Background:Previously reported complications in medial opening wedge (MOW) high tibial osteotomy (HTO) vary considerably in both rate and severity.Purpose:(1) To determine the rates of adverse events in MOW HTO classified into different grades of severity based on the treatments required and (2) to compare patient-reported outcomes between the different adverse event classifications.Study Design:Case series; Level of evidence, 4.Methods:All patients receiving MOW HTO at a single medical center from 2005 to 2009 were included. Internal fixation was used in all cases, with either a nonlocking (Puddu) or locking (Tomofix) plate. Patients were evaluated at 2, 6, and 12 weeks; 6 and 12 months; and annually thereafter. Types of potential surgical and postoperative adverse events, categorized into 3 classes of severity based on the subsequent treatments, were defined a priori. Medical records and radiographs were then reviewed by an independent observer. The Western Ontario and McMaster Universities Arthritis In...

Adverse Event Rates and Classifications in Medial Opening Wedge High Tibial Osteotomy

BackgroundValgus high tibial osteotomy (HTO) may be associated with changes in the patellar height and posterior tibial slope.HypothesisPatellar height increases and posterior tibial slope decreases after closed-wedge HTO, whereas patellar height decreases and tibial slope increases after open-wedge osteotomy.Study DesignCohort study; Level of evidence, 3.MethodsLateral radiographs of 100 knees were assessed for patellar height (PH) (Insall-Salvati index [ISI], Caton-De Champ index [CDI], and Blackburne-Peel index [BPI]) as well as posterior tibial slope. Measurements were done before HTO (50 closed wedge [CW], 50 open wedge [OW]), direct postoperatively, and before removal of the hardware.ResultsIn the CW group, all 3 PH indices were increased direct postoperatively and at removal of the hardware, with changes in CDI and BPI being significant (P < .05). The effect size (ES) for the direct postoperative PH increase was medium (ES = 0.48) according to CDI. In the OW group, all 3 indices showed a significan...

Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients.

Valgus high tibial osteotomy (HTO) results in changes in the frontal as well as sagittal planes. Our hypothesis suggests that patellar height increases and posterior tibial inclination decreases after closed wedge (cw) HTO, whereas patellar height decreases and tibial slope increases after open wedge (ow) HTO. Lateral radiographs of 100 knees were assessed for patellar height (PH) using Insall-Salvati (ISI), Caton-De Champ (CDI) and Blackburne-Peel indices (BPI) as well as posterior tibial slope. Measurements were done before HTO (50 cw and 50 ow), direct postoperatively and before hardware removal. In the cw-group all three PH indices increased direct postoperatively and at removal of the hardware with changes in CDI and BPI being significant (P 0.05). Posterior tibial slope showed a significant decrease of 3.1 ± 3.4° after closed wedge HTO and a significant increase of 2.1 ± 3.6° after ow HTO direct postoperatively. In cw-HTO the correlations between frontal plane correction and PH changes were moderate (CDI: r = 0.57; BPI: r = 0.64). In ow-HTO these correlations were weak (CDI: r = 0.44; BPI: r = 0.46). According to ISI there was no correlation (cw: r = 0.11; ow: r =0.16). There was no correlation between PH changes according to CDI and slope changes. The incidence of patella infera increases after open wedge HTO, whereas the incidence of patella alta increases after closed wedge HTO. We recommend considering the PH and tibial slope before planning for HTO or TKR after HTO, also performing cw-HTO or ow-HTO with the tuberosity left at the proximal tibia in cases of patellofemoral complaint or patella infera.

Patellar height and posterior tibial slope after open and closed wedge high tibial osteotomy

Summary Introduction: Valgus high tibial osteotomy is considered to be an effective treatment for uni- compartmental medial osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. However, the effects on posterior tibial slope of closing- or opening-wedge osteotomies remain controversial. Hypothesis: We analyzed the modifications of tibial slope after opening- and closing-wedge high tibial osteotomies and compared the results of these two procedures. We hypothesized that there was no difference in postoperative tibial slope between opening and closing-wedge osteotomies.

Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study.

