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Pre-surgery HKA angle and WBL percentage are nearly perfectly correlated to the Miniaci angle when planning open wedge high tibial osteotomies

  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Xu Jiang
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China

    Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Di Zhang
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Bo Li
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China
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  • Mengning Yan
    Correspondence
    Co-corresponding authors: Mengning Yan (Email: ), Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    Affiliations
    Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China
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  • Xumin Hu
    Correspondence
    Xumin Hu (Email: ), Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China
    Affiliations
    Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China
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  • Liao Wang
    Correspondence
    Liao Wang (Email: ), Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    Affiliations
    Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China
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  • Liangbin Gao
    Correspondence
    Liangbin Gao (Email: ), Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China
    Affiliations
    Department of Orthopaedic Surgery, Sun Yat -Sen Memorial Hospital, Sun Yat -Sen University, Guangzhou 510120, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
Published:November 08, 2022DOI:https://doi.org/10.1016/j.arthro.2022.11.007

      Abstract

      Purpose

      To investigate the conversion formulas between the Miniaci angle, pre-surgery parameters, and changes in pre-surgery parameters in open-wedge high tibial osteotomy (OWHTO), including hip-knee-ankle (HKA) angle, weight-bearing line (WBL) percentage, mechanical medial proximal tibial angle (mMPTA), ΔHKA angle, ΔWBL percentage, ΔmMPTA, and other parameters.

      Methods

      From January 2012 to December 2019, 247 lower limbs of 144 patients with medial unicompartmental knee osteoarthritis combined with proximal tibia vara were enrolled. Inclusion criteria were adults, medial unicompartmental knee osteoarthritis, Kellgren–Lawrence classification grade ≤ Ⅲ, mMPTA ≤85° and mechanical lateral distal femoral angle (mLDFA) is normal (85°-90°), and patella facing anterior in the bipedal standing position. Exclusion criteria were history of fracture, trauma, or orthopaedic surgery; developmental dysplasia of the hip or femoral head necrosis; femoral bowing deformity; deformity of the tibial shaft; and leg length discrepancy. Using standing whole-leg radiographs (WLRs), an OWHTO simulation was performed to determine the Miniaci angle by delivering the WBL to the Fujisawa point. The relationship of the Miniaci angle, the pre-surgery parameters, and the changes in pre-surgery parameters were analysed by spearman's correlation and linear regression analyses. The relationship between the post-surgery HKA angle and pre-surgery parameters was analysed by multiple linear regression model.

      Results

      The Miniaci angle showed a near perfect correlation with the pre-surgery HKA angle (y=-1.05x+192.10, r2=0.99), pre-surgery WBL percentage (y=-0.25x+15.14, r2=0.97), ΔHKA angle (y=1.04x-0.03, r2=1.00), ΔWBL percentage (y=0.25x-0.52, r2=0.97), and ΔmMPTA (y=1.04x-0.03, r2=1.00). The ΔHKA angle showed nearly perfect correlation with the ΔmMPTA (y=1.00x, r2=1.00), and ΔWBL percentage (y=0.24x-0.47, r2=0.97).

      Conclusions

      The pre-surgery HKA angle, pre-surgery WBL percentage, ΔHKA angle, ΔWBL, and ΔmMPTA percentage are nearly perfectly correlated to the Miniaci angle, while the ΔmMPTA and ΔWBL percentage are nearly perfectly correlated to the ΔHKA angle.

      Clinical Relevance

      With the conversion formulas determined in the current study, surgeons can calculate the Miniaci angle based on the pre-surgery parameters without the assistance of digital software for complex surgical simulation. The Miniaci angle is closely related to the gap of the medial opening wedge. Based on the Miniaci angle and the depth of the osteotomy, surgeons can calculate the gap required prior to surgery using trigonometric functions and then simply measure the gap during surgery.

      Keywords

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