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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2015

01-12-2015 | Knee

Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy

Authors: Matthias Cotic, Stephan Vogt, Matthias J. Feucht, Tim Saier, Philipp Minzlaff, Stefan Hinterwimmer, Andreas B. Imhoff

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2015

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Abstract

Purpose

The purpose of this study was to prospectively evaluate the clinical, radiographic, and sports-related outcome at 24 months after valgus-producing medial open-wedge high tibial osteotomy (owHTO) using a 2nd generation peek-carbon composite plate.

Methods

Between 2010 and 2011, the 2nd generation PEEKPower HTO-Plate® was used for medial owHTO in 28 consecutive patients (19 men, 9 women; mean age ± SD: 45 ± 11 years; mean varus deviation ± SD: 4° ± 2°). All of the patients had an osteotomy gap height of ≤12 mm without bone grafting. Visual analog scale (VAS) for pain, WOMAC score, and Lysholm score were evaluated preoperatively and at 12 and 24 months postoperatively. Sports-related outcomes included the Tegner scale, and a self-designed questionnaire preoperatively and 24 months postoperatively. Fixation stability of the implant was evaluated radiographically in two planes by comparing the medial proximal tibial angle (MPTA) and tibial slope 2 days after medial owHTO (baseline measurements) and after implant removal (follow-up measurements). Complications were recorded during the whole study period.

Results

Compared to preoperative conditions, VAS, WOMAC, and Lysholm scores improved significantly (p < 0.05) at the 12- and 24-month follow-up. No significant differences were found between the 12- and 24-month follow-up. After 24 months, the sports frequency increased significantly (p < 0.05). No significant differences between baseline and follow-up measurements for the MPTA and tibial slope were observed. Total complication rate was 4 %, with one patient developing non-union.

Conclusion

In the clinical practice, the 2nd generation PEEKPower HTO-Plate® is a safe and efficient implant for medial owHTO without bone grafting in patients with an osteotomy gap of ≤12 mm.

