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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2017

13.03.2015 | knee

Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis

verfasst von: Omer Ozel, Bulent Yucel, Serhat Mutlu, Osman Orman, Harun Mutlu

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 1/2017

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Abstract

Purpose

In this study, postoperative changes in the posterior tibial slope angle and clinical outcomes following open-wedge high tibial osteotomy were evaluated.

Methods

This study included 39 knees (18 left, 21 right) of 35 patients (three male, 32 female; median age, 53 years; age range 37–64 years) with symptomatic isolated medial joint osteoarthritis who underwent open-wedge high tibial osteotomy and fixation with a Puddu plate. The patients were clinically assessed according to the Lysholm knee score, a visual analogue pain scale, and a patient satisfaction questionnaire. Radiological assessment was made according to the changes in the posterior tibial slope angle and the correlation between these changes and clinical signs. The median follow-up period was 11 years (range 7–14 years).

Results

Significant improvements were observed in the preoperative and postoperative clinical scores of the Lysholm knee scale, visual analogue pain scale, and patient satisfaction questionnaire (p < 0.05). Radiological assessment showed that the posterior tibial slope angle was significantly higher during the postoperative and follow-up periods (p  0.05). There was no correlation between the postoperative Lysholm scores and the increase in the posterior tibial slope angle (p = n.s.).

Conclusions

We conclude that both the conventional Puddu plate design and its anteromedial plate placement are what increase the tibial slope after an opening-wedge proximal tibial osteotomy. Therefore, current new plate design may help preserve the posterior tibial slope angle.

