Application of improved precision alignment method of lower limbs mechanical alignment on open wedge high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 QING Zhong ¹ , YE Jiumin ² , MA Jianbing ¹ , LI Hui ¹ , WANG Zhiyuan ¹

1. Knee Ward of Joint Surgery Department, Honghui Hospital, Xi’an Jiao Tong University, Xi’an Shaanxi, 710054, P.R.China;
2. No.1 Department of Anesthesia, Honghui Hospital, Xi’an Jiao Tong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

QING Zhong, Email: 363317794@qq.com

Keywords：

Knee joint; osteoarthritis; open wedge high tibial osteotomy; lower limb mechanical alignment

DOI：

10.7507/1002-1892.201701037

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ObjectiveTo evaluate the effects of the improved precision alignment method of lower limbs mecha-nical alignment for osteoarthritis of the knee in open wedge high tibial osteotomy (OWHTO).MethodsA retrospective analysis was made on the clinical data of 62 patients (68 knees) with knee osteoarthritis in the medial compartment treated with OWHTO between January 2012 and December 2015 who accorded with the inclusion criteria. The traditional method for positioning lower limb mechanical force line was used in 29 cases (32 knees) (traditional group), and improved method for positioning lower limb mechanical force line in 33 cases (36 knees) (modified group). There was no significant difference in gender, age, side, course of disease, and osteoarthritis grading between two groups (P>0.05) with comparable. The operation time, intraoperative fluoroscopy times, and intraoperative blood loss were recorded in two groups; Before and after operation, the lower limb mechanical force line was observed on the X-ray films, which was expressed by hip-knee-ankle angle (HKA). The clinical efficacy was evaluated by the American Hospital for Special Surgery (HSS) score, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC).ResultsIncision hematoma occurred in 1 case of traditional group and was cured at 3 weeks after symptomatic treatment; and primary healing was obtained in the other patients, with no early complications. The operation time and intraoperative fluoroscopy times of the modified group were significantly lower than those of the traditional group (t=11.934, P=0.000; t=11.663, P=0.000), but there was no significant difference in blood loss between the two groups (t=0.209, P=0.835). The patients were followed up for 6 to 24 months (mean, 12.7 months) in the traditional group and for 3 to 22 months (mean, 13.2 months) in the modified group. The medial knee pain disappeared in all patients. At last follow-up, the HSS score and WOMAC score were significantly improved when compared with preoperative scores in two groups (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray examination showed that the tibiofemoral angle was corrected in the two groups. The HKA angle at immediate after operation and last follow-up was significantly higher than angle at pre-operation in two groups (P<0.05), but there was no significant difference between at immediate after operation and at last follow-up (P>0.05).ConclusionCompared with the traditional method for positioning lower limb mechanical force line, the improved precision alignment method can reduce the times of intraoperative fluoroscopy and shorten the operation time, which reduces the radiation exposure of both doctors and patients.

Citation： QING Zhong, YE Jiumin, MA Jianbing, LI Hui, WANG Zhiyuan. Application of improved precision alignment method of lower limbs mechanical alignment on open wedge high tibial osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 659-664. doi: 10.7507/1002-1892.201701037 Copy

