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

Abstract

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.

Keywords

internal fixator - medial opening-wedge high tibial osteotomy - osteoarthritis - implant failure

Publikationsverlauf

Eingereicht: 02. Mai 2019

Angenommen: 27. November 2019

Artikel online veröffentlicht:
13. Januar 2020

• References

• 1 Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 2009; 91 (11) 1459-1465
• 2 Smith TO, Sexton D, Mitchell P, Hing CB. Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 2011; 18 (06) 361-368
• 3 McNamara I, Birmingham TB, Fowler PJ, Giffin JR. High tibial osteotomy: evolution of research and clinical applications--a Canadian experience. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 23-31
• 4 Takeuchi R, Ishikawa H, Aratake M. et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 2009; 25 (01) 46-53
• 5 Saito T, Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y. Five- to ten-year outcome following medial opening-wedge high tibial osteotomy with rigid plate fixation in combination with an artificial bone substitute. Bone Joint J 2014; 96-B [phone]
• 6 Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 2010; 26 (12) 1607-1616
• 7 Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2003; 11 (03) 132-138
• 8 Miller BS, Downie B, McDonough EB, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy 2009; 25 (06) 639-646
• 9 Nha KW, Kim HJ, Ahn HS, Lee DH. Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy: a meta-analysis. Am J Sports Med 2016; 44 (11) 3006-3013
• 10 Moon SW, Park SH, Lee BH. et al. The effect of hinge position on posterior tibial slope in medial open-wedge high tibial osteotomy. Arthroscopy 2015; 31 (06) 1128-1133
• 11 Diffo Kaze A, Maas S, Waldmann D, Zilian A, Dueck K, Pape D. Biomechanical properties of five different currently used implants for open-wedge high tibial osteotomy. J Exp Orthop 2015; 2 (01) 14
• 12 Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH. Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 2013; 29 (06) 1063-1071
• 13 Osti M, Gohm A, Schlick B, Benedetto KP. Complication rate following high tibial open-wedge osteotomy with spacer plates for incipient osteoarthritis of the knee with varus malalignment. Knee Surg Sports Traumatol Arthrosc 2015; 23 (07) 1943-1948
• 14 Schröter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy 2011; 27 (05) 644-652
• 15 Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon) 2004; 19 (09) 944-950
• 16 Raja Izaham RM, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury 2012; 43 (06) 898-902
• 17 Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979; 10 (03) 585-608
• 18 Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 1992; (274) 248-264
• 19 Noyes FR, Barber SD, Simon R. High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- to seven-year follow-up study. Am J Sports Med 1993; 21 (01) 2-12
• 20 Feucht MJ, Minzlaff P, Saier T. et al. Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. Int Orthop 2014; 38 (11) 2273-2280
• 21 Nakayama H, Schröter S, Yamamoto C. et al. Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc 2018; 26 (06) 1873-1878
• 22 Heijens E, Kornherr P, Meister C. The coronal hypomochlion: a tipping point of clinical relevance when planning valgus producing high tibial osteotomies. Bone Joint J 2016; 98-B [phone]
• 23 Asada S, Akagi M, Mori S, Matsushita T, Hashimoto K, Hamanishi C. Increase in posterior tibial slope would result in correction loss in frontal plane after medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2012; 20 (03) 571-578
• 24 Jacobi M, Villa V, Reischl N. et al. Factors influencing posterior tibial slope and tibial rotation in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015; 23 (09) 2762-2768
• 25 Lee BH, Ha CW, Moon SW. et al. Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy. Knee 2017; 24 (02) 362-371
• 26 Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 2005; 33 (03) 378-387
• 27 LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 2010; 38 (01) 160-170
• 28 El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S. Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 2010; 38 (02) 323-329
• 29 Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW. Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 2008; 15 (02) 128-133
• 30 Nerhus TK, Ekeland A, Solberg G, Sivertsen EA, Madsen JE, Heir S. Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 910-917
• 31 Pape D, Kohn D, van Giffen N, Hoffmann A, Seil R, Lorbach O. Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 82-89
• 32 Nelissen EM, van Langelaan EJ, Nelissen RG. Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 2010; 34 (02) 217-223
• 33 Luo CA, Hwa SY, Lin SC, Chen CM, Tseng CS. Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses. BMC Musculoskelet Disord 2015; 16: 235
• 34 Han SB, Bae JH, Lee SJ. et al. Biomechanical properties of a new anatomical locking metal block plate for opening wedge high tibial osteotomy: uniplane osteotomy. Knee Surg Relat Res 2014; 26 (03) 155-161