Effect of knee suspension on posterior tibial slope after medial opening-wedge high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jun , LIANG Shuai , YAO Yunfeng , Lü Hao ,  JING Juehua

Department of Orthopedics, the Second Hospital of Anhui Medical University, Hefei Anhui, 230601, P. R. China;

Corresponding?author：

JING Juehua, Email: 278353834@qq.com

Keywords：

Knee osteoarthritis; high tibial osteotomy; posterior tibial slope; suspended knee joint

DOI：

10.7507/1002-1892.202202056

Video：

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Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). Conclusion OWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.

Citation： LI Jun, LIANG Shuai, YAO Yunfeng, Lü Hao, JING Juehua. Effect of knee suspension on posterior tibial slope after medial opening-wedge high tibial osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 703-707. doi: 10.7507/1002-1892.202202056 Copy

1.	王飛, 陳百成, 高石軍, 等. 內側撐開和外側閉合脛骨高位截骨術治療膝內翻骨關節炎. 中華骨科雜志, 2010, 30(6): 558-562.
2.	中華醫學會骨科分會關節外科學組, 吳階平醫學基金會骨科學專家委員會. 膝骨關節炎階梯治療專家共識 (2018年版). 中華關節外科雜志 (電子版), 2019, 13(1): 124-130.
3.	Papachristou G. Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg, 2004, 124(5): 288-297.
4.	Lau LCM, Chui ECS, Fan JCH, et al. Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial). BMJ Open, 2021, 11(2): e041129. doi: 10.1136/bmjopen-2020-041129.
5.	張藝, 亓建洪. 脛骨平臺后傾角與半月板損傷的相關性研究進展. 中國矯形外科雜志, 2020, 28(8): 721-724.
6.	白皓宇, 王逍遙, 宋曉暉, 等. 脛骨平臺后傾角在前交叉韌帶損傷中的研究進展. 現代醫學, 2018, 46(5): 598-601.
7.	Wang JH, Bae JH, Lim HC, et al. 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.
8.	Ma W, Han Z, Sun S, et al. Use of a suspended and straightened knee joint position when fixing steel plates can prevent the increase in postoperative posterior tibial slope after open-wedge high tibial osteotomy. J Orthop Surg Res, 2021, 16(1): 684. doi: 10.1186/s13018-021-02834-3.
9.	Lee YS, Park SJ, Shin VI, et al. Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng, 2010, 38(3): 583-593.
10.	Noyes FR, Mayfield W, Barber-Westin SD, et al. Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med, 2006, 34(8): 1262-1273.
11.	Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med, 2005, 33(3): 378-387.
12.	Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3): 282-296.
13.	趙允, 胡文晉, 黃競敏, 等. 內側撐開高位脛骨截骨術聯合調整脛骨平臺后傾角治療屈曲受限型膝內翻骨關節炎的早期療效. 中國修復重建外科雜志, 2018, 32(2): 157-161.
14.	Lobenhoffer P, Agneskirchner J, Zoch W. Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade, 2004, 33(2): 153-160.
15.	Jiang J, Liu Z, Wang X, et al. Increased posterior tibial slope and meniscal slope could be risk factors for meniscal injuries: A systematic review. Arthroscopy, 2022. doi: 10.1016/j.arthro.2022.01.013.
16.	D?hlin L, Inderhaug E, Strand T, et al. The effect of posterior tibial slope on the risk of revision surgery after anterior cruciate ligament reconstruction. Am J Sports Med, 2022, 50(1): 103-110.
17.	Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res, 2011, 29(2): 223-231.
18.	El-Azab H, Halawa A, Anetzberger H, et al. 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), 2008, 90(9): 1193-1197.
19.	Marti CB, Gautier E, Wachtl SW, et al. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy, 2004, 20(4): 366-372.
20.	Kim GB, Kim KI, Song SJ, et al. Increased posterior tibial slope after medial open-wedge high tibial osteotomy may result in degenerative changes in anterior cruciate ligament. J Arthroplasty, 2019, 34(9): 1922-1928.
21.	LaPrade RF, Oro FB, Ziegler CG, et al. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med, 2010, 38(1): 160-170.

1. 王飛, 陳百成, 高石軍, 等. 內側撐開和外側閉合脛骨高位截骨術治療膝內翻骨關節炎. 中華骨科雜志, 2010, 30(6): 558-562.
2. 中華醫學會骨科分會關節外科學組, 吳階平醫學基金會骨科學專家委員會. 膝骨關節炎階梯治療專家共識 (2018年版). 中華關節外科雜志 (電子版), 2019, 13(1): 124-130.
3. Papachristou G. Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg, 2004, 124(5): 288-297.
4. Lau LCM, Chui ECS, Fan JCH, et al. Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial). BMJ Open, 2021, 11(2): e041129. doi: 10.1136/bmjopen-2020-041129.
5. 張藝, 亓建洪. 脛骨平臺后傾角與半月板損傷的相關性研究進展. 中國矯形外科雜志, 2020, 28(8): 721-724.
6. 白皓宇, 王逍遙, 宋曉暉, 等. 脛骨平臺后傾角在前交叉韌帶損傷中的研究進展. 現代醫學, 2018, 46(5): 598-601.
7. Wang JH, Bae JH, Lim HC, et al. 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.
8. Ma W, Han Z, Sun S, et al. Use of a suspended and straightened knee joint position when fixing steel plates can prevent the increase in postoperative posterior tibial slope after open-wedge high tibial osteotomy. J Orthop Surg Res, 2021, 16(1): 684. doi: 10.1186/s13018-021-02834-3.
9. Lee YS, Park SJ, Shin VI, et al. Achievement of targeted posterior slope in the medial opening wedge high tibial osteotomy: a mathematical approach. Ann Biomed Eng, 2010, 38(3): 583-593.
10. Noyes FR, Mayfield W, Barber-Westin SD, et al. Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med, 2006, 34(8): 1262-1273.
11. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med, 2005, 33(3): 378-387.
12. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3): 282-296.
13. 趙允, 胡文晉, 黃競敏, 等. 內側撐開高位脛骨截骨術聯合調整脛骨平臺后傾角治療屈曲受限型膝內翻骨關節炎的早期療效. 中國修復重建外科雜志, 2018, 32(2): 157-161.
14. Lobenhoffer P, Agneskirchner J, Zoch W. Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade, 2004, 33(2): 153-160.
15. Jiang J, Liu Z, Wang X, et al. Increased posterior tibial slope and meniscal slope could be risk factors for meniscal injuries: A systematic review. Arthroscopy, 2022. doi: 10.1016/j.arthro.2022.01.013.
16. D?hlin L, Inderhaug E, Strand T, et al. The effect of posterior tibial slope on the risk of revision surgery after anterior cruciate ligament reconstruction. Am J Sports Med, 2022, 50(1): 103-110.
17. Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res, 2011, 29(2): 223-231.
18. El-Azab H, Halawa A, Anetzberger H, et al. 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), 2008, 90(9): 1193-1197.
19. Marti CB, Gautier E, Wachtl SW, et al. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy, 2004, 20(4): 366-372.
20. Kim GB, Kim KI, Song SJ, et al. Increased posterior tibial slope after medial open-wedge high tibial osteotomy may result in degenerative changes in anterior cruciate ligament. J Arthroplasty, 2019, 34(9): 1922-1928.
21. LaPrade RF, Oro FB, Ziegler CG, et al. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med, 2010, 38(1): 160-170.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of knee suspension on posterior tibial slope after medial opening-wedge high tibial osteotomy

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