Level of evidence

IV.
Literatur
1.
Zurück zum Zitat Baumgarten KM, Fealy S, Lyman S, Wickiewicz TL (2007) The coronal plane high tibial osteotomy. Part 1: a clinical and radiographic analysis of intermediate term outcomes. HSS J 3:147–154CrossRefPubMedPubMedCentral Baumgarten KM, Fealy S, Lyman S, Wickiewicz TL (2007) The coronal plane high tibial osteotomy. Part 1: a clinical and radiographic analysis of intermediate term outcomes. HSS J 3:147–154CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133CrossRefPubMed Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133CrossRefPubMed
3.
Zurück zum Zitat Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB (2013) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21(1):152–160CrossRefPubMed Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB (2013) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21(1):152–160CrossRefPubMed
4.
Zurück zum Zitat Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg [Am] 75:196–201CrossRef Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg [Am] 75:196–201CrossRef
5.
Zurück zum Zitat Cullu E, Aydoğdu S, Alparslan B, Sur H (2005) Tibial slope changes following dome-type high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:38–43CrossRefPubMed Cullu E, Aydoğdu S, Alparslan B, Sur H (2005) Tibial slope changes following dome-type high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:38–43CrossRefPubMed
6.
Zurück zum Zitat Elmalı N, Esenkaya I, Can M, Karakaplan M (2013) Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes. Knee Surg Sports Traumatol Arthrosc 21(12):2689–2695CrossRefPubMed Elmalı N, Esenkaya I, Can M, Karakaplan M (2013) Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes. Knee Surg Sports Traumatol Arthrosc 21(12):2689–2695CrossRefPubMed
7.
Zurück zum Zitat El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg [Br] 90:1193–1197CrossRef El-Azab H, Halawa A, Anetzberger H, Imhoff AB, Hinterwimmer S (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg [Br] 90:1193–1197CrossRef
8.
Zurück zum Zitat Ganji R, Omidvar M, Izadfar A, Alavinia SM (2013) Opening wedge high tibial osteotomy using tibial wedge allograft: a case series study. Eur J Orthop Surg Traumatol 23(1):111–114CrossRefPubMed Ganji R, Omidvar M, Izadfar A, Alavinia SM (2013) Opening wedge high tibial osteotomy using tibial wedge allograft: a case series study. Eur J Orthop Surg Traumatol 23(1):111–114CrossRefPubMed
9.
Zurück zum Zitat Getgood A, Collins B, Slynarski K, Kurowska E, Parker D, Engebretsen L, MacDonald PB, Litchfield R (2011) Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study. Knee Surg Sports Traumatol Arthrosc 21(1):260–269CrossRefPubMed Getgood A, Collins B, Slynarski K, Kurowska E, Parker D, Engebretsen L, MacDonald PB, Litchfield R (2011) Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study. Knee Surg Sports Traumatol Arthrosc 21(1):260–269CrossRefPubMed
10.
Zurück zum Zitat Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382CrossRefPubMed Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382CrossRefPubMed
11.
Zurück zum Zitat Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg [Am] 86:506–511CrossRef Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg [Am] 86:506–511CrossRef
12.
Zurück zum Zitat Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg [Am] 69:332–354CrossRef Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg [Am] 69:332–354CrossRef
13.
Zurück zum Zitat Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg [Am] 66:1040–1048CrossRef Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg [Am] 66:1040–1048CrossRef
14.
Zurück zum Zitat Jung KA, Kim SJ, Lee SC, Song MB, Yoon KH (2008) ‘Fine-tuned’ correction of tibial slope with a temporary external fixator in opening wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:305–310CrossRefPubMed Jung KA, Kim SJ, Lee SC, Song MB, Yoon KH (2008) ‘Fine-tuned’ correction of tibial slope with a temporary external fixator in opening wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:305–310CrossRefPubMed
15.
Zurück zum Zitat Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplasty 16:168–173CrossRefPubMed Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplasty 16:168–173CrossRefPubMed
16.
Zurück zum Zitat Keppler P, Gebhard F, Grützner PA, Wang G, Zheng G, Hüfner T, Hankemeier S, Nolte LP (2004) Computer aided high tibial open wedge osteotomy. Injury 35(Suppl 1):S-A68–S-A78CrossRef Keppler P, Gebhard F, Grützner PA, Wang G, Zheng G, Hüfner T, Hankemeier S, Nolte LP (2004) Computer aided high tibial open wedge osteotomy. Injury 35(Suppl 1):S-A68–S-A78CrossRef
17.
Zurück zum Zitat Kim JH, Kim JR, Lee DH, Bang JY, Hong IT (2013) Combined medial open-wedge high tibial osteotomy and modified Maquet procedure for medial compartmental osteoarthritis and patellofemoral arthritis of the knee. Eur J Orthop Surg Traumatol 23(6):679–683CrossRefPubMed Kim JH, Kim JR, Lee DH, Bang JY, Hong IT (2013) Combined medial open-wedge high tibial osteotomy and modified Maquet procedure for medial compartmental osteoarthritis and patellofemoral arthritis of the knee. Eur J Orthop Surg Traumatol 23(6):679–683CrossRefPubMed
18.
Zurück zum Zitat Kimura Y, Ishibashi Y, Tsuda E, Fukuda A, Tsukada H (2009) Sagittal realignment osteotomy for increased posterior tibial slope after opening-wedge high tibial osteotomy: a case report. Sports Med Arthrosc Rehabil Ther Technol 1:26PubMedPubMedCentral Kimura Y, Ishibashi Y, Tsuda E, Fukuda A, Tsukada H (2009) Sagittal realignment osteotomy for increased posterior tibial slope after opening-wedge high tibial osteotomy: a case report. Sports Med Arthrosc Rehabil Ther Technol 1:26PubMedPubMedCentral
19.
Zurück zum Zitat LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170CrossRefPubMed LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170CrossRefPubMed
20.
Zurück zum Zitat Lee DH, Nha KW, Park SJ, Han SB (2012) Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy. Arthroscopy 28(12):1842–1850CrossRefPubMed Lee DH, Nha KW, Park SJ, Han SB (2012) Preoperative and postoperative comparisons of navigation and radiologic limb alignment measurements after high tibial osteotomy. Arthroscopy 28(12):1842–1850CrossRefPubMed
21.
