How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?
Tóm tắt
Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.
Tài liệu tham khảo
Jakob R, Murphy S (1992) Tibial osteotomy for varus gonarthrosis: indication, planning, and operative technique. Instr Course Lect 41:87
Prodromos CC, Amendola A, Jakob RP (2015) High tibial osteotomy: indications, techniques. Instr Course Lect 64:555–565
Gomoll AH (2011) High tibial osteotomy for the treatment of unicompartmental knee osteoarthritis: a review of the literature, indications, and technique. Phys Sportsmed 39(3):45–54
Bonasia DE, Governale G, Spolaore S, Rossi R, Amendola A (2014) High tibial osteotomy. Curr Rev Musculoskelet Med 7(4):292–301
Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23(8):852–861
Mina C, Garrett WE Jr, Pietrobon R, Glisson R, Higgins L (2008) High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee. Am J Sports Med 36(5):949–955
Hankemeier S, Mommsen P, Krettek C, Jagodzinski M, Brand J, Meyer C et al (2010) Accuracy of high tibial osteotomy: comparison between open-and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 18(10):1328–1333
Amendola A, Fowler P, Litchfield R, Kirkley S, Clatworthy M (2004) Opening wedge high tibial osteotomy using a novel technique-early results and complications. J Knee Surg 17(03):164–169
Lo W, Cheung K, Yung S, Chiu K (2009) Arthroscopy-assisted computer navigation in high tibial osteotomy for varus knee deformity. J Orthop Surg 17(1):51–55
Lee D-H, Park S-C, Park H-J, Han S-B (2016) Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24(12):3704–3712
Kyung BS, Kim JG, Jang K-M, Chang M, Moon Y-W, Ahn JH et al (2013) Are navigation systems accurate enough to predict the correction angle during high tibial osteotomy? Comparison of navigation systems with 3-dimensional computed tomography and standing radiographs. Am J Sports Med 41(10):2368–2374
Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20(4):366–372
Gebhard F, Krettek C, Hüfner T, Grützner PA, Stöckle U, Imhoff AB et al (2011) Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Arch Orthop Trauma Surg 131(3):297–302
Wang G, Zheng G, Keppler P, Gebhard F, Staubli A, Mueller U et al (2005) Implementation, accuracy evaluation, and preliminary clinical trial of a CT-free navigation system for high tibial opening wedge osteotomy. Comput Aided Surg 10(2):73–86
Parker DA, Viskontas DG (2007) Osteotomy for the early varus arthritic knee. Sports Med Arthrosc Rev 15(1):3–14
Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10(3):585–608
Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67(7):1136–1140
Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75(2):196–201
Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69(3):332–354
Martay JLB, Palmer AJR, Bangerter NK, Clare S, Monk AP, Brown CP et al (2018) A preliminary modeling investigation into the safe correction zone for high tibial osteotomy. Knee 25(2):286–295
Kuriyama S, Watanabe M, Nakamura S, Nishitani K, Tanaka Y, Sekiguchi K et al (2020) Large medial proximal tibial angles cause excessively medial tibiofemoral contact forces and abnormal knee kinematics following open-wedge high tibial osteotomy. Clin Biomech 80:105190
Atkinson HF, Birmingham TB, Schulz JM, Primeau CA, Leitch KM, Pritchett SL et al (2021) High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06516-9
Jakob RP, Jacobi M (2004) Closing wedge osteotomy of the tibial head in treatment of single compartment arthrosis. Orthopade 33(2):143–152
Kim MK, Ko BS, Park JH (2019) The proper correction of the mechanical axis in high tibial osteotomy with concomitant cartilage procedures-a retrospective comparative study. J Orthop Surg Res 14(1):281
Odenbring S, Egund N, Hagstedt B, Larsson J, Lindstrand A, Toksvig-Larsen S (1991) Ten-year results of tibial osteotomy for medial gonarthrosis. Arch Orthop Trauma Surg 110(2):103–108
El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34(10):e622–e628
Sim JA, Kwak JH, Yang SH, Choi ES, Lee BK (2010) Effect of weight-bearing on the alignment after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 18(7):874–878
Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13(2):87–92
Yin Y, Li S, Zhang R, Guo J, Hou Z, Zhang Y (2020) What is the relationship between the “Fujisawa point” and postoperative knee valgus angle? A theoretical, computer-based study. Knee 27(1):183–191
Bin S-I, Kim H-J, Ahn H-S, Rim DS, Lee D-H (2016) Changes in patellar height after opening wedge and closing wedge high tibial osteotomy: a meta-analysis. Arthroscopy 32(11):2393–2400
Lee S-S, So S-Y, Jung E-Y, Kim H-J, Lee BH, Wang JH (2019) Predictive factors for patellofemoral degenerative progression after opening-wedge high tibial osteotomy. Arthroscopy 35(6):1703–1710
Song SJ, Bae DK, Kim KI, Lee CH (2016) Conversion total knee arthroplasty after failed high tibial osteotomy. Knee Surg Relat Res 28(2):89
Miniaci A, Ballmer F, Ballmer P, Jakob R (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259
Lee YS, Kim MG, Byun HW, Kim SB, Kim JG (2015) Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23(3):846–851
Elson D, Petheram T, Dawson M (2015) High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc 23(7):2041–2048
Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264
Schröter S, Ihle C, Elson D, Döbele S, Stöckle U, Ateschrang A (2016) Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 24(11):3410–3417
Blackburn J, Ansari A, Porteous A, Murray J (2018) Reliability of two techniques and training level of the observer in measuring the correction angle when planning a high tibial osteotomy. Knee 25(1):130–134
