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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2023

Open Access 22-08-2022 | KNEE

Preoperative joint line convergence angle correction is a key factor in optimising accuracy in varus knee correction osteotomy

Authors: P. Behrendt, R. Akoto, I. Bartels, G. Thürig, H. Fahlbusch, A. Korthaus, D. Dalos, M. Hoffmann, K.-H. Frosch, M. Krause

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2023

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Abstract

Purpose

This study aimed to identify and prevent preoperative factors that can be influenced in preoperative planning to reduce postoperative malcorrections.

Methods

The method used in this study was a retrospective two-centre analysis of 78 pre and postoperative fully weight-bearing radiographs of patients who underwent valgus osteotomy correction due to symptomatic medial compartment osteoarthritis. A computer software (TraumaCad®) was used to aim for an intersection point of the mechanical tibiofemoral axis (mTFA) with the tibia plateau at 55–60% (medial = 0%, lateral = 100%). Postoperative divergence ± 5% of this point was defined as over- and undercorrection. Preoperative joint geometry factors were correlated with postoperative malcorrection. Planning was conducted using the established method described by Miniaci (Group A) and with additional correction of the joint line convergence angle (JLCA) using the formula JLCA-2/2 (Group B). Additionally, in a small clinical case series, planning was conducted with JLCA correction. Statistical analysis was performed using (multiple) linear regression analysis and analysis of variance (ANOVA) with p < 0.05 considered significant.

Results

In 78 analysed cases, postoperative malcorrection was detected in 37.2% (5.1% undercorrection, 32.1% overcorrection). Linear regression analysis revealed preoperative body mass index (BMI, p = 0.04), JLCA (p = 0.0001), and osteotomy level divergence (p = 0.0005) as factors correlated with overcorrection. In a multiple regression analysis, JLCA and osteotomy level divergence remained significant factors. Preoperative JLCA correction reduced the planned osteotomy gap (A 9.7 ± 2.8 mm vs B 8.3 ± 2.4 mm; p > 0.05) and postoperative medial proximal tibial angle (MPTA: A 94.3 ± 2.1° vs B 92.3 ± 1.5°; p < .05) in patients with preoperative JLCA ≥ 4°. The results were validated using a virtual postoperative correction of cases with overcorrection. A case series (n = 8) with a preoperative JLCA > 4 revealed a postoperative accuracy using the JLCA correction of 3.4 ± 1.9%.

Conclusion

Preoperative JLCA ≥ 4° and tibial osteotomy level divergence were identified as risk factors for postoperative overcorrection. Preoperative JLCA correction using the formula JLCA-2/2 is proposed to better control ideal postoperative correction and reduce MPTA. The intraoperatively realised osteotomy level should be precisely in accordance with preoperative planning.

Level of evidence

III, cross-sectional study.
Literature
1.
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 14:291–300CrossRefPubMed
2.
Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861CrossRefPubMed
3.
4.
Bode G, Schmal H, Pestka JM, Ogon P, Südkamp NP, Niemeyer P (2013) A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5. Arch Orthop Trauma Surg 133:43–49CrossRefPubMed
5.
Chung JH, Choi CH, Kim SH, Kim SJ, Lee SK, Jung M (2021) Effect of the osteotomy inclination angle in the sagittal plane on the posterior tibial slope of the tibiofemoral joint in medial open-wedge high tibial osteotomy: three-dimensional computed tomography analysis. J Clin Med 10(18):4272CrossRefPubMedPubMedCentral
6.
Donnez M, Ollivier M, Munier M, Berton P, Podgorski JP, Chabrand P et al (2018) Are three-dimensional patient-specific cutting guides for open wedge high tibial osteotomy accurate? An in vitro study. J Orthop Surg Res 13:171CrossRefPubMedPubMedCentral
7.
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 274:248–264CrossRef
8.
Faber S, Zellner J, Angele P, Spahn G, Löer I, Zinser W et al (2020) Decision making for concomitant high tibial osteotomy (HTO) in cartilage repair patients based on a nationwide cohort study of 4968 patients. Arch Orthop Trauma Surg 140:1437–1444CrossRefPubMedPubMedCentral
9.
Feucht MJ, Mehl J, Forkel P, Imhoff AB, Hinterwimmer S (2017) Distal femoral osteotomy using a lateral opening wedge technique. Oper Orthop Traumatol 29:320–329CrossRefPubMed
10.
Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Fujita K, Yamamuro Y (2019) Comparison of clinical and radiologic outcomes between normal and overcorrected medial proximal tibial angle groups after open-wedge high tibial osteotomy. Arthroscopy 35:2898-2908.e2891CrossRefPubMed
11.
Hankemeier S, Gosling T, Richter M, Hufner T, Hochhausen C, Krettek C (2006) Computer-assisted analysis of lower limb geometry: higher intraobserver reliability compared to conventional method. Comput Aided Surg 11:81–86CrossRefPubMed
12.
13.
Hohloch L, Kim S, Mehl J, Zwingmann J, Feucht MJ, Eberbach H et al (2018) Customized post-operative alignment improves clinical outcome following medial open-wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 26:2766–2773CrossRefPubMed
14.
Holschen M, Lobenhoffer P (2016) Complications of corrective osteotomies around the knee. Orthopade 45:13–23CrossRefPubMed
15.
Imhoff FB, Fucentese SF, Harrer J, Tischer T (2021) The influence of axial deformities and their correction on the development and progression of osteoarthritis. Orthopade 50:378–386CrossRefPubMedPubMedCentral
16.
Ji W, Luo C, Zhan Y, Xie X, He Q, Zhang B (2019) A residual intra-articular varus after medial opening wedge high tibial osteotomy (HTO) for varus osteoarthritis of the knee. Arch Orthop Trauma Surg 139:743–750CrossRefPubMed
17.
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 29:1063–1071CrossRefPubMed
18.
19.
Kazimoğlu C, Akdoğan Y, Sener M, Kurtulmuş A, Karapinar H, Uzun B (2008) Which is the best fixation method for lateral cortex disruption in the medial open wedge high tibial osteotomy? A biomechanical study. Knee 15:305–308CrossRefPubMed
20.
Kim MS, Son JM, Koh IJ, Bahk JH, In Y (2017) Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 137:1035–1045CrossRefPubMed
21.
Krause M, Drenck TC, Korthaus A, Preiss A, Frosch KH, Akoto R (2018) Patella height is not altered by descending medial open-wedge high tibial osteotomy (HTO) compared to ascending HTO. Knee Surg Sports Traumatol Arthrosc 26:1859–1866CrossRefPubMed
22.
Lee SS, Celik H, Lee DH (2018) Predictive factors for and detection of lateral hinge fractures following open wedge high tibial osteotomy: plain radiography versus computed tomography. Arthroscopy 34:3073–3079CrossRefPubMed
23.
24.
Lobenhoffer P, Agneskirchner J, Zoch W (2004) Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator. Orthopade 33:153–160CrossRefPubMed
25.
Micicoi G, Khakha R, Kley K, Wilson A, Cerciello S, Ollivier M (2020) Managing intra-articular deformity in high Tibial osteotomy: a narrative review. J Exp Orthop 7:65CrossRefPubMedPubMedCentral
26.
Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25:639–646CrossRefPubMed
27.
Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy A new fixation device. Clin Orthop 246:250–259CrossRef
28.
Moon SW, Park SH, Lee BH, Oh M, Chang M, Ahn JH et al (2015) The Effect of hinge position on posterior tibial slope in medial open-wedge high tibial osteotomy. Arthroscopy 31:1128–1133CrossRefPubMed
29.
Moon SW, Ryu JY, Lee SJ, Woo SW, Park SH, Choi Y (2021) The effect of the sagittal plane osteotomy inclination on the posterior tibial slope in medial open wedge HTO: experimental study with a square column model. BMC Musculoskelet Disord 22:89CrossRefPubMedPubMedCentral
30.
Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson JN et al (2017) Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 103:245–250CrossRefPubMed
31.
Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K et al (2018) Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc 26:1873–1878CrossRefPubMed
32.
Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136:1337–1342CrossRefPubMed
33.
Park JG, Kim JM, Lee BS, Lee SM, Kwon OJ, Bin SI (2020) Increased preoperative medial and lateral laxity is a predictor of overcorrection in open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28:3164–3172CrossRefPubMed
34.
35.
Ryu DJ, Lee SS, Jung EY, Kim JH, Shin TS, Wang JH (2021) Reliability of preoperative planning method that considers latent medial joint laxity in medial open-wedge proximal tibial osteotomy. Orthop J Sports Med 9:23259671211034150CrossRefPubMedPubMedCentral
36.
Schelker BL, Moret CS, Dogan O, Amsler F, Rasch H, Hügli RW et al (2022) Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome. Knee Surg Sports Traumatol Arthrosc 30:397–406CrossRefPubMed
37.
Schröter S, Günzel J, Freude T, Ateschrang A, Stöckle U, Albrecht D (2012) Precision in the planning of open wedge HTO. Z Orthop Unfall 150:368–373PubMed
38.
Schröter S, Ihle C, Elson DW, Döbele S, Stöckle U, Ateschrang A (2016) Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. Knee Surg Sports Traumatol Arthrosc 24:3410–3417CrossRefPubMed
39.
Schröter S, Ihle C, Mueller J, Lobenhoffer P, Stöckle U, van Heerwaarden R (2013) Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc 21:189–196CrossRefPubMed
40.
Tsuji M, Akamatsu Y, Kobayashi H, Mitsugi N, Inaba Y, Saito T (2020) Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 140:707–715CrossRefPubMed
41.
Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS (2016) Comparison of cable method and miniaci method using picture archiving and communication system in preoperative planning for open wedge high tibial osteotomy. Knee Surg Relat Res 28:283–288CrossRefPubMedPubMedCentral
Metadata
Title
Preoperative joint line convergence angle correction is a key factor in optimising accuracy in varus knee correction osteotomy
Authors
P. Behrendt
R. Akoto
I. Bartels
G. Thürig
H. Fahlbusch
A. Korthaus
D. Dalos
M. Hoffmann
K.-H. Frosch
M. Krause
Publication date
22-08-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07092-2

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