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A Novel Quantitative Evaluation of Bone Formation After Opening Wedge High Tibial Osteotomy Using Tomosynthesis

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Abstract

This study aimed to establish and validate a novel evaluation method using digital tomosynthesis to quantify bone formation in the gap after opening wedge high tibial osteotomy (OW-HTO). We retrospectively analyzed bone formation in the gap in 22 patients who underwent OW-HTO using digital tomosynthesis at 1, 2, 3, 6, 9, and 12 months postoperatively. Bone formation was semi-quantitatively assessed using the modified van Hemert’s score and density measurements on digital tomosynthesis images. The gap filling value (GFV) was calculated as the ratio of the intensities of the opening gap and the tibial shaft. In addition, the relationship between the modified van Hemert’s score and GFV was evaluated. The reproducibility of GFV had an interclass correlation coefficient (ICC [1,2]) of 0.958 for intraobserver reliability and an ICC (2,1) of 0.975 for interobserver reliability. The GFV increased in a time-dependent manner and was moderately correlated with the modified van Hemert’s score (r = 0.630, p < 0.001). The GFV plateaued at 6 months postoperatively. In addition, the GFV was higher in patients with a modified van Hemert’s score of 2 than in patients with a modified van Hemert’s score of 3 (p = 0.008). The GFVs obtained using digital tomosynthesis can be used to assess postoperative bone formation in the opening gap after OW-HTO with high accuracy and reproducibility.

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Data Availability

The authors declare that they had full access to all of the data in this study, and the authors take complete responsibility for the integrity of the data and the accuracy of the data analysis.

References

  1. Fürmetz J, Patzler S, Wolf F, Degen N, Prall WC, Soo C, Brocker W, Thaller PH. Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome. BMC Musculoskelet Disord 21:201, 2020

    Article  Google Scholar 

  2. Pannell WC, Heidari KS, Mayer EN, Zimmerman K, Heckmann N, McKnight B, Hill JR, Vangsnes CT, Hatch GF, Weber AE. High tibial osteotomy survivorship: A population-based study. Orthop J Sports Med 7:2325967119890693, 2019

    Article  Google Scholar 

  3. Jin QH, Lee W-G, Song E-K, Jin C, Seon J-K. Comparison of long-term survival analysis between open-wedge high tibial osteotomy and unicompartmental knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.11.008, November 11, 2020

  4. Sasaki E, Akimoto H, Iio K, Fujita Y, Saruga T, Kakizaki H, Ishibashi Y. Long-term survival rate of closing wedge high tibial osteotomy with high valgus correction: a 15-year follow-up study. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06128-9, June 29, 2020.

    Article  PubMed  Google Scholar 

  5. Song SJ, Bae DK, Kim KI, Park CH. Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics. Knee Surg Sports Traumatol Arthrosc 27:1310-1319, 2019

    Article  Google Scholar 

  6. Meehan JP, Danielsen B, Kim SH, Jamali AA, White RH. Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty. J Bone Joint Surg Am 96:529-535, 2014

    Article  Google Scholar 

  7. Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 97:715-720, 2015

    Article  Google Scholar 

  8. Bashar A, Bryant D, Kevin W, Robert GJ. Graft choice in medial opening wedge high tibial osteotomy: auto vs allograft. Orthopaedic Proceedings 93B:581–581, 2011

    Google Scholar 

  9. Jung WH, Takeuchi R, Kim DH, Nag R. Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 28.5. 1380-1387, 2020

    Article  Google Scholar 

  10. Chiari C, Grgurevic L, Bordukalo-Niksic T, Oppermann H, Valentinitsch A, Nemecek E, Staats K, Schreiner M, Trost C, Kolb A, Kainberger F, Pehar S, Milosevic M, Martinovic S, Peric M, Sampath TK, Vukicevic S, Windhager R. Recombinant human BMP6 applied within autologous blood coagulum accelerates bone healing: Randomized controlled trial in high tibial osteotomy patients. J Bone Miner Res 35:1893-1903, 2020

    Article  CAS  Google Scholar 

  11. Kawata M, Jo T, Taketomi S, Inui H, Yamagami R, Matsui H, Fushimi K, Yasunaga H, Tanaka S. Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database. Knee Surg Sports Traumatol Arthrosc, https://doi.org/10.1007/s00167-020-05943-4April 1, 2020

  12. Kim HJ, Seo I, Shin JY, Lee KS, Park KH, and Kyuan HS. Comparison of bone healing in open-wedge high tibial osteomy between the use of allograft bone chips with autologous bone marrow and the use of allograft bone chips alone for gap filling. J Knee Surg 33:576-581, 2020

    Article  Google Scholar 

  13. Tanaka T, Kumagae Y, Chazono M, Kitasato S, Kakuta A, Marumo K. A novel evaluation system to monitor bone formation and β-tricalcium phosphate resorption in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 23:2007-2011, 2015

    Article  CAS  Google Scholar 

  14. Fucentese SF, Tscholl PM, Sutter R, Brucker PU, Meyer DC, Koch PP. Bone autografting in medial open wedge high tibial osteotomy results in improved osseous gap healing on computed tomography, but no functional advantage: a prospective, randomised, controlled trial. Knee Surg Sports Traumatol Arthrosc, 27:2951–2957, 2019

