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The short-term follow-up results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft: the minimum 1-year follow-up results.

Lee SC, Jung KA, Nam CH, Jung SH, Hwang SH - Clin Orthop Surg (2010)

Bottom Line: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001).According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76 degrees , and the average correction angle at the last follow-up was 10.93 +/- 2.50 degrees (p < 0.001).The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Mok-dong Himchan Hospital, Seoul, Korea.

ABSTRACT

Background: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity.

Methods: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score.

Results: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76 degrees , and the average correction angle at the last follow-up was 10.93 +/- 2.50 degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80 degrees and 8.04 +/- 1.30 degrees , respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks.

Conclusions: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

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The corticocancellous wedge piece (the medial calcar portion of the allograft hemi-femoral head) was inserted into the area between the plates.
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Figure 4: The corticocancellous wedge piece (the medial calcar portion of the allograft hemi-femoral head) was inserted into the area between the plates.

Mentions: After the arthroscopy, the anteromedial aspect of the tibia was exposed through a 6 cm vertical skin incision, and a sharp dissection was performed to expose the deep fascia over the pes anserineus, which was retracted distally using a periosteal elevator to expose the superficial fibers of the medial ligament (Fig. 1). A blunt Hohmann retractor was then passed deep to the medial collateral ligament around the posteromedial corner of the proximal tibia, and also along the posterior cortex of the tibia to protect the posterior neurovascular structures. For a biplanar medial open wedge osteotomy,10) two Kirschner wires were placed under fluoroscopic guidance to mark the saw cut. The start point on the medial tibia is normally approximately 3-4 cm distal to the medial joint line. The anteroposterior plane of the osteotomy should be in the same plane as the tibial slope. The lateral aiming point was the upper third of the proximal tibiofibular joint. Behind the tibial tuberosity, the osteotomy was performed with using a thin osteotome to protect the patellar tendon in a plane parallel to the anterior cortex of the tuberosity. A tibial osteotomy was performed just distal to the guide pin, initially with an oscillating saw and then with a thin osteotome. The extent of the osteotomy was checked by fluoroscopy to ensure an appropriate depth and direction of the cut (up to 1 cm medial to the lateral cortex). Opening of the osteotomy and adequate correction in the coronal plane were confirmed by placing a rod from the center of the hip joint to the center of the ankle joint (the weight bearing axis) under fluoroscopic guidance. The rod should be located at 62% of the tibial width and just lateral to the lateral tibial spine.4) The tibial slope was controlled using two plates with different sized space blocks (B. Braun, Aesculap) (Fig. 2). First, a properly sized open wedge plate with a space block was inserted posteromedially with gentle valgus force. The tibial slope was identified on the fluoroscopic image after placing the first plate within the posteromedial osteotomy gap. The anterior plate was placed behind the oblique tuberosity osteotomy and the anterior plate was 2 to 4 mm shorter depending on the size of the posterior plate. The fluoroscopic image was then compared with the preoperative radiographic image. Osteosynthesis was performed as follows. Two screws were applied to the first plate that was placed posteromedially. A smaller plate was then inserted within the anteromedial gap and locked with another two screws. A final fluoroscopic assessment was performed to ensure proper alignment of the lower extremities and adequate positioning of the open wedge plate. An allogenic bone graft was then inserted within the osteotomy gap. In each case, a proximal tibial corticocancellous wedge allograft (hemi-femoral head) and cancellous pieces (Fig. 3) were provided by the Musculoskeletal Transplant Foundation (the Korean Bone Bank). The wedge (ordered to match the size of the predetermined osteotomy opening and it was made up of the medial calcar portion of allogenic bone) was then measured and cut to precisely fill the osteotomy defect. Cancellous pieces were then inserted into the posteromedial (the same size of space block as the Aescula plate) and middle areas of the ostotomy tines, and a corticocancellous piece was inserted into the anterior area between the plates (Fig. 4). In addition, a careful radiographic evaluation of the lateral hinge bone was used to detect the presence of any fracture. If there was a fracture, then supplementary lateral fixation with a 6.5 mm cannulated screw or staple was carried out. The wound was closed with leaving a hemovac drain; the wound was dressed with a compression wrap and a long-leg splint was applied.