Level of evidence

III.
Literature
1.
Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 16(1):21–26PubMed
2.
Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14(3):291–300CrossRefPubMed
3.
Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM (2008) Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty 23(2):159–163CrossRefPubMed
4.
5.
Aryee S, Imhoff AB, Rose T, Tischer T (2008) Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 29(26):3497–3502CrossRefPubMed
6.
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(10):948–954CrossRefPubMed
7.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed
8.
Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Sudkamp N, Niemeyer P (2013) Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-013-2762-y
9.
Bonnin MP, Laurent JR, Zadegan F, Badet R, Archbold HP, Servien E (2013) Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 21(1):64–73CrossRefPubMed
10.
Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A (1996) Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 82(3):195–200PubMed
11.
Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90(12):1548–1557CrossRefPubMed
12.
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(2):193–198PubMedCentralCrossRefPubMed
13.
Brosset T, Pasquier G, Migaud H, Gougeon F (2011) Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 97(7):705–711CrossRefPubMed
14.
15.
Cotic M, Vogt S, Hinterwimmer S, Feucht MJ, Slotta-Huspenina J, Schuster T, Imhoff AB (2014) A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-014-2914-8
16.
DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38(10):2077–2084CrossRefPubMed
17.
El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38(2):323–329CrossRefPubMed
18.
El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34(10):e622–e628PubMed
19.
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180CrossRefPubMed
20.
Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WC, Wymenga AB (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11(6):457–461CrossRefPubMed
21.
Getgood A, Collins B, Slynarski K, Kurowska E, Parker D, Engebretsen L, MacDonald PB, Litchfield R (2013) 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
22.
Gougoulias N, Khanna A, Maffulli N (2009) Sports activities after lower limb osteotomy. Br Med Bull 91:111–121CrossRefPubMed
23.
Gould DD, Kelly DD, Goldstone LL, Gammon JJ (2001) Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. J Clin Nurs 10(5):697–706CrossRefPubMed
24.
Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9(1):15–20CrossRefPubMed
25.
26.
Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff AB (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39(4):851–856CrossRefPubMed
27.
28.
29.
Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39(1):64–70CrossRefPubMed
30.
Jacobi M, Wahl P, Jakob RP (2010) Avoiding intraoperative complications in open-wedge high tibial valgus osteotomy: technical advancement. Knee Surg Sports Traumatol Arthrosc 18(2):200–203CrossRefPubMed
31.
32.
Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH (2013) Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 29(6):1063–1071CrossRefPubMed
33.
Kaper BP, Bourne RB, Rorabeck CH, Macdonald SJ (2001) Patellar infera after high tibial osteotomy. J Arthroplasty 16(2):168–173CrossRefPubMed
34.
Kendoff D, Citak M, Pearle A, Gardner MJ, Hankemeier S, Krettek C, Hufner T (2007) Influence of lower limb rotation in navigated alignment analysis: implications for high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 15(8):1003–1008. doi:10.​1007/​s00167-007-0308-x CrossRefPubMed
35.
Kim SJ, Koh YG, Chun YM, Kim YC, Park YS, Sung CH (2009) Medial opening wedge high-tibial osteotomy using a kinematic navigation system versus a conventional method: a 1-year retrospective, comparative study. Knee Surg Sports Traumatol Arthrosc 17(2):128–134CrossRefPubMed
36.
Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grutzner P (2009) Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 91(11):2581–2588CrossRefPubMed
37.
38.
Lewold S, Robertsson O, Knutson K, Lidgren L (1998) Revision of unicompartmental knee arthroplasty: outcome in 1,135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand 69(5):469–474CrossRefPubMed
39.
Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138PubMed
40.
Lobenhoffer PP, Agneskirchner JJ, Zoch WW (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33(2):153–160CrossRefPubMed
41.
Longino PD, Birmingham TB, Schultz WJ, Moyer RF, Giffin JR (2013) Combined tibial tubercle osteotomy with medial opening wedge high tibial osteotomy minimizes changes in patellar height: a prospective cohort study with historical controls. Am J Sports Med 41(12):2849–2857CrossRefPubMed
42.
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 Joint Surg Br 91(11):1459–1465CrossRefPubMed
43.
Maffulli N, Loppini M, Longo UG, Denaro V, Oliva F (2013) Bovine xenograft locking Puddu plate versus tricalcium phosphate spacer non-locking Puddu plate in opening-wedge high tibial osteotomy: a prospective double-cohort study. Int Orthop 37(5):819–826PubMedCentralCrossRefPubMed
44.
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(4):735–742CrossRefPubMed
45.
Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19(3):333–339CrossRefPubMed
46.
Mont MA, Stuchin SA, Paley D, Sharkey PF, Parvisi J, Tria AJ Jr, Bonutti PM, Etienne G (2004) Different surgical options for monocompartmental osteoarthritis of the knee: high tibial osteotomy versus unicompartmental knee arthroplasty versus total knee arthroplasty: indications, techniques, results, and controversies. Instr Course Lect 53:265–283PubMed
47.
Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res 367:18–27CrossRefPubMed
48.
Nelissen EM, van Langelaan EJ, Nelissen RG (2010) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 34(2):217–223PubMedCentralCrossRefPubMed
49.
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
50.
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(12):1607–1616CrossRefPubMed
51.
Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33(3):378–387CrossRefPubMed
52.
Orsel S, Altun M, Bekmezci T, Tonbul M, Yalaman O (2006) Early results of medial opening wedge osteotomy in varus gonarthrosis. Acta Orthop Traumatol Turc 40(3):193–198PubMed
53.
Pape D, Kohn D, van Giffen N, Hoffmann A, Seil R, Lorbach O (2013) Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21(1):82–89CrossRefPubMed
54.
Parker DA, Viskontas DG (2007) Osteotomy for the early varus arthritic knee. Sports Med Arthrosc 15(1):3–14CrossRefPubMed
55.
56.
Pornrattanamaneewong C, Narkbunnam R, Chareancholvanich K (2012) Medial proximal tibial angle after medial opening wedge HTO: a retrospective diagnostic test study. Indian J Orthop 46(5):525–530PubMedCentralCrossRefPubMed
57.
Rivard CH, Rhalmi S, Coillard C (2002) In vivo biocompatibility testing of peek polymer for a spinal implant system: a study in rabbits. J Biomed Mater Res 62(4):488–498CrossRefPubMed
58.
Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19(10):590–599PubMed
59.
Salzmann GM, Ahrens P, Naal FD, El-Azab H, Spang JT, Imhoff AB, Lorenz S (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37(2):312–318CrossRefPubMed
60.
Schroter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D (2011) High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy 27(5):644–652CrossRefPubMed
61.
Schroter S, Ihle C, Mueller J, Lobenhoffer P, Stockle U, van Heerwaarden R (2013) Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc 21(1):189–196CrossRefPubMed
62.
Scotchford CA, Garle MJ, Batchelor J, Bradley J, Grant DM (2003) Use of a novel carbon fibre composite material for the femoral stem component of a THR system: in vitro biological assessment. Biomaterials 24(26):4871–4879CrossRefPubMed
63.
Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653CrossRefPubMed
64.
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(3):469–474PubMed
65.
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–B62CrossRefPubMed
66.
Staubli AE, Jacob HA (2010) Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop 34(2):167–172PubMedCentralCrossRefPubMed
67.
Steinberg EL, Rath E, Shlaifer A, Chechik O, Maman E, Salai M (2013) Carbon fiber reinforced PEEK Optima–a composite material biomechanical properties and wear/debris characteristics of CF-PEEK composites for orthopedic trauma implants. J Mech Behav Biomed Mater 17:221–228CrossRefPubMed
68.
Stoffel KK, Stachowiak GG, Kuster MM (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 19(9):944–950CrossRef
69.
Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53CrossRefPubMed
70.
Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94CrossRefPubMed
71.
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed
72.
Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH (2009) Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 22(3):218–225CrossRefPubMed
73.
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(12):2411–2418CrossRefPubMed
74.
75.
Westrich GH, Peters LE, Haas SB, Buly RL, Windsor RE (1998) Patella height after high tibial osteotomy with internal fixation and early motion. Clin Orthop Relat Res 354:169–174CrossRefPubMed
Metadata
Title
Prospective evaluation of a new plate fixator for valgus-producing medial open-wedge high tibial osteotomy
Authors
Matthias Cotic
Stephan Vogt
Matthias J. Feucht
Tim Saier
Philipp Minzlaff
Stefan Hinterwimmer
Andreas B. Imhoff
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3287-8

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