Purpose
The primary aim of this study was to evaluate the 3-dimensional morphology of the
proximal tibia around the osteotomy plane in open-wedge high tibial osteotomy, focusing
on the posterolateral (PL) and posteromedial (PM) tibial condyles, and to clarify
the changes in morphologic parameters due to differences in patient characteristics
and hinge position. The secondary aim was to examine whether morphologic features
were associated with insufficient osteotomy, which increases the risk of lateral hinge
fracture (LHF).
Methods
The PL and PM anteroposterior distance, asymmetry ratio, and discrepancy between PL
and PM distances along the tibial osteotomy plane were measured. We investigated changes
in the parameters due to differences in patient characteristics and hinge position.
Osteotomy configurations and LHFs were evaluated using postoperative computed tomography
scans.
Results
The 3-dimensional preoperative plans of 117 knees (male, 41 knees; female, 76 knees)
were evaluated. PL distances were larger than PM distances in almost all cases. The
average asymmetry ratio was 1.35, and the standard deviation was 0.22. Higher hinge
position was associated with a larger asymmetry ratio and discrepancy (P < .001). The asymmetry ratio and discrepancy were independently positively correlated
with male sex (P = .002 and P = .001, respectively) and gentle posterior tibial slope (P < .001 and P < .001, respectively). Osteotomies with type III LHFs showed lower osteotomy sufficiency
than osteotomies without LHFs (P < .001).
Conclusions
PL tibial condyle protrusion was more pronounced in male patients and those with a
high hinge position, and may result in insufficient PL osteotomy, which is a risk
factor for type III LHF during open-wedge high tibial osteotomy. The optimal hinge
position was located approximately 15 mm and 20 mm distal to the lateral tibial plateau
in female and male patients, respectively.
Level of Evidence
IV: retrospective case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The long-term outcome of high tibial osteotomy: A ten- to 20-year follow-up.J Bone Joint Surg Br. 2008; 90: 592-596
- Uni-compartmental knee arthroplasty versus high tibial osteotomy for knee osteoarthritis: A systematic review and meta-analysis.J Arthroplasty. 2018; 33: 952-959
- The cost-effectiveness of surgical treatment of medial unicompartmental knee osteoarthritis in younger patients a computer model-based evaluation.J Bone Joint Surg Am. 2015; 97: 807-817
- Adverse event rates and classifications in medial opening wedge high tibial osteotomy.Am J Sports Med. 2014; 42: 1118-1126
- Computed tomography detects hinge fractures after medial opening wedge high tibial osteotomy: A systematic review.Arthroscopy. 2021; 37: 1337-1352
- The complications of high tibial osteotomy: closing- versus opening-wedge methods.J Bone Joint Surg Br. 2010; 92: 1245-1252
- Smoking and unstable hinge fractures cause delayed gap filling irrespective of early weight bearing after open wedge osteotomy.Arthroscopy. 2015; 31: 254-265
- Diagnostic value of computed tomography and risk factors for lateral hinge fracture in the open wedge high tibial osteotomy.Arthroscopy. 2018; 34: 1032-1043
- May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union.Knee Surg Sport Traumatol Arthrosc. 2011; 19: 333-339
- Unstable lateral hinge fracture or occult complete osteotomy adversely affects correction accuracy in open-wedge high tibial osteotomy.Arthroscopy. 2021; 37: 3297-3306
- Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: A new classification of lateral hinge fracture.Arthroscopy. 2012; 28: 85-94
- The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy.Bone Joint J. 2015; 97: 1226-1231
- Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy.Bone Joint J. 2017; 99: 1313-1318
- A “safe zone” in medial open-wedge high tibia osteotomy to prevent lateral cortex fracture.Knee Surg Sport Traumatol Arthrosc. 2013; 21: 90-95
- The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy.Bone Joint J. 2017; 99: 887-893
- Ph D. Posterolateral malposition of the cortical hinge during medial open-wedge high tibial osteotomy increases posterior tibial slope: Incomplete posterior osteotomy may shift the hinge from lateral to posterolateral.Arthroscopy. 2021; 37: 2202-2203
Morita Y, Kuriyama S, Maeda T, et al. Hinge fractures reaching the tibial plateau can be caused by forcible opening of insufficient posterior osteotomy during open-wedge high tibial osteotomy [published online January 4, 2022]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-021-06816-0.
- Lateral tibial bone mineral density around the level of the proximal tibiofibular joint.Knee Surg Sport Traumatol Arthrosc. 2014; 22: 1678-1683
- Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury.Knee Surg, Sport Traumatol Arthrosc. 2020; 28: 1365-1371
- Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis.Orthop Traumatol Surg Res. 2019; 105: 77-83
- Clinical efficacy of preoperative 3D planning for reducing surgical errors during open-wedge high tibial osteotomy.J Orthop Res. 2019; 37: 898-907
- An anteroposterior axis of the tibia for total knee arthroplasty.Clin Orthop Relat Res. 2004; 420: 213-219
- Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method.Knee Surg Sport Traumatol Arthrosc. 2012; 20: 586-593
- Gender differences in knee morphology and the prospects for implant design in total knee replacement.Knee. 2018; 25: 545-558
- Radiographic assessment of the safe zone for medial oblique opening wedge high tibial osteotomy.J Orthop Surg (Hong Kong). 2012; 20: 353-355
- Comparative analysis of osteotomy accuracy between the conventional and devised technique using a protective cutting system in medial open-wedge high tibial osteotomy.J Orthop Sci. 2015; 20: 129-136
- Lateral hinge fracture delays healing of the osteotomy gap in opening wedge high tibial osteotomy with a beta-tricalcium phosphate block.Knee. 2020; 27: 192-197
- An early sign of intraarticular fracture of the lateral tibial plateau during opening wedge high tibial osteotomy.Knee. 2013; 20: 66-68
- Vascular safety during high tibial osteotomy: A cadaveric angiographic study.Am J Sports Med. 2010; 38: 810-815
- Sagittal and coronal plane location of the popliteal artery in the open-wedge high tibial osteotomy.Knee Surg Sport Traumatol Arthrosc. 2014; 22: 2629-2634
- The effects of different hinge positions on posterior tibial slope in medial open-wedge high tibial osteotomy.Knee Surg Sport Traumatol Arthrosc. 2018; 26: 1851-1858
- Effect of fibular height and lateral tibial condylar geometry on lateral cortical hinge fracture in open wedge high tibial osteotomy.Arthroscopy. 2019; 35: 1713-1720
- Morphology of proximal tibiofibular joint, a new risk factor for knee osteoarthritis: A radiological study.Int J Clin Exp Med. 2018; 11: 10873-10880
- Three-dimensional morphology of the knee reveals ethnic differences.Clin Orthop Relat Res. 2012; 470: 172-185
Article Info
Publication History
Published online: August 09, 2022
Accepted:
July 13,
2022
Received:
February 4,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: S.K. reports grants from Olympus Terumo Biomaterials Corp., Tokyo, Japan, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
