Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2013

01-01-2013 | Knee

Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study

Authors: Alan Getgood, Brett Collins, Konrad Slynarski, Emilia Kurowska, David Parker, Lars Engebretsen, Peter B. MacDonald, Robert Litchfield

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2013

Login to get access

Abstract

Purpose

To evaluate the safety and efficacy of the novel iBalance Medial Opening Wedge High Tibial Osteotomy (HTO) system in executing lower limb realignment in patients with symptomatic varus gonarthrosis.

Methods

A multicentre case series of iBalance medial opening wedge HTO was compared to an historic case-matched control series of HTO’s performed using another implant. Subjects were prospectively observed at 3, 6 and 12 months after surgery. Primary endpoints included the reporting of adverse events, weight-bearing status without pain and radiographic evidence of bony union. Secondary endpoints included maintenance of osteotomy correction angle, patient reported outcome (KOOS and SF-36) and gait analysis.

Results

Thirty-two consecutive patients were included in the iBalance group (mean age 49.7, 30–67; M:F, 20:12), paired with 32 control subjects (49.8, 35–66; 21:11). Three patients (9.4%) in the iBalance group experienced a complication requiring intervention versus one patient (3.1%) in the control group. No statistically significant differences were seen between groups in terms of time to weight bearing, radiographic union, implant stability or patient reported outcome. Gait analysis revealed a statistically significant reduction in knee external adduction moment (P < 0.001).

Conclusions

The iBalance medial opening wedge HTO system has been shown to be a safe, novel implant for use in proximal tibial osteotomy. This study shows that the iBalance medial opening wedge HTO system has an equivalent short-term safety and efficacy profile to the 2nd generation Puddu system.
Literature
1.
go back to reference Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160PubMedCrossRef Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160PubMedCrossRef
2.
go back to reference Amendola A, Fowler PJ, Litchfield R, Kirkley S, Clatworthy M (2004) Opening wedge high tibial osteotomy using a novel technique: early results and complications. J Knee Surg 17:164–169PubMed Amendola A, Fowler PJ, Litchfield R, Kirkley S, Clatworthy M (2004) Opening wedge high tibial osteotomy using a novel technique: early results and complications. J Knee Surg 17:164–169PubMed
3.
go back to reference Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF (2006) High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 14:948–954PubMedCrossRef Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF (2006) High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc 14:948–954PubMedCrossRef
4.
go back to reference Barber FA, Hapa O, Bynum JA (2010) Comparative testing by cyclic loading of rotator cuff suture anchors containing multiple high-strength sutures. Arthroscopy 26:S134–S141PubMedCrossRef Barber FA, Hapa O, Bynum JA (2010) Comparative testing by cyclic loading of rotator cuff suture anchors containing multiple high-strength sutures. Arthroscopy 26:S134–S141PubMedCrossRef
5.
go back to reference Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, Jenkyn TR, Fowler PJ (2009) Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient-reported outcomes. Arthritis Rheum 61:648–657PubMedCrossRef Birmingham TB, Giffin JR, Chesworth BM, Bryant DM, Litchfield RB, Willits K, Jenkyn TR, Fowler PJ (2009) Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient-reported outcomes. Arthritis Rheum 61:648–657PubMedCrossRef
6.
go back to reference Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ (2010) Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 81:193–198PubMedCrossRef Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ (2010) Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 81:193–198PubMedCrossRef
7.
go back to reference Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A 1-year randomised, controlled study. J Bone Jt Surg Br 88:1454–1459CrossRef Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A 1-year randomised, controlled study. J Bone Jt Surg Br 88:1454–1459CrossRef
8.
go back to reference Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, Chiou TL, Chang YL, Su CF, Lin SZ, Chen SY (2008) Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 15:1240–1245PubMedCrossRef Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, Chiou TL, Chang YL, Su CF, Lin SZ, Chen SY (2008) Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 15:1240–1245PubMedCrossRef
9.
go back to reference Coventry MB (1979) Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin N Am 10:191–210 Coventry MB (1979) Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin N Am 10:191–210
10.
go back to reference Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264PubMed Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264PubMed
11.
go back to reference Hunt MA, Fowler PJ, Birmingham TB, Jenkyn TR, Giffin JR (2006) Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 49:401–406PubMed Hunt MA, Fowler PJ, Birmingham TB, Jenkyn TR, Giffin JR (2006) Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 49:401–406PubMed
12.
go back to reference Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8:383–392PubMedCrossRef Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8:383–392PubMedCrossRef
13.
go back to reference Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33:153–160PubMedCrossRef Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33:153–160PubMedCrossRef
14.
go back to reference Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ (2009) Fixation stability of opening-versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Jt Surg Br 91:1459–1465 Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ (2009) Fixation stability of opening-versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Jt Surg Br 91:1459–1465
15.
go back to reference 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 24:796–804PubMedCrossRef 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 24:796–804PubMedCrossRef
16.
go back to reference Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26:1607–1616PubMedCrossRef Niemeyer P, Schmal H, Hauschild O, von Heyden J, Sudkamp NP, Kostler W (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26:1607–1616PubMedCrossRef
17.
go back to reference Noyes FR, Barber SD, Simon R (1993) High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A 2–7-year follow-up study. Am J Sports Med 21:2–12PubMedCrossRef Noyes FR, Barber SD, Simon R (1993) High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A 2–7-year follow-up study. Am J Sports Med 21:2–12PubMedCrossRef
18.
go back to reference Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211PubMedCrossRef Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211PubMedCrossRef
19.
go back to reference Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653PubMedCrossRef Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124:649–653PubMedCrossRef
20.
go back to reference Specogna AV, Birmingham TB, Da Silva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2004) Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg 17:203–210PubMed Specogna AV, Birmingham TB, Da Silva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2004) Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg 17:203–210PubMed
21.
go back to reference Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia: early results in 92 cases. Injury 34(Suppl 2):B55–B62PubMedCrossRef Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia: early results in 92 cases. Injury 34(Suppl 2):B55–B62PubMedCrossRef
22.
go back to reference Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified arthrex osteotomy plate (Puddu plate) and the TomoFix plate. Clin Biomech (Bristol, Avon) 19:944–950CrossRef Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified arthrex osteotomy plate (Puddu plate) and the TomoFix plate. Clin Biomech (Bristol, Avon) 19:944–950CrossRef
23.
go back to reference Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after Tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22:218–225PubMedCrossRef Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after Tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22:218–225PubMedCrossRef
24.
go back to reference Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13:279–289PubMed Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13:279–289PubMed
Metadata
Title
Short-term safety and efficacy of a novel high tibial osteotomy system: a case controlled study
Authors
Alan Getgood
Brett Collins
Konrad Slynarski
Emilia Kurowska
David Parker
Lars Engebretsen
Peter B. MacDonald
Robert Litchfield
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1709-4

Other articles of this Issue 1/2013

Knee Surgery, Sports Traumatology, Arthroscopy 1/2013 Go to the issue