Dataset Information

Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy.

ABSTRACT: Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure. The correction amount is verified with spacers and intraoperative imaging, while correction of the patient's heel height is simultaneously measured. A plate is secured into the osteotomy site, and the site is filled with bone allograft. The anterolateral tibial osteotomy has been reported to be an effective surgical procedure for correcting concomitant genu recurvatum and genu valgus malalignment.

SUBMITTER: Dean CS

PROVIDER: S-EPMC5021538 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy.

Dean Chase S CS Chahla Jorge J Moulton Samuel G SG Nitri Marco M Serra Cruz Raphael R LaPrade Robert F RF

Arthroscopy techniques 20160523 3

Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure. The correction amount is verified with spacers and intrao ...[more]

PMID: 27656374

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Project description:BackgroundNot all surgical osteotomy steps have been properly investigated for their potential impact on surgical accuracy. The main study objective was to investigate the osteotomy parameters that have respectively major and minor impact on coronal and sagittal bony accuracy in medial opening-wedge high tibial osteotomy (MOWHTO).MethodsThree tibias from an existing 3D MOWHTO osteotomy database were chronologically selected based on segmentation quality, tibial plateau size and the presence of tibial varus. The study consisted of three parts: (I) translating the hinge axis in the coronal plane and switching the osteotomy starting point (30-40 mm) and depth, (II) the hinge axis was rotated stepwise by 10° to perform five simulations, (III) the hinge axis was rotated in the axial plane stepwise by 10° towards anterolateral to perform four simulations (0°, +10°, +20°, +30°). The medial proximal tibial angle (MPTA) and lateral tibial slope were the primary outcomes. Simulations were performed with 5, 10 and 15 mm gap distraction.ResultsIn the coronal plane, maximum difference in osteotomy depth was 10 mm which represented an MPTA difference of 0.8°-1.1° in 10 mm gap distraction and 1.2°-2.0° in 15 mm gap distraction. Tibial slope remained unchanged. Rotating the hinge axis in the sagittal plane delivered minor changes on both MPTA (<0.5°) and tibial slope (<1.5°) at 10 mm gap distraction. Per 10° of axial rotation of the hinge axis towards anterolateral, the tibial slope increased by 1.0°-1.3° in 10 mm gap distraction while the MPTA remains nearly unchanged.ConclusionsThe study showed that the medio-lateral osteotomy length is the main parameter for obtaining bony accuracy in the coronal plane and maintaining a strict perpendicular axial hinge axis position is crucial in preserving the native tibial slope. Correct axial alignment of the hinge axis can be obtained by creating an equal osteotomy depth of the anterior and posterior tibial cortices in the lateral metaphyseal area.

Project description:PurposeTo evaluate the short-term clinical outcomes, complications, hospitalization time, and readmission rate related to day-case opening wedge high tibial osteotomy (OWHTO) with intraosseous PEEK (polyether ether ketone) implant, in the treatment of knee osteoarthritis.MethodsAn observational study on patients treated with OWHTO using intraosseous PEEK implant was performed with a period of 12 months follow-up. Grade of Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed preoperatively, at 6 months, and at 12 months postoperatively. A simple t test was used to analyze the outcomes. P values <.05 were considered significant. Complications and revision surgeries were registered.ResultsIn the period from 2016 to 2017, a consecutive group of 40 patients (13 female, 27 male) with symptomatic medial knee osteoarthritis and varus malalignment were included in the study. The average age of the patients was 54.9 (± 7.6) years. In total, 30 (77%) patients met the criterion for minimal clinically important difference in KOOS scores. The KOOS symptoms improved from 58.1 ± 20 to 78.5 ± 16.5 (P < .0001), pain from 48.1 ± 18.2 to 78.6 ± 18.5 (P < .0001), activities of daily living from 59.0 ± 19.5 to 84.1 ± 15.2 (P < .0001), sport from 23.2 ± 17.6 to 55.6 ± 26.3 (P < .0001), and quality of life from 28.4 ± 12.8 to 61.5 ± 22.5 (P < .0001) at 1-year follow-up. The average hospitalization time at the Day Surgery Unit was 5.6 ± 0.7 hours, and 4 (10%) patients had to be readmitted to the hospital within 2 weeks postoperatively. The overall complication rate was 18%. Complications that required revision surgery were registered in 4 patients (10%), including 2 non-unions and 2 progressions of osteoarthritis.ConclusionsThe day-case OWHTO with intraosseous PEEK implant was a success in 77% of the cases. The results and complications were comparable with other published studies. Despite a short hospitalization time, the readmission rate was low.Level of evidenceIV, therapeutic case series.

Dataset Information

Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy.

Publications

Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy.

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