The short-term follow-up results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft: the minimum 1-year follow-up results.

Lee SC, Jung KA, Nam CH, Jung SH, Hwang SH - Clin Orthop Surg (2010)

The corticocancellous wedge piece (the medial calcar portion of the allograft hemi-femoral head) was inserted into the area between the plates.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2824095&req=5

Figure 4: The corticocancellous wedge piece (the medial calcar portion of the allograft hemi-femoral head) was inserted into the area between the plates.
Mentions: After the arthroscopy, the anteromedial aspect of the tibia was exposed through a 6 cm vertical skin incision, and a sharp dissection was performed to expose the deep fascia over the pes anserineus, which was retracted distally using a periosteal elevator to expose the superficial fibers of the medial ligament (Fig. 1). A blunt Hohmann retractor was then passed deep to the medial collateral ligament around the posteromedial corner of the proximal tibia, and also along the posterior cortex of the tibia to protect the posterior neurovascular structures. For a biplanar medial open wedge osteotomy,10) two Kirschner wires were placed under fluoroscopic guidance to mark the saw cut. The start point on the medial tibia is normally approximately 3-4 cm distal to the medial joint line. The anteroposterior plane of the osteotomy should be in the same plane as the tibial slope. The lateral aiming point was the upper third of the proximal tibiofibular joint. Behind the tibial tuberosity, the osteotomy was performed with using a thin osteotome to protect the patellar tendon in a plane parallel to the anterior cortex of the tuberosity. A tibial osteotomy was performed just distal to the guide pin, initially with an oscillating saw and then with a thin osteotome. The extent of the osteotomy was checked by fluoroscopy to ensure an appropriate depth and direction of the cut (up to 1 cm medial to the lateral cortex). Opening of the osteotomy and adequate correction in the coronal plane were confirmed by placing a rod from the center of the hip joint to the center of the ankle joint (the weight bearing axis) under fluoroscopic guidance. The rod should be located at 62% of the tibial width and just lateral to the lateral tibial spine.4) The tibial slope was controlled using two plates with different sized space blocks (B. Braun, Aesculap) (Fig. 2). First, a properly sized open wedge plate with a space block was inserted posteromedially with gentle valgus force. The tibial slope was identified on the fluoroscopic image after placing the first plate within the posteromedial osteotomy gap. The anterior plate was placed behind the oblique tuberosity osteotomy and the anterior plate was 2 to 4 mm shorter depending on the size of the posterior plate. The fluoroscopic image was then compared with the preoperative radiographic image. Osteosynthesis was performed as follows. Two screws were applied to the first plate that was placed posteromedially. A smaller plate was then inserted within the anteromedial gap and locked with another two screws. A final fluoroscopic assessment was performed to ensure proper alignment of the lower extremities and adequate positioning of the open wedge plate. An allogenic bone graft was then inserted within the osteotomy gap. In each case, a proximal tibial corticocancellous wedge allograft (hemi-femoral head) and cancellous pieces (Fig. 3) were provided by the Musculoskeletal Transplant Foundation (the Korean Bone Bank). The wedge (ordered to match the size of the predetermined osteotomy opening and it was made up of the medial calcar portion of allogenic bone) was then measured and cut to precisely fill the osteotomy defect. Cancellous pieces were then inserted into the posteromedial (the same size of space block as the Aescula plate) and middle areas of the ostotomy tines, and a corticocancellous piece was inserted into the anterior area between the plates (Fig. 4). In addition, a careful radiographic evaluation of the lateral hinge bone was used to detect the presence of any fracture. If there was a fracture, then supplementary lateral fixation with a 6.5 mm cannulated screw or staple was carried out. The wound was closed with leaving a hemovac drain; the wound was dressed with a compression wrap and a long-leg splint was applied.

Bottom Line: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001).According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76 degrees , and the average correction angle at the last follow-up was 10.93 +/- 2.50 degrees (p < 0.001).The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Mok-dong Himchan Hospital, Seoul, Korea.

ABSTRACT

Background: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity.

Methods: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score.

Results: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76 degrees , and the average correction angle at the last follow-up was 10.93 +/- 2.50 degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80 degrees and 8.04 +/- 1.30 degrees , respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks.

Conclusions: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

Show MeSH
Related in: MedlinePlus