Skip to main content

Advertisement

SpringerLink
Log in

A novel device for greater precision and safety in open-wedge high tibial osteotomy: cadaveric study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The complications of the open-wedge osteotomy technique (slope, hypo- and hypercorrection and fractures) are related to difficulties in the control of the open-wedge angle during surgery.

Materials and methods

In this cadaveric study, we evaluated the safety and precision of a novel system, the Realignment High Control System (RHC), in the correction of knee mechanical axis and slope. The RHC has a fixation plate coupled to a dynamic device that opens the osteotomy continuously, allowing plate fixation before osteotomy wedge opening.

Results

All procedures were easily performed, with no fractures. The openings equaled the indicated by the navigation system for 7.5° and 10°, and for 5°, there was a statistically, although not clinically significant, difference of 0.6°. The slope shown by the RHC setting and in the navigation system was significantly different for the 10° setting only, with a mean difference of 0.563°.

Conclusions

RHC facilitates the surgical technique of high tibial osteotomy, with gradual wedge opening, precise correction of the mechanical axis, and appropriate control of the tibial slope, even with larger openings.

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

Similar content being viewed by others

References

  1. Bonasia DE, Dettoni F, Sito G et al (2014) Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 42(3):690–698. https://doi.org/10.1177/0363546513516577

    Article  PubMed  Google Scholar 

  2. Parker DA, Beatty KT, Giuffre B et al (2011) Articular cartilage changes in patients with osteoarthritis after osteotomy. Am J Sports Med 39(5):1039–1045. https://doi.org/10.1177/0363546510392702

    Article  PubMed  Google Scholar 

  3. Prodromos CC, Amendola A, Jakob RP (2015) High tibial osteotomy: indications, techniques, and postoperative management. Instr Course Lect 64:555–565

    PubMed  Google Scholar 

  4. Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24(2):61–69

    Article  Google Scholar 

  5. Lee YS, Lee BK, Kwon JH et al (2014) Serial assessment of weight-bearing lower extremity alignment radiographs after open-wedge high tibial osteotomy. Arthroscopy 30(3):319–325. https://doi.org/10.1016/j.arthro.2013.11.028

    Article  PubMed  Google Scholar 

  6. Ogawa H, Matsumoto K, Ogawa T et al (2016) Effect of wedge insertion angle on posterior tibial slope in medial opening wedge high tibial osteotomy. Orthop J Sports Med 4(2):2325967116630748. https://doi.org/10.1177/2325967116630748

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sterett WI, Steadman JR, Huang MJ et al (2010) Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 38(7):1420–1424. https://doi.org/10.1177/0363546509360403

    Article  PubMed  Google Scholar 

  8. Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Jt Surg Br 43-B:746–751

    Article  CAS  Google Scholar 

  9. Ribeiro CH, Severino NR, Moraes PMBF (2014) Opening wedge high tibial osteotomy: navigation system compared to the conventional technique in a controlled clinical study. Int Orthop 38(8):1627–1631. https://doi.org/10.1007/s00264-014-2341-y

    Article  PubMed  PubMed Central  Google Scholar 

  10. Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30(10 Suppl):S127–S133

    PubMed  Google Scholar 

  11. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28:s1269–s1274

    PubMed  Google Scholar 

  12. Amendola A, Abonaria DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34(2):155–160

    Article  Google Scholar 

  13. Jacobi M, Wahl P, Jakob RP (2010) Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc 18:200–203

    Article  Google Scholar 

  14. 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. https://doi.org/10.1007/s00402-017-2729-4

    Article  PubMed  Google Scholar 

  15. Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653

    Article  Google Scholar 

  16. Jung WH, Chun CW, Lee JH et al (2013) Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 29(6):1063–1071. https://doi.org/10.1016/j.arthro.2013.02.020

    Article  PubMed  Google Scholar 

  17. Miller BS, Dorsey WO, Bryant CR et al (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557

    Article  Google Scholar 

  18. Dexel J, Fritzsche H, Beyer F et al (2017) Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. Knee Surg Sports Traumatol Arthrosc 25(3):832–837. https://doi.org/10.1007/s00167-015-3730-5

    Article  PubMed  Google Scholar 

  19. Han SB, Lee DH, Shetty GM et al (2013) A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 21:90–95

    Article  CAS  Google Scholar 

  20. Song IH, Song EK, Seo HY et al (2012) Patellofemoral alignment and anterior knee pain after closing- and opening-wedge valgus high tibial osteotomy. Arthroscopy 28:1087–1093

