Skip to main content

Advertisement

SpringerLink
Log in

“One millimetre equals one degree”: a simple way to achieve in 92% of cases the desired correction after opening proximal tibial osteotomy for genu varum

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

Abstract

Introduction

When performing a high tibial osteotomy (HTO) for genu varum deformity, it is not always easy to obtain the correct amount of overcorrection. The aims of this study were to review the results of a simple and reproducible method of correction that we have called “1 mm equals 1°”. We have applied this technique to the medial opening wedge osteotomy. Our hypothesis was that one degree of correction corresponded with one degree of opening.

Methods

97 proximal medial opening wedge osteotomies were measured intraoperatively with a navigation system and at 3 months with long-leg X-rays. The hip–knee–ankle (HKA) angle preoperatively was on average 173.8 ± 2.3° (170°–177°). In most cases, an opening of 4° greater than the initial varus was performed using our formula that one degree varus was equal to 1 mm of opening. In other words, when the varus was 6°, an opening of 10 mm was performed. The void left by the opening wedge was filled with a calcium triphosphate wedge and the construct fixed and held with a locking plate.

Results

Aiming for a knee axis of 184 ± 2°, which corresponds to 2°–6° of overcorrection, we obtained the following results: HKA intraoperatively measured angle with navigation was on average 183.5 ± 0.9° (182°–184°) and HKA radiologically postoperatively angle was 182.5° ± 1.6° (179°–189°). We therefore achieved the desired overcorrection of 2°–6° in 92% of cases based on our postoperative radiographs and in 100% cases based on intraoperative measurements with computer navigation.

Conclusion

The method of “1 mm equals 1°” is a simple, reliable, and reproducible method to achieve in 92% of cases the desired overcorrection (i.e., 184 ± 2°) with valgising proximal medial opening wedge osteotomy in genu varum.

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

Similar content being viewed by others

Availability of data and materials

All references are available.

References

  1. Hernigou Ph, 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 69:332–354

    Article  CAS  PubMed  Google Scholar 

  2. Holden DL, James SL, Larson RL, Slocum DB (1988) Proximal tibial osteotomy in patients who are fifty years old or less. J Bone Joint Surg Am 70:977–982

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Lootvoet L, Massinon A, Rossillon R, Himmer O, Lambert K, Ghosez JP (1993) Ostéotomie tibiale haute de valgisation pour gonarthrose sur genu varum : à propos d’une série de 193 cas revus après 6 à 10 ans de recul. Rev Chir Orthop Reparatrice Appar Mot 79:375–384 (In French)

    CAS  PubMed  Google Scholar 

  5. Jenny JY, Tavan A, Jenny G, Kehr P (1998) Taux de survie à long terme des ostéotomies tibiales de valgisation pour gonarthrose. Rev Chir Orthop Reparatrice Appar Mot 84:350–357 (In French)

    CAS  PubMed  Google Scholar 

  6. Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthrosis. A 0 to 21-year follow-up study. Clin Orthop Relat Res 353:185–193

    Article  Google Scholar 

  7. 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 

  8. Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85(3):469–474

    Article  PubMed  Google Scholar 

  9. Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy. A ten to 20-year follow up. J Bone Joint Surg Br 90:592–596

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb® wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35(8):1151–1156

    Article  PubMed  Google Scholar 

  14. Schröter S, Ihle C, Mueller J, Lobenhoffer P, Stöckle U, van Heerwarden R (2013) Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc 21(1):189–196

    Article  PubMed  Google Scholar 

  15. He A, Mao Y, Zhou Y, Kong Q, Zhang H, Chen Y et al (2020) Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy. J Orthop Surg Res 15:504. https://doi.org/10.1186/s13018-020-02033-6

    Article  PubMed  PubMed Central  Google Scholar 

  16. Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopaedics 28(Suppl 10):S1269–S1274

    Google Scholar 

  17. Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34:185–190

    Article  PubMed  Google Scholar 

  18. Gebhard F, Krettek C, Hüfner T, Grützner PA, Ulrich 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

    Article  PubMed  Google Scholar 

  19. Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R et al (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593

