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Opening wedge high tibial osteotomy using a monoaxial dynamic external fixator

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To prospectively assess midterm results in 37 patients (41 knees) who were treated with opening wedge high tibial osteotomy (OW-HTO) with the use of a monoaxial dynamic external fixator (MDEF) for medial knee osteoarthritis.

Methods

Clinical and subjective evaluations were performed using the IKDC and KOOS evaluation forms and the modified Knee Society Clinical Rating System (KSS). Pin tract infections were evaluated according to Checketts–Otterburns classification. Radiographic evaluation included long-standing AP lower limb, standard lateral, Rosenberg and Merchant views.

Results

Thirty-six patients (40 knees) were evaluated at a mean follow-up period of 7 years. Ten patients (25 %) developed a minor pin tract infection. Subjective KOOS and IKDC scores showed statistically significant improvement. Clinical evaluation with IKDC and KSS forms showed no patient with instability or a range-of-motion deficit worst than pre-operatively. At MDEF removal, the mechanical axis was on average 4.5° valgus; anatomical axis 6.8° valgus; the Mikulicz’ line crossed the tibial plateau on average at 64 % of the width of the tibial plateau measured from medial; the posterior slope 5°; the metaphyseal varus 4.3°; and the Insall/Salvati ratio 1.02. At latest follow-up, five patients had a loss of correction of 1°–2° on mechanical axis and one patient had a loss of correction of 3° on mechanical axis and 4 % of mechanical axis on tibial plateau.

Conclusions

The use of a MDEF to perform an OW-HTO showed a good maintenance of correction achieved with satisfactory midterm outcome results in all patients but three who underwent total knee replacement. The only severe post-operative complication was one case of non-union in a heavy smoker.

Level of evidence

Prospective and therapeutic study, Level IV.

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References

  1. Aglietti P, Rinonapoli E, Stringa G, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 176:239–251

    Google Scholar 

  2. Insall JN (1993) Osteotomy. In: Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti P (eds) Surgery of the knee. Churchill Livingstone, New York, pp 635–676

    Google Scholar 

  3. Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. J Bone Joint Surg Am 47-A:984–990

    Article  Google Scholar 

  4. Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 16:21–26

    PubMed  Google Scholar 

  5. Amendola A, Rorabeck CH, Bourne RB, Apyan PM (1989) Total knee arthoplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty 4(Suppl):S11–S17

    Article  PubMed  Google Scholar 

  6. Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15:597–603

    Article  CAS  PubMed  Google Scholar 

  7. Odenbring S, Egund N, Knutson K, Lindstrand A, Toksvig-Larsen S (1990) Revision after osteotomy for gonarthrosis: a 10-19-year follow-up of 314 cases. Acta Orthop Scand 61:128–130

    Article  CAS  PubMed  Google Scholar 

  8. Debeyre J (1951) Surgical treatment of arthroses of the knee. Sem Hop 27(61–62):2515–2518

    CAS  PubMed  Google Scholar 

  9. Amendola A, Fowler PJ, Litchfield R, Kirkley S, Clatworthy M (2004) Opening wedge high tibial osteotomy using a novel technique: early results and complications. J Knee Surg 17:164–169

    CAS  PubMed  Google Scholar 

  10. Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85-A:78–85

    Article  PubMed  Google Scholar 

  11. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  PubMed  Google Scholar 

  12. Billings A, Scott DF, Camargo MP, Hofmann AA (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg Am 82:70–79

    Article  CAS  PubMed  Google Scholar 

  13. Ellis RE, Tso CY, Rudan JF, Harrison MM (1999) A surgical planning and guidance system for high tibial osteotomy. Comput Aided Surg 4:264–274

    Article  CAS  PubMed  Google Scholar 

  14. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy: a new fixation device. Clin Orthop Relat Res 246:250–259

    Google Scholar 

  15. Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia-early results in 92 cases. Injury 34(Suppl 2):B55–B62

    Article  PubMed  Google Scholar 

  16. Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 19:944–950

    Article  Google Scholar 

  17. Adili A, Bhandari M, Giffin R, Whately C, Kwok DC (2002) Valgus high tibial osteotomy: comparison between an Ilizarov and a coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 10:169–176

    Article  PubMed  Google Scholar 

  18. Fowler JL, Gie GA, MacEachern AG (1991) Upper tibial valgus osteotomy using a dynamic external fixator. J Bone Joint Surg Br 73-B:690–691

    Google Scholar 

  19. Magyar G, Toksvig-Larsen S, Lindstrand A (1998) Open wedge tibial osteotomy by callus distraction in gonarthrosis. Operative technique and early results in 36 patients. Acta Orthop Scand 69:147–151

    Article  CAS  PubMed  Google Scholar 

  20. Magyar G, Toksvig-Larsen S, Lindstrand A (1999) Hemicallotasis open-wedge osteotomy for osteoarthritis of the knee: complications in 308 operations. J Bone Joint Surg Br 81-B:449–451

    Article  Google Scholar 

  21. Sen C, Kocaoglu M, Eralp L (2003) The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up). Knee Surg Sports Traumatol Arthrosc 11:139–144

    Article  PubMed  Google Scholar 

  22. Weale AE, Lee AS, MacEachern AG (2001) High tibial osteotomy using a dynamic axial external fixator. Clin Orthop Relat Res 382:154–167