    Article  Google Scholar 

  21. Gaasbeek R, Welsing R, Barink M et al (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  23. El-Azab H, Glabgly P, Paul J et al (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 38:323–329

    Article  Google Scholar 

  24. Song MH, Yoo SH, Kang SW et al (2015) Coronal alignment of the lower limb and the incidence of constitutional varus knee in Korean females. Knee Surg Relat Res 27:49–55

    Article  Google Scholar 

  25. Bombaci H, Canbora K, Onur G et al (2005) The effect of open wedge osteotomy on the posterior tibial slope. Acta Orthop Traumatol Turc 39(5):404–410

    PubMed  Google Scholar 

  26. Matsuda S, Miura H, Nagamine R et al (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12(3):165–168

    CAS  PubMed  Google Scholar 

  27. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Arch Orthop Trauma Surg 124(9):575–584

    Article  CAS  Google Scholar 

  28. Thiel W (1992) The preservation of the whole corpse with natural color. Ann Anat 174(3):185–195

    Article  CAS  Google Scholar 

  29. Pitto RP, Graydon AJ, Bradley L et al (2006) Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Jt Surg Br 88:601–605

    Article  CAS  Google Scholar 

  30. Ribeiro CH, Severino NR, Fucs PM (2013) Preoperative surgical planning versus navigation system in valgus tibial osteotomy: a cross-sectional study. Int Orthop 37(8):1483–1486

    Article  Google Scholar 

  31. Seo SS, Kim CW, Seo JH et al (2016) Does superficial medial collateral ligament release in open-wedge high tibial osteotomy for varus osteoarthritic knees increase valgus laxity? Am J Sports Med 44(4):908–915

    Article  Google Scholar 

  32. Pape D, Adam F, Rupp S et al (2004) Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis. Orthopade 33(2):208–217

    Article  CAS  Google Scholar 

  33. Gwinner C, Fuchs M, Sentuerk U, Perka CF, Walter TC, Schatka I, Rogasch JMM (2019) Assessment of the tibial slope is highly dependent on the type and accuracy of the preceding acquisition. Arch Orthop Trauma Surg 139(12):1691–1697. https://doi.org/10.1007/s00402-019-03201-y

    Article  PubMed  Google Scholar 

  34. Ogawa H, Matsumoto K, Akiyama H (2018) New angle measurement device to control the posterior tibial slope angle in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 138(3):299–305. https://doi.org/10.1007/s00402-017-2846-0(Epub 2017 Nov 17)

    Article  PubMed  Google Scholar 

  35. Davis ET, Pagkalos J, Gallie PA et al (2014) Defining the errors in the registration process during imageless computer navigation in total knee arthroplasty: a cadaveric study. J Arthroplasty 29:698–701

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Knee Surgery Division, Hospital Orto, Av. Nove de Julho, 1017, Vila Icaraí, São José dos Campos, SP, 12243-690, Brazil

    Cristiano Hossri Ribeiro

  2. Ápice Clinic, Sorocaba, SP, Brazil

    Mauricio Sante Bettio Mod

  3. Safrima, Bern, Switzerland

    Daniel Isch

  4. Asklepios Klinik, Bad Abbach, Germany

    Clemens Baier & Guenther Maderbacher

  5. Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo (SCSP), São Paulo, Brazil

    Nilson Roberto Severino

  6. Surgery and Orthopaedics Department, Universidade Estadual de São Paulo (Unesp), Botucatu, SP, Brazil

    Daniele Cristina Cataneo

Authors
  1. Cristiano Hossri Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mauricio Sante Bettio Mod
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Isch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clemens Baier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guenther Maderbacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nilson Roberto Severino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniele Cristina Cataneo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cristiano Hossri Ribeiro.

Ethics declarations

Conflicts of interest

Cristiano Hossri Ribeiro and Daniel Isch created the new system and receive royalties for the product from Astrolab (the manufacturer). The other authors have no conflicts of interest to disclose.

Additional information

Publisher's Note

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

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ribeiro, C.H., Mod, M.S.B., Isch, D. et al. A novel device for greater precision and safety in open-wedge high tibial osteotomy: cadaveric study. Arch Orthop Trauma Surg 140, 203–208 (2020). https://doi.org/10.1007/s00402-019-03300-w

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03300-w

Keywords

Search

Navigation