Lee DH, Han SB, Oh KJ, Lee JS, Kwon JH, Kim JI et al (2014) The weight-bearing scanogram technique provides better coronal limb alignment than the navigation technique in open high tibial osteotomy. Knee 21(2):451–455
Yang JC-S, Chen C-F, Luo C-A, Chang M-C, Lee OK, Huang Y et al (2018) Clinical experience using a 3D-printed patient-specific instrument for medial opening wedge high tibial osteotomy. BioMed Res Int. https://doi.org/10.1155/2018/9246529
Tardy N, Steltzlen C, Bouguennec N, Cartier J-L, Mertl P, Batailler C et al (2020) Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy? Orthop Traumatol Surg Res 106(8):S231–S236
Yoon S-D, Zhang G, Kim H-J, Lee B-J, Kyung H-S (2016) Comparison of cable method and miniaci method using picture archiving and communication system in preoperative planning for open wedge high tibial osteotomy. Knee Surg Relat Res 28(4):283
Moore J, Mychaltchouk L, Lavoie F (2017) Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25(3):846–852
Kim MS, Son JM, Koh IJ, Bahk JH, In Y (2017) Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 137(8):1035–1045
Kim HJ, Yoon JR, Choi GW, Yang JH (2016) Imageless navigation versus conventional open wedge high tibial osteotomy: a meta-analysis of comparative studies. Knee Surg Relat Res 28(1):16–26
Yan J, Musahl V, Kay J, Khan M, Simunovic N, Ayeni OR (2016) Outcome reporting following navigated high tibial osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(11):3529–3555
Nha KW, Shin YS, Kwon HM, Sim JA, Na YG (2019) Navigated versus conventional technique in high tibial osteotomy: a meta-analysis focusing on weight bearing effect. Knee Surg Relat Res 31(2):81–102
Song E-K, Seon J-K, Park S-J, Seo H-Y (2008) Navigated open wedge high tibial osteotomy. Sports Med Arthrosc Rev 16(2):84–90
Hofmann S, Lobenhoffer P, Staubli A, Van RH (2009) Osteotomies of the knee joint in patients with monocompartmental arthritis. Der Orthopade. 38(8):755–769
Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K et al (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53
Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K et al (2018) 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 26(6):1873–1878
Song J-H, Bin S-I, Kim J-M, Lee B-S (2020) What is an acceptable limit of joint-line obliquity after medial open wedge high tibial osteotomy? Analysis based on midterm results. Am J Sports Med 48(12):3028–3035
Oh K-J, Ko YB, Bae JH, Yoon ST, Kim JG (2016) Analysis of knee joint line obliquity after high tibial osteotomy. J Knee Surg 29(08):649–657
El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open-and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38(2):323–329
Nha K-W, Kim H-J, Ahn H-S, Lee D-H (2016) Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy: a meta-analysis. Am J Sports Med 44(11):3006–3013
Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382
Song E-K, Seon J-K, Park S-J (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30(10):S127
Wang JH, Bae JH, Lim HC, Shon WY, Kim CW, Cho JW (2009) Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med 37(12):2411–2418
Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15(8):978–984
Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15(9):1094–1100
Kim K-I, Kim D-K, Song S-J, Lee S-H, Bae D-K (2017) Medial open-wedge high tibial osteotomy may adversely affect the patellofemoral joint. Arthroscopy 33(4):811–816
Gaasbeek R, Sonneveld H, Van Heerwaarden R, Jacobs W, Wymenga A (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11(6):457–461
Horikawa T, Kubota K, Hara S, Akasaki Y (2020) Distal tuberosity osteotomy in open-wedge high tibial osteotomy does not exacerbate patellofemoral osteoarthritis on arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc 28(6):1750–1756
Kamada S, Shiota E, Saeki K, Kiyama T, Maeyama A, Yamamoto T (2019) Severe varus knees result in a high rate of undercorrection of lower limb alignment after opening wedge high tibial osteotomy. J Orthop Surg (Hong Kong) 27(2):2309499019846660
Hernigou P, Queinnec S, Picard L, Guissou I, Naanaa T, Duffiet P et al (2013) Safety of a novel high tibial osteotomy locked plate fixation for immediate full weight-bearing: a case-control study. Int Orthop 37(12):2377–2384
Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646
Kazımoğlu C, Akdoğan Y, Şener M, Kurtulmuş A, Karapınar H, Uzun B (2008) Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study. Knee 15(4):305–308
Lee S-S, Celik H, Lee D-H (2018) Predictive factors for and detection of lateral hinge fractures following open wedge high tibial osteotomy: plain radiography versus computed tomography. Arthroscopy 34(11):3073–3079
Nakamura R, Komatsu N, Fujita K, Kuroda K, Takahashi M, Omi R et al (2017) Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J 99(10):1313–1318
Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW (2013) A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 21(1):90–95
So S-Y, Lee S-S, Jung EY, Kim JH, Wang JH (2019) Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05555-7
Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136(10):1337–1342
Pape D, Duchow J, Rupp S, Seil R, Kohn D (2006) Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(2):141–148
Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH et al (2020) Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28(5):1411–1418
Ryu DJ, Lee S-S, Jung EY, Kim JH, Shin TS, Wang JH (2021) Reliability of preoperative planning method that considers latent medial joint laxity in medial open-wedge proximal tibial osteotomy. Orthop J Sports Med 9(10):232596712110341
Heijens E, Kornherr P, Meister C (2016) The coronal hypomochlion: a tipping point of clinical relevance when planning valgus producing high tibial osteotomies. Bone Joint J. https://doi.org/10.1302/0301-620X.98B5.33394