    Article  CAS  PubMed  Google Scholar 

  20. Chaouche S, Jacquet C, Fabre-Aubrespy M, Sharma A, Argenson JN, Parratte S et al (2019) Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. Int Orthop 43:2757–2765

    Article  PubMed  Google Scholar 

  21. 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 10:585–608

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  23. Hernigou P, Ovadia H, Goutallier D (1992) Mathematical modelling of open-wedge tibial osteotomy and correction tables. Rev Chir Orthop Reparatrice Appar Mot 78(4):258–263

    CAS  PubMed  Google Scholar 

  24. Ramadier JO, Buard JE, Lortat-Jacob A, Benoit J (1982) Radiological assessment of knee deformity in the frontal plane. Rev Chir Orthop Reparatrice Appar Mot 68(1):75–78 (In French)

    CAS  PubMed  Google Scholar 

  25. Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS (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):283–288. https://doi.org/10.5792/ksrr.16.052

    Article  PubMed  PubMed Central  Google Scholar 

  26. Saragaglia D, Pradel P, Picard F (2004) L’ostéotomie de valgisation assistée par ordinateur dans le genu varum arthrosique : résultats radiologiques d’une étude cas-témoin de 56 cas. E-mémoires de l’Académie Nationale de Chirurgie 3:21–25. Available at: http://www.bium.univ-paris5.fr/acad-chirurgie

  27. Nicolau X, Bonnomet F, Micicoi G, Eichler D, Ollivier M, Favreau H et al (2020) Accuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical method. Int Orthop 44(12):2613–2619. https://doi.org/10.1007/s00264-020-04777-6

    Article  PubMed  Google Scholar 

  28. Saragaglia D, Blaysat M, Mercier N, Grimaldi M (2012) Results of forty-two computer assisted double level osteotomies for severe genu varum deformity. Int Orthop 36:999–1003

    Article  PubMed  Google Scholar 

  29. Saragaglia D, Chedal-Bornu B (2014) Computer-assisted osteotomy for valgus knees: medium-term results of 29 cases. Orthop Traumatol Surg Res 100:527–530

    Article  CAS  PubMed  Google Scholar 

  30. Santic V, Tudor A, Sestan B, Legovic D, Sirola L, Ivan Rakovac I (2010) Bone allograft provides bone healing in the medial opening high tibial osteotomy. Int Orthop 34(2):225–229

    Article  PubMed  Google Scholar 

  31. Hernigou P, Roussignol X, Flouzat-Lachaniette CH, Filippini P, Guissou I, Poignard A (2010) Opening wedge tibial osteotomy for large varus deformity with Ceraver™ resorbable beta tricalcium phosphate wedges. Int Orthop 34:191–199

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University Grenoble-Alpes, 23 Av. Des Maquis du Grésivaudan, 38700, La Tronche, France

    Dominique Saragaglia

  2. CHU Grenoble-Alpes, South Teaching Hospital, Kimberley avenue, 38130, Echirolles, France

    C. Horteur

  3. Department of Trauma and Orthopaedics, South Tees NHS Foundation Trust, Middlesbrough, UK

    R. Refaie

  4. 3 Allée du Joanny, 38640, Claix, France

    Dominique Saragaglia

Authors
  1. Dominique Saragaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Horteur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Refaie
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DS: construction and writing of the article. CH: revision and analysis of the files. RR: translation and proofreading of the article.

Corresponding author

Correspondence to Dominique Saragaglia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest related to this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent to participate and to publish

All the patients gave their consent to participate anonymously in the study.

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

Saragaglia, D., Horteur, C. & Refaie, R. “One millimetre equals one degree”: a simple way to achieve in 92% of cases the desired correction after opening proximal tibial osteotomy for genu varum. Arch Orthop Trauma Surg 143, 2395–2400 (2023). https://doi.org/10.1007/s00402-022-04458-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04458-6

Keywords

Search

Navigation