Skip to main content
SpringerLink
Log in

Comparative analysis of osteotomy accuracy between the conventional and devised technique using a protective cutting system in medial open-wedge high tibial osteotomy

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Introduction

Open-wedge high tibial osteotomy (OWHTO) is associated with potential intraoperative problems. For prevention of these problems, we thought that some surgical improvements were required and devised a protective cutting system (PCS). The purposes of this study were (1) to test our devised protective cutting system and (2) compare its accuracy in osteotomy to that of a conventional technique.

Materials and methods

A comparative study was performed with 19 patients who underwent OWHTO with PCS (group I) and 16 patients who underwent OWHTO using a conventional technique (group II). For the evaluation of osteotomy accuracy, osteotomy lines of the anterior and posterior cortex were analyzed in the 3D surface models [Total (T), Osteotomy (O), Ratio (O/T), Effective osteotomy (E), Deviation direction (DD), and length (DL)]. Analysis of changes of the medial and lateral tibial slope was performed independently, and intraoperative complications were also analyzed.

Results

In the osteotomy line of the anterior aspect, O-anterior and Ratio (O- and T-anterior) showed statistical significance, and a larger osteotomy was observed in group II (p = 0.02 and 0.01, respectively). In the osteotomy line of the posterior aspect, Ratio (O- and T-posterior) and E-posterior showed statistical significance (p = 0.01 and 0.01, respectively). In the comparison between the change of the medial and lateral tibial slope, statistical significance was observed in both groups, and the medial tibial slope showed a larger increase than that of the lateral side (p = < 0.01 and <0.01, respectively). There were more intraoperative complications such as fracture and deviation of the osteotomy plane in group II, and this was more prominent at the posterior aspect.

Conclusions

OWHTO with PCS could improve the accuracy of osteotomies, especially those of the posterior cortex of the proximal tibia, thus resulting in a reduction of intraoperative complications.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Jacobi M, Wahl P, Jakob RP. Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc. 2010;18:200–3.

    Article  PubMed  Google Scholar 

  2. Yang D, Zhou Y, Tang Q, Xu H, Yang X. Anatomical relationship between the proximal tibia and posterior neurovascular structures: a safe zone for surgeries involving the proximal tibia. J Arthroplasty. 2011;26:1123–7.

    Article  PubMed  Google Scholar 

  3. Miller BS, Downie B, McDonough EB, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy. 2009;25:639–46.

    Article  PubMed  Google Scholar 

  4. Dee M, Sojka JM, Daccarett MS, Mormino MA. Evaluation of popliteal artery injury risk with locked lateral plating of the tibial plateau. J Orthop Trauma. 2011;25:603–7.

    Article  PubMed  Google Scholar 

  5. Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg. 2004;124:649–53.

    Article  PubMed  Google Scholar 

  6. Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KW. A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc. 2011;. doi:10.1007/s00167-011-1706-7.

    Google Scholar 

  7. Marti CB, Gautier E, Wachtl SW, Jakob RP. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy. 2004;20:366–72.

    Article  PubMed  Google Scholar 

  8. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med. 2005;33:378–87.

    Article  PubMed  Google Scholar 

  9. Song EK, Seon JK, Park SJ. How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics. 2007;30:S127–31.

    PubMed  Google Scholar 

  10. Wang JH, Bae JH, Lim HC, Shon WY, Kim CW, Cho JW. Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med. 2009;37:2411–8.

    Article  PubMed  Google Scholar 

  11. Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2013;21:32–8.

    Article  CAS  PubMed  Google Scholar 

  12. Lee DH, Nha KW, Park SJ, Han SB. Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy. Arthroscopy. 2012;28:1842–50.

    Article  PubMed  Google Scholar 

  13. Lee YS, Kim MG, Byun HW, Kim SB, Kim JG. Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. (2013).

  14. Lee YS, Won JS, Oh WS, Park HG, Lee BK. Lateral tibial bone mineral density around the level of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc. 2013;22:1678–83.

    Article  PubMed  Google Scholar 

  15. Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P. Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14:291–300.

    Article  CAS  PubMed  Google Scholar 

  16. Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc. 2006;14:948–54.

    Article  PubMed  Google Scholar 

  17. Schroter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy. 2011;27:644–52.

    Article  PubMed  Google Scholar 

  18. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury. 2003;34(Suppl 2):B55–62.

    Article  PubMed  Google Scholar 

  19. El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S. The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br. 2008;90:1193–7.

    Article  CAS  PubMed  Google Scholar 

  20. Asada S, Akagi M, Mori S, Matsushita T, Hashimoto K, Hamanishi C. Increase in posterior tibial slope would result in correction loss in frontal plane after medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2012;20:571–8.

    Article  PubMed  Google Scholar 

  21. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA. 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. 2005;87:1227–32.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2012R1A1B3000971).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Yong Seuk Lee & Gi Ho Moon

Authors
  1. Yong Seuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gi Ho Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Seuk Lee.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, Y.S., Moon, G.H. Comparative analysis of osteotomy accuracy between the conventional and devised technique using a protective cutting system in medial open-wedge high tibial osteotomy. J Orthop Sci 20, 129–136 (2015). https://doi.org/10.1007/s00776-014-0663-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-014-0663-7

Keywords

Search

Navigation