Zurück zum Zitat Liu W, Maitland ME (2003) Influence of anthropometric and mechanical variations on functional instability in the ACL deficient knee. Ann Biomed Eng 31:1153–1161CrossRefPubMed Liu W, Maitland ME (2003) Influence of anthropometric and mechanical variations on functional instability in the ACL deficient knee. Ann Biomed Eng 31:1153–1161CrossRefPubMed
22.
Zurück zum Zitat Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA (2013) Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):32–38CrossRefPubMed Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA (2013) Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):32–38CrossRefPubMed
23.
Zurück zum Zitat Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20(4):366–372CrossRefPubMed Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20(4):366–372CrossRefPubMed
24.
Zurück zum Zitat Matar WY, Boscariol R, Dervin GF (2009) Open wedge high tibial osteotomy: a roentgenographic comparison of a horizontal and an oblique osteotomy on patellar height and sagittal tibial slope. Am J Sports Med 37:735–742CrossRefPubMed Matar WY, Boscariol R, Dervin GF (2009) Open wedge high tibial osteotomy: a roentgenographic comparison of a horizontal and an oblique osteotomy on patellar height and sagittal tibial slope. Am J Sports Med 37:735–742CrossRefPubMed
25.
Zurück zum Zitat McNamara I, Birmingham TB, Fowler PJ, Giffin JR (2013) High tibial osteotomy: evolution of research and clinical applications–a Canadian experience. Knee Surg Sports Traumatol Arthrosc 21(1):23–31CrossRefPubMed McNamara I, Birmingham TB, Fowler PJ, Giffin JR (2013) High tibial osteotomy: evolution of research and clinical applications–a Canadian experience. Knee Surg Sports Traumatol Arthrosc 21(1):23–31CrossRefPubMed
26.
Zurück zum Zitat Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg [Am] 78:1353–1358CrossRef Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg [Am] 78:1353–1358CrossRef
27.
Zurück zum Zitat Niemeyer P, Koestler W, Kaehny C, Kreuz PC, Brooks CJ, Strohm PC, Helwig P, Suedkamp NP (2008) Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 24(7):796–804CrossRefPubMed Niemeyer P, Koestler W, Kaehny C, Kreuz PC, Brooks CJ, Strohm PC, Helwig P, Suedkamp NP (2008) Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 24(7):796–804CrossRefPubMed
28.
Zurück zum Zitat Ozalay M, Ozkoc G, Circi E, Akpinar S, Hersekli MA, Uysal M, Cesur N (2008) The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:948–951CrossRefPubMed Ozalay M, Ozkoc G, Circi E, Akpinar S, Hersekli MA, Uysal M, Cesur N (2008) The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 16:948–951CrossRefPubMed
29.
Zurück zum Zitat Ozkaya U, Kabukçuoğlu Y, Parmaksizoğlu AS, Yeniocak S, Ozkazanli G (2008) Changes in patellar height and tibia inclination angle following open-wedge high tibial osteotomy. [Article in Turkish]. Acta Orthop Traumatol Turc 42:265–271CrossRefPubMed Ozkaya U, Kabukçuoğlu Y, Parmaksizoğlu AS, Yeniocak S, Ozkazanli G (2008) Changes in patellar height and tibia inclination angle following open-wedge high tibial osteotomy. [Article in Turkish]. Acta Orthop Traumatol Turc 42:265–271CrossRefPubMed
30.
Zurück zum Zitat Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study. Clin Orthop Relat Res 353:185–193CrossRef Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study. Clin Orthop Relat Res 353:185–193CrossRef
31.
Zurück zum Zitat Rodner CM, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (2006) Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 34:1431–1441CrossRefPubMed Rodner CM, Adams DJ, Diaz-Doran V, Tate JP, Santangelo SA, Mazzocca AD, Arciero RA (2006) Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 34:1431–1441CrossRefPubMed
32.
Zurück zum Zitat Rubino LJ, Schoderbek RJ, Golish SR, Baumfeld J, Miller MD (2008) The effect of plate position and size on tibial slope in high tibial osteotomy: a cadaveric study. J Knee Surg 21:75–79CrossRefPubMed Rubino LJ, Schoderbek RJ, Golish SR, Baumfeld J, Miller MD (2008) The effect of plate position and size on tibial slope in high tibial osteotomy: a cadaveric study. J Knee Surg 21:75–79CrossRefPubMed
33.
Zurück zum Zitat Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg [Am] 71:245–248CrossRef Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg [Am] 71:245–248CrossRef
34.
Zurück zum Zitat Sen C, Kocaoglu M, Bilen E, Dikici F, Hepgur G (2001) Comparison of two different techniques for high tibial osteotomy: internal fixation vs circular external fixator. [Article in Turkish]. Acta Orthop Traumatol Turc 35:382–389 Sen C, Kocaoglu M, Bilen E, Dikici F, Hepgur G (2001) Comparison of two different techniques for high tibial osteotomy: internal fixation vs circular external fixator. [Article in Turkish]. Acta Orthop Traumatol Turc 35:382–389
35.
Zurück zum Zitat Song EK, Seon JK, Park SJ, Seo HY (2008) Navigated open wedge high tibial osteotomy. Sports Med Arthrosc 16:84–90CrossRefPubMed Song EK, Seon JK, Park SJ, Seo HY (2008) Navigated open wedge high tibial osteotomy. Sports Med Arthrosc 16:84–90CrossRefPubMed
36.
Zurück zum Zitat Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg [Am] 85:469–474CrossRef Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg [Am] 85:469–474CrossRef
37.
Zurück zum Zitat Sterett WI, Miller BS, Joseph TA, Rich VJ, Bain EM (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22:13–16CrossRefPubMed Sterett WI, Miller BS, Joseph TA, Rich VJ, Bain EM (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22:13–16CrossRefPubMed
38.
Zurück zum Zitat Wang JH, Bae JH, Lim HC, Shon WY, Kim CW, Cho JW (2009) Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med 37:2411–2418CrossRefPubMed Wang JH, Bae JH, Lim HC, Shon WY, Kim CW, Cho JW (2009) Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med 37:2411–2418CrossRefPubMed
39.
Zurück zum Zitat Windsor RE, Insall JN, Vince KG (1988) Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg [Am] 70:547–555CrossRef Windsor RE, Insall JN, Vince KG (1988) Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg [Am] 70:547–555CrossRef
40.
Zurück zum Zitat Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195 Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195
Metadaten
Titel
Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis
verfasst von
Omer Ozel
Bulent Yucel
Serhat Mutlu
Osman Orman
Harun Mutlu
Publikationsdatum
13.03.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 1/2017
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3571-2

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