Skip to main content

Advertisement

SpringerLink
Log in

Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture

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

Abstract

Purpose

With surgical modifications reflecting plate design differences of the specific rigid locking plate adding a metal wedge, uniplane high tibial osteotomy (HTO) has fewer lateral-hinge fractures and fewer plate irritations than biplane HTO.

Methods

Uniplane HTO with a rigid locking plate adding a metal wedge was compared with biplane HTO with a rigid locking plate including a proximal D-hole. For comparison, the HTO patients’ medical records and radiological results in a single institution were retrospectively reviewed. The Oxford knee score 2 years post-operation, CT scan at post-operative day 2 and serial standing long-bone scanography were reviewed to evaluate clinical outcome and radiological results, including the incidence of lateral-hinge fracture, plate irritation and correction loss to varus alignment.

Results

A total of 103 knees, including 59 uniplane HTO and 44 biplane HTO, were enrolled. The Oxford scores were 38.1 ± 7.8 in the uniplane group and 35.9 ± 8.3 in the biplane group (ns). On CT scans, more lateral-hinge fractures developed in the biplane group, and seven knees (12%) of the uniplane group and 12 knees (27%) of the biplane group had Takeuchi type I stable hinge fracture (p < 0.05); unstable fracture was not noted in either group. Plate irritation occurred in nine knees (19%) of the uniplane group and in 14 knees (32%) of the biplane group, and the difference was statistically significant (p < 0.05).

Conclusion

In clinical situations including the use of surgical modifications reflecting plate design differences, fewer lateral-hinge fractures developed after uniplane medial opening-wedge HTO compared with biplane HTO. Uniplane HTO potentially represents a better option than biplane HTO for the prevention of lateral-hinge fracture.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dessyn E, Sharma A, Donnez M, Chabrand P, Ehlinger M, Argenson JN, Parratte S, Ollivier M (2019) Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05404-7

    Article  PubMed  Google Scholar 

  2. Diffo Kaze A, Maas S, Hoffmann A, Pape D (2017) Mechanical strength assessment of a drilled hole in the contralateral cortex at the end of the open wedge for high tibial osteotomy. J Exp Orthop 4(1):23

    Article  Google Scholar 

  3. Ha JK, Yeom CH, Jang HS, Song HE, Lee SJ, Kim KH, Chung KS, Bhat MG, Kim JG (2016) Biomechanical analysis of a novel wedge locking plate in a porcine tibial model. Clin Orthop Surg 8(4):373–378

    Article  Google Scholar 

  4. Han JH, Yang JH, Bhandare NN, Suh DW, Lee JS, Chang YS, Yeom JW, Nha KW (2016) Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 24(8):2567–2577

    Article  Google Scholar 

  5. Han SB, Bae JH, Lee SJ, Jung TG, Kim KH, Kwon JH, Nha KW (2014) Biomechanical properties of a new anatomical locking metal block plate for opening wedge high tibial osteotomy: uniplane osteotomy. Knee Surg Relat Res 26(3):155–161

    Article  Google Scholar 

  6. Han SB, Choi JH, Mahajan A, Shin YS (2019) Incidence and predictors of lateral hinge fractures following medial opening-wedge high tibial osteotomy using locking plate system: better performance of computed tomography scans. J Arthroplasty 34(5):846–851

    Article  Google Scholar 

  7. Han SB, In Y, Oh KJ, Song KY, Yun ST, Jang KM (2019) Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study. J Arthroplasty 34(3):439–445

    Article  Google Scholar 

  8. 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

    Article  CAS  Google Scholar 

  9. Jo HS, Park JS, Byun JH, Lee YB, Choi YL, Cho SH, Moon DK, Lee SH, Hwang SC (2018) The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 26(6):1851–1858

    Article  Google Scholar 

  10. Kuwashima U, Tashiro Y, Okazaki K, Mizu-Uchi H, Hamai S, Murakami K, Iwamoto Y (2017) Comparison of the impact of closing wedge versus opening wedge high tibial osteotomy on proximal tibial deformity and subsequent revision to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(3):869–875

    Article  Google Scholar 

  11. Lansdaal JR, Mouton T, Wascher DC, Demey G, Lustig S, Neyret P, Servien E (2017) Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25(12):3670–3678

