Applicability of a modified angular correction measurement method for open-wedge high tibial osteotomy
The purpose of this study was to evaluate the clinical potential of a new measurement technique for open-wedge high tibial osteotomy (HTO) based on the medial cortex opening (MCO) associated with the Miniaci preoperative planning technique.
A retrospective review of 97 cases of valgus-producing HTO that were performed between 2008 and 2013, using the intra-operative fluoroscopic mechanical axis technique, was carried out. The Miniaci-based measurement technique was then used as a theoretical point of comparison with the intent to compare the disparity between postoperative and ideal lower extremity (LE) mechanical axis with the measured disparity between postoperative and Miniaci-based planned MCO.
A significant correlation was observed for the comparison of the disparity between postoperative and Miniaci-based planned MCO and the disparity between postoperative and ideal LE mechanical axis (0.53, P = 0.001). This would suggest that the MCO associated with the Miniaci preoperative planning technique would have resulted in a better alignment had it been the chosen method to guide the amount of osteotomy opening. No significant correlation was observed between perioperative and postoperative LE mechanical axis (n.s.), the variable on which the current technique is based, confirming the poor reliability of the fluoroscopic mechanical axis technique.
This study suggests a more accurate and precise technique of realizing the appropriate angular correction when performing a HTO, which could lead to better clinical outcomes.
Level of evidence
KeywordsArthritis High tibial osteotomy Knee
The authors thank Miguel Chagnon, Ph.D., for statistical advice.
Compliance with ethical standards
Conflict of interest
There is no conflict of interest.
- 5.Dancey C, Reidy J (2004) Statistics without maths for psychology. Prentice Hall, LondonGoogle Scholar
- 6.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 274:248–264Google Scholar
- 9.Engel GM, Lippert FG III (1981) Valgus tibial osteotomy: avoiding the pitfalls. Clin Orthop Relat Res 160:137–143Google Scholar
- 10.Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy in osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10(3):585–608Google Scholar
- 19.Kolb W, Guhlmann H, Windisch C, Kolb K (2012) High tibial open-wedge osteotomy: new techniques and early results. In: Osteoarthritis—diagnosis, treatment and surgery. Intech, pp 319–346Google Scholar
- 20.Lavoie F, Cresson T, Trudeau-Rivest E, Aissaoui A, De Guise JA (2010) Evaluation de routine de la morphologie tridimensionnelle des membres inférieurs par imagerie biplanaire simultanée basse-dose. In: Advanced course on knee arthroplasty: 3-D knee function. Sauramps Medical, Montpellier, pp 39–48Google Scholar
- 22.Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res 229:193–200Google Scholar
- 23.Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 246:250–259Google Scholar
- 25.Odenbring S, Berggren AM, Peil L (1993) Roentgenographic assessment of the hip–knee–ankle axis in medial gonarthrosis. A study of reproducibility. Clin Orthop Relat Res 289:195–196Google Scholar