J Knee Surg 2022; 35(11): 1229-1235
DOI: 10.1055/s-0040-1722659
Original Article

Biplane Medial Opening-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope more than Uniplane Osteotomy

Dong Won Suh
1   Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, Korea
,
Kyung Wook Nha
2   Department of Orthopaedic Surgery, Ilsanpaik Hospital, Inje University, Ilsan, Gyeonggi-do, Korea
,
Seung Beom Han
3   Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
,
Kuhoang Cheong
1   Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, Korea
,
Bong Soo Kyung
1   Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, Korea
› Author Affiliations

Abstract

Few clinical studies have compared uniplane high tibial osteotomy (HTO) with biplane HTO. The study aim was to compare the radiological and clinical results of uniplane HTO and biplane HTO, especially in terms of the increase in the posterior tibial slope (PTS). Medial opening-wedge HTO patients' medical records and radiological results from a single institution were retrospectively reviewed. Pre- and postoperative serial radiographs, including the Rosenberg, lateral view, and standing anteroposterior view of the whole lower extremity, magnetic resonance imaging at postoperative day 2, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score at postoperative 2 years were reviewed to evaluate radiological and clinical results, including the change in PTS. A total of 61 knees, including 34 for uniplane and 27 for biplane HTOs, were enrolled. There were no significant differences in the pre- and postoperative mechanical angles or incidences of the lateral hinge fractures, and all patients showed complete union at postoperative 2 years. The PTS was increased more in the biplane group than in the uniplane group (3.1 ± 2.6 in biplane vs. 0.8 ± 1.7 in uniplane, p < 0.05). The WOMAC scores were 72 ± 9.3 in the uniplane and 75 ± 5.8 in the biplane group (not significant). The increase in PTS was lower in uniplane medial opening HTO than in biplane HTO.



Publication History

Received: 16 March 2020

Accepted: 29 November 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Lobenhoffer P, Agneskirchner J, Zoch W. [Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator] (in German). Orthopade 2004; 33 (02) 153-160
  • 2 Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2003; 11 (03) 132-138
  • 3 Han JH, Yang JH, Bhandare NN. et al. Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2567-2577
  • 4 Kuwashima U, Tashiro Y, Okazaki K. et al. Comparison of the impact of closing wedge versus opening wedge high tibial osteotomy on proximal tibial deformity and subsequent revision to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25 (03) 869-875
  • 5 Sun H, Zhou L, Li F, Duan J. Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis. J Knee Surg 2017; 30 (02) 158-165
  • 6 Pape D, Dueck K, Haag M, Lorbach O, Seil R, Madry H. Wedge volume and osteotomy surface depend on surgical technique for high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 127-133
  • 7 Türkmen F, Kaçıra BK, Özkaya M. et al. Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2914-2920
  • 8 Nha KW, Shin MJ, Suh DW, Nam YJ, Kim KS, Kyung BS. Uniplane medial opening wedge high tibial osteotomy relative to a biplane osteotomy can reduce the incidence of lateral-hinge fracture. Knee Surg Sports Traumatol Arthrosc 2020; 28 (05) 1436-1444
  • 9 Nha KW, Kim HJ, Ahn HS, Lee DH. Change in posterior tibial slope after open-wedge and closed-wedge high tibial osteotomy: a meta-analysis. Am J Sports Med 2016; 44 (11) 3006-3013
  • 10 Amis AA. Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 197-205
  • 11 Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 2004; 32 (02) 376-382
  • 12 Rodner CM, Adams DJ, Diaz-Doran V. et al. Medial opening wedge tibial osteotomy and the sagittal plane: the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med 2006; 34 (09) 1431-1441
  • 13 Lee YS, Park SJ, Shin VI, Lee JH, Kim YH, Song EK. Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng 2010; 38 (03) 583-593
  • 14 Marti CB, Gautier E, Wachtl SW, Jakob RP. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 2004; 20 (04) 366-372
  • 15 Song EK, Seon JK, Park SJ. How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 2007; 30 (Suppl. 10) S127-S131
  • 16 Wang JH, Bae JH, Lim HC, Shon WY, Kim CW, Cho JW. Medial open wedge high tibial osteotomy: the effect of the cortical hinge on posterior tibial slope. Am J Sports Med 2009; 37 (12) 2411-2418
  • 17 Han SB, Lee DH, Shetty GM, Chae DJ, Song JG, Nha KWA. A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture. Knee Surg Sports Traumatol Arthrosc 2013; 21 (01) 90-95
  • 18 Suh DW, Kyung BS, Han SB, Cheong K, Lee WH. Efficacy of tranexamic acid for hemostasis in patients undergoing high tibial osteotomy. J Knee Surg 2018; 31 (01) 50-55
  • 19 Han SB, Bae JH, Lee SJ. et al. Biomechanical properties of a new anatomical locking metal block plate for opening wedge high tibial osteotomy: uniplane osteotomy. Knee Surg Relat Res 2014; 26 (03) 155-161
  • 20 Nha KW, Oh SM, Ha YW. et al. A retrospective comparison of union rates after open wedge high tibial osteotomies with and without synthetic bone grafts (hydroxyapatite and β-tricalciumphosphate) at 2 years. Arthroscopy 2018; 34 (09) 2621-2630
  • 21 Nha KW, Oh SM, Ha YW, Patel MK, Seo JH, Lee BH. Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2019; 27 (06) 2021-2029
  • 22 Takeuchi R, Aratake M, Bito H. et al. Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise. Knee Surg Sports Traumatol Arthrosc 2008; 16 (11) 1030-1037
  • 23 Takeuchi R, Ishikawa H, Aratake M. et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 2009; 25 (01) 46-53
  • 24 Lansdaal JR, Mouton T, Wascher DC. et al. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3670-3678
  • 25 Takeuchi R, Ishikawa H, Kumagai K. et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 2012; 28 (01) 85-94
  • 26 Jo IH, Lee OS, Lee SH, Kim KW, Lee YS. Retro-tubercular gap widening can be caused by inappropriate anterior osteotomy and large opening gap in the medial biplanar open-wedge HTO. Knee Surg Sports Traumatol Arthrosc 2019; 27 (09) 2910-2916
  • 27 Nakamura R, Komatsu N, Fujita K. et al. Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy. Bone Joint J 2017; 99-B (10) 1313-1318
  • 28 Ogawa H, Matsumoto K, Akiyama H. The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: a case control study. Bone Joint J 2017; 99-B (07) 887-893
  • 29 Lee OS, Lee YS. Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy. Arthroscopy 2018; 34 (04) 1032-1043
  • 30 Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR. Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 2014; 42 (05) 1118-1126
  • 31 Nawas HT, Vansadia DV, Heltsley JR, Suri M, Montgomery S, Jones DG. Factors affecting the union of opening wedge high tibial osteotomy using a titanium wedge plate. Ochsner J 2016; 16 (04) 464-470
  • 32 Han SB, In Y, Oh KJ, Song KY, Yun ST, Jang KM. Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study. J Arthroplasty 2019; 34 (03) 439-445
  • 33 Lee SS, Celik H, Lee DH. Predictive factors for and detection of lateral hinge fractures following open wedge high tibial osteotomy: plain radiography versus computed tomography. Arthroscopy 2018; 34 (11) 3073-3079
  • 34 Han SB, Choi JH, Mahajan A, Shin YS. Incidence and predictors of lateral hinge fractures following medial opening-wedge high tibial osteotomy using locking plate system: better performance of computed tomography scans. J Arthroplasty 2019; 34 (05) 846-851