    Article  Google Scholar 

  23. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87:1227–1232

    Article  CAS  PubMed  Google Scholar 

  24. Bachhal V, Sankhala SS, Jindal N, Dhillon MS (2011) High tibial osteotomy with a dynamic axial fixator: precision in achieving alignment. J Bone Joint Surg Br 93(7):897–903

    Article  CAS  PubMed  Google Scholar 

  25. Checketts RG, Otterburn M, MacEachern AG (1993) Pin track infection: definition, incidence and prevention. Int J Orthop Trauma 3:16–19

    Google Scholar 

  26. 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

    Google Scholar 

  27. Roos E, Roos G, Lohmander S, Ekdahl C, Beynnon B (1998) Knee injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 2:88–96

    Article  Google Scholar 

  28. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    CAS  PubMed  Google Scholar 

  29. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 24:13–14

    Google Scholar 

  30. Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM (1988) The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 70-A:1479–1483

    Article  Google Scholar 

  31. Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patello-femoral congruence. J Bone Joint Surg Am 56:1391–1396

    Article  CAS  PubMed  Google Scholar 

  32. Moore TM, Harvey JP Jr (1974) Roentgenographic measurement of tibial-plateau depression due to fracture. J Bone Joint Surg Am 56-A:155–160

    Article  Google Scholar 

  33. Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A (1996) Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 82:195–200

    CAS  PubMed  Google Scholar 

  34. Genin P, Weill G, Julliard R (1993) The tibial slope: proposal for a measurement method. J Radiol 74:27–33

    CAS  PubMed  Google Scholar 

  35. Insall JN, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104

    Article  CAS  PubMed  Google Scholar 

  36. Caton J (1989) Method of measuring the height of the patella. Acta Orthop Belg 55(3):385–386

    CAS  PubMed  Google Scholar 

  37. Kellegren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–501

    Article  Google Scholar 

  38. Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Supplementum 227:1–72

    Google Scholar 

  39. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  PubMed  Google Scholar 

  40. Wright J, Heck D, Hawker G, Dittus R, Freund D, Joyce D, Paul J, Young W, Coyte P (1995) Rates of tibial osteotomies in Canada and the United States. Clin Orthop Relat Res 319:266–275

    Google Scholar 

  41. Kitson J, Weale AE, Lee AS, MacEachern AG (2001) Patellar tendon length following opening wedge high tibial osteotomy using an external fixator with particular reference to later total knee replacement. Injury 32(Suppl 4):140–143

    Article  Google Scholar 

  42. Nakamura E, Mizuta H, Kudo S, Takagi K, Sakamoto K (2001) Open-wedge osteotomy of the proximal tibia with hemicallotasis. J Bone Joint Surg Br 83-B:1111–1115

    Article  Google Scholar 

  43. Myrnerts R (1980) Failure of the correction of varus deformity obtained by high tibial osteotomy. Acta Orthop Scand 51:569–573

    Article  CAS  PubMed  Google Scholar 

  44. Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372

    Article  PubMed  Google Scholar 

  45. Flecher X, Parratte S, Aubianac JM, Argenson JN (2006) A 12-28-Year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96

    Article  PubMed  Google Scholar 

  46. W-Dahl A, Toksvig-Larsen S, Lindstrand A (2003) No difference between daily and weekly pin site care: a randomized study of 50 patients with external fixation. Acta Orthop Scand 74:704–708

    Article  PubMed  Google Scholar 

  47. Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB (2013) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21(1):152–160

    Article  PubMed  Google Scholar 

  48. Coventry MB (1984) Upper tibial osteotomy. Clin Orthop Relat Res 182:46–52

    Google Scholar 

  49. Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy: a critical longterm study of eighty-seven cases. J Bone Joint Surg Am 75-A:196–201

    Article  Google Scholar 

  50. Tjörnstrand B, Hagstedt B, Persson BM (1978) Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee. J Bone Joint Surg Am 60(7):973–977

    Article  PubMed  Google Scholar 

  51. Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM, LEAP Study Group (2005) Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma 19(3):151–157

    Article  PubMed  Google Scholar 

  52. Moghaddam A, Weiss S, Wolfl CG, Schmeckenbecher K, Wentzensen A, Grutzner PA, Zimmermann G (2010) Cigarette smoking decreases TGF-b1 serum concentrations after long bone fracture. Inj Int J Care Inj 41:1020–1025

    Article  CAS  Google Scholar 

  53. Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M (2010) The effects of smoking on fracture healing. Surgeon 8(2):111–116

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. SOD Traumatologia e Ortopedia Generale AOU Careggi, Largo P. Palagi 1, 50139, Florence, Italy

    Nicola Mondanelli, Francesco Giron, Michele Losco, Roberto Buzzi & Paolo Aglietti

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  1. Nicola Mondanelli
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  2. Francesco Giron
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  3. Michele Losco
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  4. Roberto Buzzi
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  5. Paolo Aglietti
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Corresponding author

Correspondence to Francesco Giron.

Additional information

Paolo Aglietti: Deceased on April 18, 2013.

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Mondanelli, N., Giron, F., Losco, M. et al. Opening wedge high tibial osteotomy using a monoaxial dynamic external fixator. Knee Surg Sports Traumatol Arthrosc 25, 306–313 (2017). https://doi.org/10.1007/s00167-015-3564-1

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  • DOI: https://doi.org/10.1007/s00167-015-3564-1

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