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Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting
BACKGROUND: After open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In additi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057467/ https://www.ncbi.nlm.nih.gov/pubmed/27724861 http://dx.doi.org/10.1186/s12891-016-1277-3 |
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author | Yoo, Oui Sik Lee, Yong Seuk Lee, Myung Chul Park, Jae Hong Kim, Jae Won Sun, Doo Hoon |
author_facet | Yoo, Oui Sik Lee, Yong Seuk Lee, Myung Chul Park, Jae Hong Kim, Jae Won Sun, Doo Hoon |
author_sort | Yoo, Oui Sik |
collection | PubMed |
description | BACKGROUND: After open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry. The purpose of this study was to devise a new plate that best fit the post-contoured anatomy of the tibia by evaluating the surface geometry of the plate positioning site after OWHTO. METHODS: Thirty-one uni-planar and 38 bi-planar osteotomies were evaluated. Surgical indications were age of under 70 years, relatively active patient who performs recreational sports activities. Other indications were similar with general recommendation of HTO. Computed tomography (CT) of the operated knees was performed and it was used for the reconstruction of the 3D model. Bone model axis re-alignment was performed with coronal, sagittal, and axial plane. Morphologic analysis of the proximal tibia was performed using the following parameters: (1) radii in axial plane, 2) radii in coronal plane, and 3) angle and horizontal distance (Distance X) between the proximal and distal fragments. These were also analyzed according to the correction degree. The Analysis of Variance (ANOVA) test was conducted to verify the change depending on the correction amount of the posterior opening gap. The values obtained for the uni- and bi-planar osteotomy were compared by the independent t-test. RESULTS: There were 9 male and 60 female patients were recruited to this study; the mean age was 58.3 ± 8 and 56.9 ± 7.6 years, respectively. Preoperative weight bearing line (WBL) was 21.59 ± 11.36 and 22.32 ± 10.55 %, respectively. Mean correction degree was 10.9 ± 2.7 and 11.1 ± 2.6 mm, respectively. The radii of the tibial cross-sectional contour at the head portion tended to increase from the proximal to distal direction. The radii of the tibial cross-sectional contour at the neck portion tended to decrease from the proximal to distal direction. The radii of the coronal plane tended to increase from the proximal to distal direction. The angle between the proximal fragment and the distal one varied with the correction amount of the posterior opening gap. Shaft_Mid and Distance X of GroupI (110.08 mm and 6.11 mm, respectively) which had lower correction angle were lower than those of GroupII (130.05 mm and 6.41 mm, respectively) and those of GroupIII (136.35 mm, 8.01 mm, respectively) in coronal plane. There were significant differences (p = 0.023 < 0.05 and p = 0.009 < 0.01, respectively). CONCLUSION: Current plate design should be modified to the surface geometry of the post-correction for the proper fitting. As the correction degree increases, the plate should be bended at the both end of the opening gap in coronal plane. TRIAL REGISTRATION: ‘retrospectively registered (ISRCTN97792440). |
format | Online Article Text |
id | pubmed-5057467 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-50574672016-10-24 Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting Yoo, Oui Sik Lee, Yong Seuk Lee, Myung Chul Park, Jae Hong Kim, Jae Won Sun, Doo Hoon BMC Musculoskelet Disord Research Article BACKGROUND: After open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry. The purpose of this study was to devise a new plate that best fit the post-contoured anatomy of the tibia by evaluating the surface geometry of the plate positioning site after OWHTO. METHODS: Thirty-one uni-planar and 38 bi-planar osteotomies were evaluated. Surgical indications were age of under 70 years, relatively active patient who performs recreational sports activities. Other indications were similar with general recommendation of HTO. Computed tomography (CT) of the operated knees was performed and it was used for the reconstruction of the 3D model. Bone model axis re-alignment was performed with coronal, sagittal, and axial plane. Morphologic analysis of the proximal tibia was performed using the following parameters: (1) radii in axial plane, 2) radii in coronal plane, and 3) angle and horizontal distance (Distance X) between the proximal and distal fragments. These were also analyzed according to the correction degree. The Analysis of Variance (ANOVA) test was conducted to verify the change depending on the correction amount of the posterior opening gap. The values obtained for the uni- and bi-planar osteotomy were compared by the independent t-test. RESULTS: There were 9 male and 60 female patients were recruited to this study; the mean age was 58.3 ± 8 and 56.9 ± 7.6 years, respectively. Preoperative weight bearing line (WBL) was 21.59 ± 11.36 and 22.32 ± 10.55 %, respectively. Mean correction degree was 10.9 ± 2.7 and 11.1 ± 2.6 mm, respectively. The radii of the tibial cross-sectional contour at the head portion tended to increase from the proximal to distal direction. The radii of the tibial cross-sectional contour at the neck portion tended to decrease from the proximal to distal direction. The radii of the coronal plane tended to increase from the proximal to distal direction. The angle between the proximal fragment and the distal one varied with the correction amount of the posterior opening gap. Shaft_Mid and Distance X of GroupI (110.08 mm and 6.11 mm, respectively) which had lower correction angle were lower than those of GroupII (130.05 mm and 6.41 mm, respectively) and those of GroupIII (136.35 mm, 8.01 mm, respectively) in coronal plane. There were significant differences (p = 0.023 < 0.05 and p = 0.009 < 0.01, respectively). CONCLUSION: Current plate design should be modified to the surface geometry of the post-correction for the proper fitting. As the correction degree increases, the plate should be bended at the both end of the opening gap in coronal plane. TRIAL REGISTRATION: ‘retrospectively registered (ISRCTN97792440). BioMed Central 2016-10-10 /pmc/articles/PMC5057467/ /pubmed/27724861 http://dx.doi.org/10.1186/s12891-016-1277-3 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Yoo, Oui Sik Lee, Yong Seuk Lee, Myung Chul Park, Jae Hong Kim, Jae Won Sun, Doo Hoon Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
title | Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
title_full | Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
title_fullStr | Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
title_full_unstemmed | Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
title_short | Morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
title_sort | morphologic analysis of the proximal tibia after open wedge high tibial osteotomy for proper plate fitting |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057467/ https://www.ncbi.nlm.nih.gov/pubmed/27724861 http://dx.doi.org/10.1186/s12891-016-1277-3 |
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