scholarly journals Proximal Tibiofibular Dislocation in a Closing-Wedge High Tibial Osteotomy Causes Lateral Radiological Gapping of the Knee: A Prospective Randomized Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1622
Author(s):  
Raúl Torres-Claramunt ◽  
Juan Francisco Sánchez-Soler ◽  
Pedro Hinarejos ◽  
Aleix Sala-Pujals ◽  
Joan Leal-Blanquet ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Knee Flexion ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
Proximal Tibiofibular Joint ◽  
Randomized Clinical Study ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Group 2 ◽  
Group 1

Background: To determine whether a proximal tibiofibular joint dislocation (TFJD) increases lateral compartment gapping more than a fibular head osteotomy (FHO) during a closing-wedge high tibial osteotomy (CWHTO). The second objective was to determine whether lateral compartment gapping affects clinical outcomes. Methods: A prospective randomized clinical study was carried out that included 18 patients in Group 1 (FHO) and 18 in Group 2 (TFJD). Varus-stress radiographs of all the patients with both knees at full extension and at 30° of flexion were studied pre-operatively and 12 months post-operatively. Lateral compartment gapping was measured in millimeters. The Knee Society Score (KSS) was used to assess clinical stability. Results: The difference between the pre- and post-operative measurements relative to gapping in the lateral knee compartment at 0° of knee flexion was 1.3 mm (SD 1.8) in Group 1 and 4.5 mm (SD 2.4) in Group 2 (p = 0.006). At 30° of knee flexion, this difference was 1.9 mm (SD 1.2) in Group 1 and 5.2 mm (SD 3.1) in Group 2 (p = 0.01). No differences were observed in the pre- and post-operative period relative to gapping in healthy knees. Pre-operatively, both groups presented similar KSS knee values: Group 1 with 54.7 (SD 11.7), Group 2 with 54.8 (SD 11.1) (n.s.). Post-operatively, these values were also similar: Group 1 with 93.2 (SD 7.4), Group 2 with 93.5 (SD 5.5) (n.s.). Conclusions: In patients who have undergone a CWHTO, TFJ dislocation increases knee lateral compartment gapping when compared to an FHO at 0° and 30° of knee flexion. However, this fact seems to have no repercussion on the functional status of the knees as measured with the KSS at the one-year follow-up.

scholarly journals Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement

2021 ◽  
Vol 10 (13) ◽  
pp. 2743
Author(s):  
Juan Sánchez-Soler ◽  
Alex Coelho ◽  
Raúl Torres-Claramunt ◽  
Berta Gasol ◽  
Albert Fontanellas ◽  
...  
Keyword(s):  
Survival Rate ◽  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA ≤ 180°, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24–180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7° (SD 4.9) in group 1 and 179.5° (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 ± 15.9) and group 2 (84.3 ± 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA ≤ 180° (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study.

scholarly journals Comparative analysis of the results and complications of two methods of the open wedge high tibial osteotomy

2021 ◽  
Vol 59 (5) ◽  
pp. 615-624
Author(s):  
V. E. Bialik ◽  
S. A. Makarov ◽  
L. I. Alekseeva ◽  
E. I. Bialik ◽  
V. A. Nesterenko ◽  
...  
Keyword(s):  
Surgical Technique ◽  
High Tibial Osteotomy ◽  
Excellent Result ◽  
Standard Technique ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Group 2 ◽  
One Year ◽  
Group 1

Objective – to compare the results and complications of open wedge high tibial osteotomy (OWHTO) in patients operated on according to the standard technique and using the developed method of performing the operation using the original fixator.Materials and methods. 73 patients with primary and secondary OA of the knee I–III stages were recruited into the study, which were divided into 2 groups. Group 1 consisted of 43 patients, who underwent 46 OWHTO from 2005 to 2019 using the standard technique using short plates with a fixed spacer (Puddu I (5 times) and II generation (24 times), Osteomed (17 times)) and bone grafting. Group 2 consisted of 30 patients who were operated on in 2018– 2020 using the developed surgical technique and the original fixator. To assess the result, we studied the change in pain according to the Visual Analog Scale (VAS), as well as the functional (FS) and objective scores (OS) of the knee according to the Knee Society Score (KSS) before surgery, after 3 months and 1 year after OWHTO.Results. In group 1, one year after OWHTO, the results were obtained: excellent in 43.5% of cases, good – in 41.0% and satisfactory – in 15.2% of patients. In group 2, an excellent result was obtained in 59.3% of patients, good – in 33.4% and satisfactory – in 7.3% of cases. In group 1, 15 (32.7%) patients were diagnosed with 26 complications, and in group 2 – 5 (16.6%) patients with 5 complications.Conclusions. The use of the developed surgical technique and the original fixator made it possible to increase the percentage of excellent and good treatment results from 84.5% to 92.7% and to reduce the number of complications associated with OWHTO from 32.7% to 16.6%.

Medial Closing-Wedge High Tibial Osteotomy

2020 ◽  
pp. 187-201
Author(s):  
Jean-Marie Fayard ◽  
Nicolas Jan ◽  
Padhraig O’Loughlin ◽  
Benjamin Freychet
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals An Acute Oblique Osteotomy and Suture Ligation Procedure to Shorten the Fibula in Lateral Closing-Wedge High Tibial Osteotomy

2020 ◽  
Vol 9 (9) ◽  
pp. e1299-e1308
Author(s):  
Kazunori Yasuda ◽  
Eiji Kondo ◽  
Daisuke Ueda ◽  
Jun Onodera ◽  
Koji Yabuuchi ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Suture Ligation ◽  
Oblique Osteotomy ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy

Paper # 242: Lateral Closing Wedge High Tibial Osteotomy with Fibular Shaft Osteotomy versus Tibiofibular Division

2011 ◽  
Vol 27 (10) ◽  
pp. e230-e231
Author(s):  
Jak Jang ◽  
Myung Chul Lee ◽  
Sahnghoon Lee ◽  
Joon Kyu Lee ◽  
Sang Min Lee ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Osteotomy ◽  
Closing Wedge ◽  
Wedge High Tibial Osteotomy
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