    Article  Google Scholar 

  12. Lee DH, Han SB, Oh KJ, Lee JS, Kwon JH, Kim JI, Patnaik S, Shetty GM, Nha KW (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

    Article  Google Scholar 

  13. Lee OS, Lee YS (2018) Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy. Arthroscopy 34(4):1032–1043

    Article  Google Scholar 

  14. Lee YS, Won JS, Oh WS, Park HG, Lee BK (2014) Lateral tibial bone mineral density around the level of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc 22(7):1678–1683

    Article  Google Scholar 

  15. Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33(2):153–160

    Article  CAS  Google Scholar 

  16. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138

    Article  Google Scholar 

  17. Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646

    Article  Google Scholar 

  18. Nakamura R, Komatsu N, Fujita K, Kuroda K, Takahashi M, Omi R, Katsuki Y, Tsuchiya H (2017) Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Jt J 99-b(10):1313–1318

    Article  CAS  Google Scholar 

  19. Nha KW, Oh SM, Ha YW, Nikumbha VP, Seo JH, Oh MJ, Lim CO, Kim JG (2018) A retrospective comparison of union rates after open wedge high tibial osteotomies with and without synthetic bone grafts (Hydroxyapatite and beta-tricalciumphosphate) at 2 years. Arthroscopy 34(9):2621–2630

    Article  Google Scholar 

  20. Nha KW, Oh SM, Ha YW, Patel MK, Seo JH, Lee BH (2018) Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5121-1

    Article  PubMed  Google Scholar 

  21. Ogawa H, Matsumoto K, Akiyama H (2017) The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: a case control study. Bone Jt J 99-b(7):887–893

    Article  CAS  Google Scholar 

  22. Pape D, Dueck K, Haag M, Lorbach O, Seil R, Madry H (2013) Wedge volume and osteotomy surface depend on surgical technique for high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):127–133

    Article  Google Scholar 

  23. Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18(2):204–211

    Article  Google Scholar 

  24. Siboni R, Beaufils P, Boisrenoult P, Steltzlen C, Pujol N (2018) Opening-wedge high tibial osteotomy without bone grafting in severe varus osteoarthritic knee. Rate and risk factors of non-union in 41 cases. Orthop Traumatol Surg Res 104(4):473–476

    Article  CAS  Google Scholar 

  25. Slevin O, Ayeni OR, Hinterwimmer S, Tischer T, Feucht MJ, Hirschmann MT (2016) The role of bone void fillers in medial opening wedge high tibial osteotomy: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(11):3584–3598

    Article  Google Scholar 

  26. Sun H, Zhou L, Li F, Duan J (2017) Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis. J Knee Surg 30(2):158–165

    Article  Google Scholar 

  27. Takeuchi R, Aratake M, Bito H, Saito I, Kumagai K, Ishikawa H, Akamatsu Y, Sasaki Y, Saito T (2008) Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise. Knee Surg Sports Traumatol Arthrosc 16(11):1030–1037

    Article  Google Scholar 

  28. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53

    Article  Google Scholar 

  29. Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94

    Article  Google Scholar 

  30. Turkmen F, Kacira BK, Ozkaya M, Erkocak OF, Acar MA, Ozer M, Toker S, Demir T (2016) Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 25(9):2914–2920

    Article  Google Scholar 

  31. Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, Toms A (2016) Complications associated with opening wedge high tibial osteotomy–A review of the literature and of 15 years of experience. Knee 23(2):276–282

    Article  CAS  Google Scholar 

Download references

Funding

No external funding was used.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ilsanpaik Hospital, Inje University, Ilsan, South Korea

    Kyung Wook Nha, Myung Jin Shin & Young Jun Nam

  2. Joint Center, Barunsesang Hospital, #75-5, Yatap-ro, Seongnam-si, 13497, Gyeonggi-do, South Korea

    Dong Won Suh & Bong Soo Kyung

  3. Department of Orthopaedic Surgery, Janghowon St. Mary’s Hospital, Icheon, South Korea

    Ki Seong Kim

Authors
  1. Kyung Wook Nha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myung Jin Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong Won Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Young Jun Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ki Seong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bong Soo Kyung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bong Soo Kyung.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nha, K.W., Shin, M.J., Suh, D.W. et al. Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture. Knee Surg Sports Traumatol Arthrosc 28, 1436–1444 (2020). https://doi.org/10.1007/s00167-019-05522-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05522-2

Keywords

Search

Navigation