1.	Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg (Am), 1973, 55(1): 23-48.
2.	Naudie D, Bourne RB, Rorabeck CH, et al. The Insall Award. Survivorship of the high tibial valgus osteotomy. A 10-to-22 year followup study. Clin Orthop Relat Res, 1999, (367): 18-27.
3.	Aglietti P, Rinonapoli E, Stringa G, et al. Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res, 1983, (176): 239-251.
4.	Ivarsson I, Myrnerts R, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11year follow up. J Bone J Surg (Br), 1990, 72(2): 238-244.
5.	Herbigou P, Medevielle D, Debeyre J, et al. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg (Am), 1987, 69(3): 332-354.
6.	Trieb K, Grohs J, Hanslik-Schnabel B, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2006, 14(2): 149-152.
7.	Bonasia DE, Dettoni F, Sito G, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med, 2014, 42(3): 690-698.
8.	Akizuki S, Shibakawa A, Takizawa T, et al. The long-term outcome of high tibial osteotomy: a ten-to 20-year follow up. J Bone Joint Surg (Br), 2008, 90(5): 592-596.
9.	Masrouha KZ, Sraj S, Lakkis S, et al. High tibial osteotomy in young adults with constitutional tibia vara. Knee Surg Sports Traumatol Arthrose, 2011, 19(1): 89-93.
10.	Warden SJ, Morris HG, Crossley KM, et al. Delayed-and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases. Knee Surg Sports Traumatol Arthrosc, 2005, 13(1): 34-37.
11.	Paccola CA, Fogagnolo E. Open-wedge high tibial osteotomy: a technical trick to avoid loss of reduction of the opposite cortex. Knee Surg Sports Traumatol Arthrosc, 2005, 13(1): 19-22.
12.	Lobenhoffer P, Agneskirchner JD. Improvement in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2003, 11(3): 132-138.
13.	Hankemeier S, Mommsen P, Krettek C, et al. Accuracy of high tibial osteotomy: comparison between open-and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(10): 1328-1333.
14.	Giffin JR, Shannon FJ. The role of the high tibial osteotomy in the unstable knee. Sports Med Arthrosc, 2007, 15(1): 23-31.
15.	Lee SC, Jung KA, Nam CH, et al. 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. Clin Orthop Surg, 2010, 2(1): 47-54.
16.	Dugdale TW, Noyes FR, Styer D. Preoperative planning for tibial osteotomy: The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res, 1992, (274): 248-264.
17.	黄野. 胫骨高位截骨术治疗膝关节骨关节炎的现状. 中华关节外科杂志(电子版), 2016, 10(5): 1-4.
18.	胡月正, 温宏, 潘孝云, 等. 术中下肢机械力线精确定位在胫骨高位截骨中的应用. 中国骨伤, 2012, 25(9): 751-754.

1. Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg (Am), 1973, 55(1): 23-48.
2. Naudie D, Bourne RB, Rorabeck CH, et al. The Insall Award. Survivorship of the high tibial valgus osteotomy. A 10-to-22 year followup study. Clin Orthop Relat Res, 1999, (367): 18-27.
3. Aglietti P, Rinonapoli E, Stringa G, et al. Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res, 1983, (176): 239-251.
4. Ivarsson I, Myrnerts R, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11year follow up. J Bone J Surg (Br), 1990, 72(2): 238-244.
5. Herbigou P, Medevielle D, Debeyre J, et al. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg (Am), 1987, 69(3): 332-354.
6. Trieb K, Grohs J, Hanslik-Schnabel B, et al. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2006, 14(2): 149-152.
7. Bonasia DE, Dettoni F, Sito G, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med, 2014, 42(3): 690-698.
8. Akizuki S, Shibakawa A, Takizawa T, et al. The long-term outcome of high tibial osteotomy: a ten-to 20-year follow up. J Bone Joint Surg (Br), 2008, 90(5): 592-596.
9. Masrouha KZ, Sraj S, Lakkis S, et al. High tibial osteotomy in young adults with constitutional tibia vara. Knee Surg Sports Traumatol Arthrose, 2011, 19(1): 89-93.
10. Warden SJ, Morris HG, Crossley KM, et al. Delayed-and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases. Knee Surg Sports Traumatol Arthrosc, 2005, 13(1): 34-37.
11. Paccola CA, Fogagnolo E. Open-wedge high tibial osteotomy: a technical trick to avoid loss of reduction of the opposite cortex. Knee Surg Sports Traumatol Arthrosc, 2005, 13(1): 19-22.
12. Lobenhoffer P, Agneskirchner JD. Improvement in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2003, 11(3): 132-138.
13. Hankemeier S, Mommsen P, Krettek C, et al. Accuracy of high tibial osteotomy: comparison between open-and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(10): 1328-1333.
14. Giffin JR, Shannon FJ. The role of the high tibial osteotomy in the unstable knee. Sports Med Arthrosc, 2007, 15(1): 23-31.
15. Lee SC, Jung KA, Nam CH, et al. 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. Clin Orthop Surg, 2010, 2(1): 47-54.
16. Dugdale TW, Noyes FR, Styer D. Preoperative planning for tibial osteotomy: The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res, 1992, (274): 248-264.
17. 黄野. 胫骨高位截骨术治疗膝关节骨关节炎的现状. 中华关节外科杂志(电子版), 2016, 10(5): 1-4.
18. 胡月正, 温宏, 潘孝云, 等. 术中下肢机械力线精确定位在胫骨高位截骨中的应用. 中国骨伤, 2012, 25(9): 751-754.

Chinese Journal of Reparative and Reconstructive Surgery

Application of improved precision alignment method of lower limbs mechanical alignment on open wedge high tibial osteotomy

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