Tibial slope changes following dome-type high tibial osteotomy

Çullu, Emre; Aydoğdu, Semih; Alparslan, Bulent; Sur, Hakki

doi:10.1007/s00167-004-0501-0

Cited by 77 publications

(79 citation statements)

References 14 publications

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“…Furthermore, radiation time was significantly lower when using the navigation system. Navigation systems allow continuous visualisation not only of the frontal but also of the sagittal and transverse axes, and detect undesired changes of the tibial slope during the correction [3,12], which can influence knee kinematics and stability [1,4,9,12,15]. Furthermore, simultaneous 3-dimensional imaging is helpful for multiplanar corrections like valgus-flexion osteotomies in patients with combined posterolateral instability and varus malalignment.…”

Section: Discussionmentioning

confidence: 99%

Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study

Hankemeier

Hüfner

Wang

et al. 2006

Knee Surg Sports Traumatol Arthrosc

134

140

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High tibial osteotomy (HTO) is an established therapy for the treatment of symptomatic varus malaligned knees. A main reason for disappointing clinical results after HTO is the under- and overcorrection of the mechanical axis due to insufficient intraoperative visualisation. Twenty legs of fresh human cadaver were randomly assigned to navigated open-wedge HTO (n=10) or conventional HTO using the cable method (n=10). Regardless of the pre-existing alignment, the aim of all operations was to align the mechanical axis to pass through 80% of the tibial plateau (beginning with 0% at the medial edge of the tibial plateau and ending with 100% at the lateral edge). This overcorrection was chosen to ensure a sufficient amount of correction. Thus, the medial proximal tibia angle (MPTA) increased by 9.1+/-2.9 degrees (range 5.2 degrees -12.3 degrees ) on the average after navigated HTO and by 8.9+/-2.9 degrees (range 4.7 degrees -12.6 degrees ) after conventional HTO. After stabilization with a fixed angle implant, the alignment was measured by CT. After navigated HTO, the mechanical axis passed the tibial plateau through 79.7% (range 75.5-85.8%). In contrast, after conventional HTO, the average intersection of the mechanical axis was at 72.1% (range 60.4-82.4%) (P=0.020). Additionally, the variability of the mean corrections was significantly lower in the navigated group (3.3% vs. 7.2%, P=0.012). Total fluoroscopic radiation time was significantly lower in the navigated group (P=0.038) whereas the mean dose area product was not significantly different (P=0.231). The time of the operative procedure was 23 min shorter after conventional HTO (P<0.001). Navigation systems provide intraoperative 3-dimensional real time control of the frontal, sagittal, and transverse axis and may increase the accuracy of open-wedge HTO. Future studies have to analyse the clinical effects of navigation on corrective osteotomies.

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Section: Discussionmentioning

confidence: 99%

Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study

Hankemeier

Hüfner

Wang

et al. 2006

Knee Surg Sports Traumatol Arthrosc

134

140

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“…Surgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results

Faour-Martín

Valverde-García

Martín-Ferrero

et al. 2013

International Orthopaedics (SICOT)

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Purpose Surgical treatment options for medial compartment osteoarthritis of the knee include high tibial osteotomy, total knee arthroplasty or unicompartmental knee arthroplasty (UKA), depending on the patient's age, level of physical activity and the degree of deformity. Methods In this study, we evaluated the long-term results of patients who underwent the Oxford cemented meniscalbearing unicondylar knee prosthesis through a minimally invasive approach including a clinical, functional and radiographic assessment. Results Favourable clinical and radiological outcomes were registered overall at ten years after surgery. Overall results of UKA according to the American Knee Society (AKS) using Insall's criteria showed an excellent or good outcome for 492 knees (96.28 %), fair for 11 (2.15 %) and poor for eight (1.57 %) in the post-operative long term. Conclusions We believe that with appropriate surgical technique, patient selection, prosthetic design and specific training, surgeons should achieve good outcomes with the added advantages of a minimally invasive approach. High volume for this technique is important in our opinion.

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“…-There was no shortening of the patellar tendon in 65% (52/80) of cases after combined osteotomy. -The decrease of the tibial slope angle is less after combined osteotomy (according to the literature Nakamura et al [43], Cullu et al [16]) than after dome osteotomy. -The transposition of the tibial condyle is less after combined osteotomy than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835°) than after closing wedge osteotomy (9.465°) and (according to the literature Yoshida et al [67]) after dome osteotomy.…”

Section: Discussionmentioning

confidence: 96%

“…The tibial slope angle regularly decreases after closing wedge and dome osteotomy and increases after opening wedge osteotomy [5,6,16,20,22,28,34,38,43,45,53].…”

Section: Introductionmentioning

confidence: 99%

The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy

Papp

Csernátony

Kazai

et al. 2007

Knee Surg Sports Traumatol Arthrosc

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High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.] was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and 41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (in group A-66.15 months, in group B-66.61 months). We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall-Salvati ratio remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835 degrees ), than after closing wedge osteotomy (9.465 degrees ). Theoretically, the recurrence of the varus deformity, the increase of the valgus alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss; therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement.

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Tibial slope changes following dome-type high tibial osteotomy

Cited by 77 publications

References 14 publications

Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study

Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study

Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results

The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy

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