  15. Nelson G, Wu M, Hinkel C, Krishna G, Funk T, Rosenberg J. Improved targeting accuracy of lung tumor biopsies with scanning-beam digital x-ray tomosynthesis image guidance. Med Phys. 43(12):6282, 2016

    Article  Google Scholar 

  16. Tucker L, Gilbert FJ, Astley SM, Dibden A, Seth A, Morel J. Does reader performance with digital breast tomosynthesis vary according to experience with two-dimensional mammography? Radiology, 283:371—80, 2017

  17. Blum A, Noël A, Regent D, Villani N, Gillet R, Gondim Teixeira P. Tomosynthesis in musculoskeletal pathology. Diagn Interv Imaging, 99:423-441, 2018

    Article  CAS  Google Scholar 

  18. Ha AS, Lee AY, Hippe DS, Chou SHS, Chew FS. Digital tomosynthesis to evaluate fracture healing: Prospective comparison with radiography and CT. AJR Am J Roentgenol, 205:136-141, 2015

    Article  Google Scholar 

  19. Compton N, Murphy L, Lyons F, Jones J, MacMahon P, Cashman, J. Tomosynthesis: A new radiologic technique for rapid diagnosis of scaphoid fractures. Surgeon, 16:131-136, 2018

    Article  CAS  Google Scholar 

  20. Toyooka S, Masuda H, Nishihara N, Shimazaki N, Ando S, Kawano H, Nakagawa T. Tomosynthesis is equivalent to computed tomography for evaluating osseous integration after anterior cruciate ligament reconstruction. Anthrosc Sports Med Rehabil. 2:e105-e112, 2020

    Google Scholar 

  21. Schindelin J, Arganda-Carreras I, Frise E, Kaynig V, Longari M, Pietzsch T, Preibisch S, Rueden C, Saalfeld S, Schmid B, Tinevez J-Y, White DJ, Hartenstein V, Eliceiri K, Tomancak P, Cardona A. Fiji - an open-source platform for biological-image analysis. Nat Methods, 9:676-682, 2012

    Article  CAS  Google Scholar 

  22. Fujisawa Y, Masuhara K, Shiomi S. 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, 1979

  23. Koshino T, Murase T, Saito T. Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am, 85:78-85, 2003

    Article  Google Scholar 

  24. Brosset T, Pasquier G, Migaud H, Gougeon F. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFixTM) and early weight-bearing: Prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res, 97:705-711, 2011

    Article  CAS  Google Scholar 

  25. Xia W, Yin X-R, Wu J-T, Wu H-T. Comparative study of DTS and CT in the skeletal trauma imaging diagnosis evaluation and radiation dose. Eur J Radiol, 82:e76-80, 2013

    Article  Google Scholar 

  26. Tang H, Yang D, Guo S, Tang J, Liu J, Wang D, Zhou Y. Digital tomosynthesis with metal artifact reduction for assessing cementless hip arthroplasty: a diagnostic cohort study of 48 patients. Skeltal Radiol, 45:1523-1532, 2016

    Article  Google Scholar 

  27. Witek L, Alifarag A-M, Tovar N, Lopec C-D, Gil L-F, Gorbonosov M, Hannan K, Neiva R, Coelho P-G. Osteogenic parameters surrounding trabecular tantalum metal implants in osteotomies prepared via osseodensification drilling. Med Oral Patol Oral Cir Bucal, 24:e764-e769, 2019

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan

    Kyota Ishibashi, Eiji Sasaki, Shohei Yamauchi, Shizuka Sasaki, Yuka Kimura, Yuji Yamamoto & Yasuyuki Ishibashi

  2. Department of Stem Cell Therapy Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Kyota Ishibashi, Takashi Shimbo & Katsuto Tamai

  3. StemRIM Co., Ltd, Ibaraki, Osaka, Japan

    Edward Wijaya

  4. StemRIM Institute of Regeneration-Inducing Medicine, Osaka University, Suita, Japan

    Takashi Shimbo

Authors
  1. Kyota Ishibashi
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  2. Eiji Sasaki
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  3. Edward Wijaya
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  4. Shohei Yamauchi
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  5. Shizuka Sasaki
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  6. Yuka Kimura
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  9. Katsuto Tamai
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  10. Yasuyuki Ishibashi
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Contributions

K.I., E.S., E.W., and Y.I. contributed to the conception and design of the study. K.I., E.S., S.Y., S.S., and Y.K. contributed to the acquisition of the data. K.I., E.S., and E.W. contributed to the analysis and/or interpretation of the data. K.I., E.S., S.T., K.T., and Y.I. drafted the manuscript. Y.I. is the guarantor. The corresponding author attests that all the listed authors meet the authorship criteria and that no other authors meeting the criteria have been omitted.

Corresponding author

Correspondence to Kyota Ishibashi.

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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.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Ishibashi, K., Sasaki, E., Wijaya, E. et al. A Novel Quantitative Evaluation of Bone Formation After Opening Wedge High Tibial Osteotomy Using Tomosynthesis. J Digit Imaging 35, 1373–1381 (2022). https://doi.org/10.1007/s10278-022-00630-x

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  • DOI: https://doi.org/10.1007/s10278-022-00630-x

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