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Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator

BACKGROUND: High tibial osteotomy (HTO) is a well-known procedure for the correction of knee varus. The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques: acute opening wedge correction using a plate and gradua...

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Autores principales: Ghasemi, S Ali, Zhang, David T, Fragomen, Austin, Rozbruch, S Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995338/
https://www.ncbi.nlm.nih.gov/pubmed/33816141
http://dx.doi.org/10.5312/wjo.v12.i3.140
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author Ghasemi, S Ali
Zhang, David T
Fragomen, Austin
Rozbruch, S Robert
author_facet Ghasemi, S Ali
Zhang, David T
Fragomen, Austin
Rozbruch, S Robert
author_sort Ghasemi, S Ali
collection PubMed
description BACKGROUND: High tibial osteotomy (HTO) is a well-known procedure for the correction of knee varus. The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques: acute opening wedge correction using a plate and gradual correction with a monolateral external fixator. AIM: To compare of the radiological results of two different techniques: acute opening wedge correction (a plate and screw) and gradual correction (external fixator). METHODS: A total of 43 patients with plates and 36 patients with external fixators were included. All patients had moderate uniplanar varus deformities. We measured radiographic parameters, including the mechanical axis deviation (MAD), medial proximal tibial angle (MPTA), Caton-Deschamps Index (CDI), posterior proximal tibial angle, and joint line obliquity angle (JLOA). The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis. RESULTS: Demographics including age, body mass index, sex, and preoperative deformities were similar between the groups. The MAD significantly improved from 23.6 mm medial to the midline (SD = 8.2 mm) to 6.9 mm lateral to the midline (SD = 5.4 mm) (P < 0.001). The accuracy of MAD correction did not differ between the groups and was 96.1% (SD = 8.1%) in the plate group and 98.2% (SD = 5.2%) in the external fixator group (P = 0.18). The MPTA significantly improved from 83.9° (SD = 2.9°) to 90.9° (SD = 3.3°) (P < 0.001), and the change was similar between the groups. Differences were noted in patella height, with a CDI change of -19.2% (SD = 13.7%) and 3.1% (SD = 8.0%) for the plate and external fixator groups, respectively (P < 0.001). The change in JLOA was 1.6 degrees (SD = 1.1 degrees) and 0.9 degrees (SD = 0.9 degrees) for the plate and external fixator groups, respectively (P = 0.04). CONCLUSION: Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique. The patellar height decreased with the open wedge plate technique. Joint line obliquity decreased to a greater degree with the open wedge plate technique, perhaps as a result of medial collateral ligament release. The appropriate technique should be selected based on surgeon and patient preferences; however, external fixation may be a better choice when the preservation of patellar height is deemed important.
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spelling pubmed-79953382021-04-01 Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator Ghasemi, S Ali Zhang, David T Fragomen, Austin Rozbruch, S Robert World J Orthop Retrospective Study BACKGROUND: High tibial osteotomy (HTO) is a well-known procedure for the correction of knee varus. The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques: acute opening wedge correction using a plate and gradual correction with a monolateral external fixator. AIM: To compare of the radiological results of two different techniques: acute opening wedge correction (a plate and screw) and gradual correction (external fixator). METHODS: A total of 43 patients with plates and 36 patients with external fixators were included. All patients had moderate uniplanar varus deformities. We measured radiographic parameters, including the mechanical axis deviation (MAD), medial proximal tibial angle (MPTA), Caton-Deschamps Index (CDI), posterior proximal tibial angle, and joint line obliquity angle (JLOA). The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis. RESULTS: Demographics including age, body mass index, sex, and preoperative deformities were similar between the groups. The MAD significantly improved from 23.6 mm medial to the midline (SD = 8.2 mm) to 6.9 mm lateral to the midline (SD = 5.4 mm) (P < 0.001). The accuracy of MAD correction did not differ between the groups and was 96.1% (SD = 8.1%) in the plate group and 98.2% (SD = 5.2%) in the external fixator group (P = 0.18). The MPTA significantly improved from 83.9° (SD = 2.9°) to 90.9° (SD = 3.3°) (P < 0.001), and the change was similar between the groups. Differences were noted in patella height, with a CDI change of -19.2% (SD = 13.7%) and 3.1% (SD = 8.0%) for the plate and external fixator groups, respectively (P < 0.001). The change in JLOA was 1.6 degrees (SD = 1.1 degrees) and 0.9 degrees (SD = 0.9 degrees) for the plate and external fixator groups, respectively (P = 0.04). CONCLUSION: Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique. The patellar height decreased with the open wedge plate technique. Joint line obliquity decreased to a greater degree with the open wedge plate technique, perhaps as a result of medial collateral ligament release. The appropriate technique should be selected based on surgeon and patient preferences; however, external fixation may be a better choice when the preservation of patellar height is deemed important. Baishideng Publishing Group Inc 2021-03-18 /pmc/articles/PMC7995338/ /pubmed/33816141 http://dx.doi.org/10.5312/wjo.v12.i3.140 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Ghasemi, S Ali
Zhang, David T
Fragomen, Austin
Rozbruch, S Robert
Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator
title Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator
title_full Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator
title_fullStr Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator
title_full_unstemmed Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator
title_short Proximal tibial osteotomy for genu varum: Radiological evaluation of deformity correction with a plate vs external fixator
title_sort proximal tibial osteotomy for genu varum: radiological evaluation of deformity correction with a plate vs external fixator
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995338/
https://www.ncbi.nlm.nih.gov/pubmed/33816141
http://dx.doi.org/10.5312/wjo.v12.i3.140
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