study period, an amount of USD 10,000 to 100,000 from ''Fondazione Enrico ed Enrica Sovena'' (Rome, Italy), a nonprofit foundation that partially sponsored his fellowship at the Department of Orthopaedics vessels. This part of the study added visual information and gave a comprehensive overview of the vessels at risk. Results All variations of the osteotomies put at least one artery at risk. The popliteal artery was found in a risk zone for injury in two specimens during closing-wedge distal femoral osteotomy (median distance, 11.6 mm; range, 5.2-14.6 mm). The superior lateral genicular artery was in a risk zone in all the specimens during opening-wedge distal femoral osteotomy (median distance, 3.0 mm; range, 0.7-6.5 mm), and in five specimens during closing-wedge distal femoral osteotomy (median distance, 4.5 mm; range, 1.3-11.2 mm). A concomitant risk for superior medial genicular artery injury was observed in five specimens during opening-wedge distal femoral osteotomy (median distance, 8.7 mm; range, 0.8-13.9 mm) ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Injury Risk to Extraosseous Knee Vasculature During Osteotomies: A Cadaveric Study With CT and Dissection Analysis

Bisicchia

Rosso²,

Pizzimenti

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…A review of the published literature demonstrates that both HTO techniques have comparable clinical and radiographic outcomes [8]. Both also have their own sets of complications.…”

Section: Commentarymentioning

confidence: 99%

Closing Verses Opening Wedge High Tibial Osteotomy: An Evidence-Based Review

Ruzbarsky

Dare

Marx

2015

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…Complications (and their incidence) of closed-wedge high tibial osteotomy (Staubli & Jacob, 2010, Tunggal et al, 2010 No difference in the incidence of infection, deep vein thrombosis, peroneal nerve palsy, non-union or revision to knee arthroplasty (p>0.05) -Significantly greater posterior tibial slope and mean angle of correction, reduced patellar height and hip-knee-ankle angle following opening-wedge HTO (p<0.05) -No significant difference was found for any clinical outcome including pain, functional score or complications (p>0.05) Table 10. Differences in complications between Open-or closed-wedge high tibial osteotomies (Smith et al 2010). …”

Section: Surgical Techniquementioning

confidence: 99%