The purpose of our study was to compare clinical and radiological results of two groups of patients treated for medial compartment osteoarthritis of the knee with either conventional or computer-assisted open-wedge high tibial osteotomy (HTO). Goals of surgical treatment were a correction of the mechanical axis between 2° and 6° of valgus and a modification of posterior tibial slope between −2° and +2°. Twenty-four patients (27 knees) affected by varus knee deformity and operated with HTO were prospectively followed-up. They were randomly divided in two groups, A (11 patients, conventional treatment) and B (13 patients, navigated treatment). The American Knee Society Score and the Modified Cincinnati Rating System Questionnaire were used for clinical assessment. All patients were radiologically evaluated with a comparative lower limb weight-bearing digital radiograph, a standard digital anteroposterior, a latero-lateral radiograph of the knee, and a Rosenberg view. Patients were followed-up at a mean of 39 months. Clinical evaluation showed no statistical difference (n.s.) between the two groups. Radiological results showed an 86% reproducibility in achieving a mechanical axis of 182°–186° in group B compared to a 23% in group A (p = 0.0392); furthermore, in group B, we achieved a modification of posterior tibial slope between −2° and +2° in 100% of patients, while in group A, this goal was achieved only in 24% of cases (p = 0.0021). High tibial osteotomy with navigator is more accurate and reproducible in the correction of the deformity compared to standard technique. Therapeutic study, Level II.

Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques.

Our aim was to evaluate the alteration in angle of posterior slope of the tibia and the degree of patellar height following medial opening wedge high tibia osteotomy(HTO) using autologous tricortical iliac bone graft in 32 consecutive patients. Twenty three females and nine males underwent medial opening wedge high tibia osteotomy (HTO) using autologous tricortical iliac bone graft in 34 knees (33 primary medial compartment osteoarthritis and 1 idiopathic osteonecrosis of medial tibial condyle). The posterior slope of tibia was determined by the proximal tibial anatomical axis. Patellar height was measured by the Insall-Salvati and the Blackburne-Peel ratios. Preoperative and postoperative (last follow up) values of these three parameters were compared. The intra- and interobserver variability of these methods was determined before and after operation. At the end of mean follow up of 3 years this procedure produced no significant change in posterior slope. Pre and postoperative posterior slope were 8.7°±3.6° and 8.2°±2.8° respectively ( P =0.412). Pre and postoperative Insall-Salvati ratios were 0.93±0.10 and 1.05±0.11 respectively ( P The distance between the patellar and tibiofemoral joint line decreased in 82% of patients. The mean Blackburne-Peel ratio declined from 0.71±0.12 to 0.61±0.13 ( P There was no difference in the intra-and interobserver variability of measurements either before or after HTO. Opening wedge HTO using autologous tricortical iliac bone graft with internal fixation and early mobilisation prevented change in posterior slope of tibia, lengthened the patellar ligament and elevated the tibiofemoral joint line when the mean ratio of anterior and posterior gap at the osteotomy site was around two-thirds.

Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft.

Paper 66: Tibial Slope and Patellar Height After Opening Wedge High Tibia Osteotomy Using Autologous Tricortical Iliac Bone Graft

323 통신저자:나 경 욱 경기도 고양시 일산서구 대화동 2240번지 인제대학교 의과대학 일산백병원 정형외과 Tel:031-910-7968ᆞFax:031-910-7967 E-mail:kwnha@ilsanpaik.ac.kr *본 연구는 2002년 인제 학술연구기금으로 연구함. Address reprint requests to:Kyung Wook Nha, M.D. Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 2240, Daehwa-dong, Ilsanseo-gu, Goyang-si 411-706, Korea Tel:82-31-910-7968ᆞFax:82-31-910-7967 E-mail:kwnha@ilsanpaik.ac.kr Ilizarov 외고정 장치를 이용한 경골 원위부 골절의 중기 추시 결과

/pdf/mid-term-results-of-distal-tibial-fractures-treated-with-52qtaqml98.pdf

Dong Bong Lee

Papers

Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft.

Paper 66: Tibial Slope and Patellar Height After Opening Wedge High Tibia Osteotomy Using Autologous Tricortical Iliac Bone Graft

Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator