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Angle Stable Plate Fixation vs Hemicallotasis in Medial Opening Wedge High Tibial Osteotomy: A Comparative Study

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Abstract

Background

Varus alignment associated with medial compartment degeneration is the most common presentation of knee osteoarthritis and often presents in young active adults where arthroplasty might be unsuitable.

Purpose

To compare the accuracy of the angle stable medial high tibia plate and self-adjusting HTO (high tibial osteotomy) fixator in achieving correction of varus deformity of the knee by medial opening wedge HTO and to evaluate functionality between the groups.

Study Design

Prospective randomized control study.

Methods

Forty patients each underwent medial opening wedge high tibial osteotomy with acute correction and stabilization using the angle stable plate (ASP group) or with the hemicallotasis technique using the self-adjusting HTO external fixator (HCO group). Anatomical and functional outcomes were compared to the pre-operative values at the 6th and 12th month.

Results

The FTA (femoro-tibial axis), mechanical axis, and functional scores improved significantly in both groups. There was also a significant change in the patellar height and tibial slope. Except for a better KOOS (Knee Injury and Osteoarthritis Outcome Score) in the angle stable plate group at the 6-month follow-up, there were no significant differences between the groups.

Conclusion

Both methods of performing a medially based proximal tibial osteotomy gave equivalent outcomes at the 1-year follow-up.

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Data Availability

Relevant data of the present study is available from the authors at a reasonable request.

References

  1. Floerkemeier, S., Staubli, A. E., Schroeter, S., Goldhahn, S., & Lobenhoffer, P. (2013). Outcome after high tibial open-wedge osteotomy: A retrospective evaluation of 533 patients. Knee Surgery, Sports Traumatology, Arthroscopy, 21(1), 170–180.

    Article  PubMed  Google Scholar 

  2. Healy, W. L., Sharma, S., Schwartz, B., & Iorio, R. (2008). Athletic activity after total joint arthroplasty. The Journal of Bone and Joint Surgery-American Volume, 90(10), 2245–2252.

    Article  PubMed  Google Scholar 

  3. Laprade, R. F., Spiridonov, S. I., Nystrom, L. M., & Jansson, K. S. (2012). Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 28(3), 354–364. https://doi.org/10.1016/j.arthro.2011.08.310

    Article  Google Scholar 

  4. W-Dahl, A., Robertsson, O., & Lidgren, L. (2010). Surgery for knee osteoarthritis in younger patients: A Swedish register study. Acta Orthopaedica, 81(2), 161–164.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mizuta, H., Nakamura, E., Kudo, S., Maeda, T., & Takagi, K. (2004). Greater frequency of distraction accelerates bone formation in open-wedge proximal tibial osteotomy with hemicallotasis. Acta Orthopaedica Scandinavica, 75(5), 588–593.

    Article  PubMed  Google Scholar 

  6. Carlos Rodriguez-Merchan, E. (2016). Current concepts review unicompartmental knee osteoarthritis (UKOA): Unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO)? The Archives of Bone and Joint Surgery, 4, 307–313.

    PubMed  Google Scholar 

  7. Cao, Z. W., Mai, X. J., Wang, J., Feng, E. H., & Huang, Y. M. (2018). Uni-compartmental knee arthroplasty versus high tibial osteotomy for knee osteoarthritis: A systematic review and meta-analysis. The Journal Arthroplasty, 33(3), 952–959.

    Article  Google Scholar 

  8. Santoso, M. B., & Wu, L. (2017). Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. Journal of Orthopaedic Surgery and Research, 12(1), 1–10.

    Article  Google Scholar 

  9. Coventry, M. B. (1965). Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. The Journal of Bone & Joint Surgery, 47(4), 984–990.

    Article  CAS  Google Scholar 

  10. Prodromos, C. C., Amendola, A., & Jakob, R. P. (2015). High tibial osteotomy: Indications, techniques, and postoperative management. Instructional Course Lectures, 2015(64), 555–565.

    Google Scholar 

  11. Yadav, A. K., Parihar, M., Pawar, E. D., Ahuja, D., Gavhale, S., & Khanna, V. (2020). Functional outcome of high tibial osteotomy in patients with medial compartment osteoarthritis using dynamic axial fixator—A prospective study. Journal of Clinical Orthopaedics and Trauma, 11, S902–S908.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Osman, W. S., Yousef, M. G., El-Gebeily, M. A., & Metwaly, R. G. (2015). Tibial slope and patellar height changes following high tibial osteotomy (a comparative study). European Orthopaedics and Traumatology, 6(3), 247–254.

    Article  Google Scholar 

  13. Kamboj, P., Kumar, V., Khiyani, R., Mohan, L., Singh, R., & Sheoran, A. (2020). Comparative study of medial opening wedge high tibial osteotomy using fixator-cum-distractor device or locking plate in medial unicompartmental osteoarthritis of knee. Journal of Clinical Orthopaedics and Trauma, 11(xxxx), S137–S141.

    Article  PubMed  Google Scholar 

  14. Johnson, V. L., & Hunter, D. J. (2014). The epidemiology of osteoarthritis. Best Practice & Research Clinical Rheumatology, 28(1), 5–15.

    Article  Google Scholar 

  15. Fujisawa, Y., Masuhara, K., & Shiomi, S. (1979). The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthopedic Clinics of North America, 10(3), 585–608.

    Article  CAS  PubMed  Google Scholar 

  16. Marti, C. B., Gautier, E., Wachtl, S. W., & Jakob, R. P. (2004). Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 20(4), 366–372.

    Article  Google Scholar 

  17. Dodd, L., Wood, R., Templeton-Ward, O., Perry, A., & Chissel, H. (2014). High tibial osteotomy using the “Tomofix™” plating system: Short term outcomes in young adults. International Journal of Orthopedics and Rehabilitation, 1, 39–43.

    Article  Google Scholar 

  18. Jung, W.-H., Chun, C.-W., Lee, J.-H., Ha, J.-H., Kim, J.-H., & Jeong, J.-H. (2013). Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 29(6), 1063–1071.

    Article  Google Scholar 

  19. Odenbring, S., Egund, N., Hagstedt, B., Larsson, J., Lindstrand, A., & Toksvig-Larsen, S. (1991). Ten-year results of tibial osteotomy for medial gonarthrosis—The influence of overcorrection. Archives of Orthopaedic and Trauma Surgery, 110(2), 103–108.

    Article  CAS  PubMed  Google Scholar 

  20. Khurana, D., Sankhala, S. S., Malik, M., Shekhawat, V., & Rathore, D. S. (2015). Comparative study of high tibial osteotomy using dynamic axial fixator and locked low-profile plate in medial osteoarthritis of knee. European Journal of Orthopaedic Surgery & Traumatology, 25(4), 763–773.

    Article  Google Scholar 

  21. Brouwer, R. W., Bierma-Zeinstra, S. M. A., van Koeveringe, A. J., & Verhaar, J. A. N. (2005). Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. The Journal of Bone and Joint Surgery. British Volume, 87(9), 1227–1232.

    Article  CAS  PubMed  Google Scholar 

  22. El Amrani, M. H., Lévy, B., Scharycki, S., & Asselineau, A. (2010). Patellar height relevance in opening-wedge high tibial osteotomy. Orthopaedics & Traumatology, Surgery & Research, 96(1), 37–43.

    Article  Google Scholar 

  23. Pipino, G., Indelli, P. F., Tigani, D., Maffei, G., & Vaccarisi, D. (2016). Opening-wedge high tibial osteotomy: A seven—To twelve-year study. Joints, 4(1), 6–11.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ohsawa, S., Hukuda, K., Inamori, Y., & Yasui, N. (2006). High tibial osteotomy for osteoarthritis of the knee with varus deformity utilizing the hemicallotasis method. Archives of Orthopaedic and Trauma Surgery, 126(9), 588–593.

    Article  PubMed  Google Scholar 

  25. Schiedel, F., Probst, A., Buller, T. C., & Rödl, R. (2009). The postoperative patella height: A comparison of additive and subtractive high tibial osteotomy in correcting the genu varum. Archives of Orthopaedic and Trauma Surgery, 129(9), 1271–1277.

    Article  PubMed  Google Scholar 

  26. Kitson, J., Weale, A. E., Lee, A. S., & MacEachern, A. G. (2001). Patellar tendon length following opening wedge high tibial osteotomy using an external fixator with particular reference to later total knee replacement. Injury, 32(SUPPL. 4), 140–143.

    Article  Google Scholar 

  27. Elgeidi, A., El-Hawary, A., & Youssef, F. (2017). Medial opening wedge high tibial osteotomy: A technique to avoid patella infera. Journal of Clinical Orthopaedics and Trauma, 9, 303–312.

    Google Scholar 

  28. Ducat, A., Sariali, E., Lebel, B., Mertl, P., Hernigou, P., Flecher, X., et al. (2012). Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: A comparative prospective multicenter study. Orthopaedics & Traumatology, Surgery & Research, 98(1), 68–74.

    Article  CAS  Google Scholar 

  29. Nakamura, E., Mizuta, H., Kudo, S., Takagi, K., & Sakamoto, K. (2001). Open-wedge osteotomy of the proximal tibia with hemicallotasis. The Journal of Bone and Joint Surgery. British Volume, 83(8), 1111–1115.

    Article  CAS  PubMed  Google Scholar 

  30. Gerdhem, P., Abdon, P., & Odenbring, S. (2002). Hemicallotasis for medial gonarthrosis: A short-term follow-up of 21 patients. Archives of Orthopaedic and Trauma Surgery, 122(3), 134–138.

    Article  PubMed  Google Scholar 

  31. Siboni, R., Beaufils, P., Boisrenoult, P., Steltzlen, C., & Pujol, N. (2018). Opening-wedge high tibial osteotomy without bone grafting in severe varus osteoarthritic knee. Rate and risk factors of non-union in 41 cases. Orthopaedics & Traumatology: Surgery & Research, 104(4), 473–476. https://doi.org/10.1016/j.otsr.2018.01.014

    Article  CAS  Google Scholar 

  32. Magyar, G., Toksvig-Larsen, S., & Lindstrand, A. (1999). Hemicallotasis open-wedge osteotomy for osteoarthritis of the knee. The Journal of Bone and Joint Surgery. British Volume, 81(3), 449–451.

    Article  CAS  PubMed  Google Scholar 

  33. Anagnostakos, K., Mosser, P., & Kohn, D. (2013). Infections after high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy, 21(1), 161–169.

    Article  PubMed  Google Scholar 

  34. Duivenvoorden, T., van Diggele, P., Reijman, M., Bos, P. K., van Egmond, J., Bierma-Zeinstra, S. M. A., et al. (2017). Adverse events and survival after closing- and opening-wedge high tibial osteotomy: A comparative study of 412 patients. Knee Surgery, Sports Traumatology, Arthroscopy, 25(3), 895–901.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Command Hospital, Kolkata, West Bengal, India

    Chander Mohan Singh

  2. Department of Orthopaedics, 166 Military Hospital, Jammu, Jammu and Kashmir, India

    Kamparsh Thakur

  3. Department of Orthopaedics, Military Hospital Roorkee, Roorkee, Uttarakhand, India

    Gopinath Venunathan

  4. Department of Orthopaedics, Indian Field Hospital Level II plus, Juba, UNMISS, Juba, South Sudan

    Manish Prasad

  5. Military Hospital Pathankot, Punjab, India

    Hrishikesh Pande

  6. Department of Community Medicine, AFMC Pune, Maharashtra, India

    Saurabh Mahajan

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  1. Chander Mohan Singh
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Correspondence to Kamparsh Thakur.

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Singh, C.M., Thakur, K., Venunathan, G. et al. Angle Stable Plate Fixation vs Hemicallotasis in Medial Opening Wedge High Tibial Osteotomy: A Comparative Study. JOIO 57, 1793–1799 (2023). https://doi.org/10.1007/s43465-023-00969-5

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