We present four technical modifications of high tibial osteotomy which improve its safety and reproducibility. (a) Open wedge correction: opening wedge osteotomy from the medial side avoids lateral muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy, and leg shortening; only one osteotomy needs to be performed and the correction can be adapted intraoperatively. (b) Biplanar osteotomy: in addition to the transverse osteotomy of the posterior tibia a second ascending osteotomy in the coronary plane underneath the tibial tuberosity is performed. This provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting of the osteotomy planes. (c) Incomplete osteotomy with plastic deformation of the tibia: 10 mm of lateral bone stock is left intact. The osteotomy is opened gradually over several minutes by sequential impaction of flat chisels or by use of a special spreading tool. Manifest fractures of the lateral cortex with resulting instability are avoided. Rapid bone healing is promoted. (d) Rigid fixation: stable osteosynthesis allows for early mobilization and avoids losses-of-correction. We use a medial plate-fixator which can be applied percutanously. In 112 patients operated on using this modified technique no pseudarthosis or loss-of-correction was observed.

Improvements in surgical technique of valgus high tibial osteotomy.

New developments in osteotomy techniques and methods of fixation have caused a revival of interest of osteotomies around the knee. The current consensus on the indications, patient selection and the factors influencing the outcome after high tibial osteotomy is presented. This paper highlights recent research aimed at joint pressure redistribution, fixation stability and bone healing that has led to improved surgical techniques and a decrease of post-operative time to full weight-bearing.

Osteotomies around the knee

Purpose The purpose of this study was to investigate complications of the medial opening wedge high tibial osteotomy (HTO) procedure at our institution. Methods All cases of medial opening wedge HTO performed between 2001 and 2004 at our institution were identified. Medical records, operative reports, and radiographs were retrospectively reviewed for all patients who experienced a complication within 12 months postsurgery. All complications were identified for analysis. Results Forty-six patients were included in this study; 17 (36.9%) patients had a documented complication. There were 7 patients (15.2%) with loss of correction, 2 (4.3%) with intraoperative lateral cortex fractures, 2 (4.3%) with postoperative lateral cortex fractures, 2 (4.3%) with deep venous thrombosis, 2 (4.3%) with delayed unions, and 2 (4.3%) with symptomatic hardware. Patients with a loss of angular correction had a greater body mass index (BMI) than those without a loss of correction (mean BMI, 32.5 v 28.8; P = .0416). Of the 7 patients with loss of angular correction, 6 had a first-generation fixation device and 1 had a second-generation device. There was no apparent association between delayed union and graft type (allograft v autograft). Conclusions The medial opening wedge HTO is associated with a moderate frequency of complications. The frequency and type of complications seem to be similar to those reported for the lateral closing technique. Although there are technical advantages offered by the medial opening wedge HTO, their influence on the frequency and type of complications experienced by patients in our series was not apparent. Level of Evidence Level IV, case series.

Complications After Medial Opening Wedge High Tibial Osteotomy

https://www.knee.ae/wp-content/themes/international_knee_joint/pdf/high-tibial-osteotomy-current-concepts.pdf

Patient selection, stability of fixation and bone healing in high tibial osteotomies

Die hohe valgisierende Tibiakopfosteotomie ist ein etabliertes Behandlungsverfahren fur die Varusgonarthrose. Die Indikation stellt sich insbesondere bei jungeren Patienten, welche fur einen Gelenksersatz nicht in Frage kommen. Der Eingriff wird heute meist durch Entfernung eines lateral basierten Knochenkeils, Fibulaosteotomie und Osteosynthese der Tibia uber einen lateralen Zugang durchgefuhrt. Diese Technik ist allerdings mit einer nicht unerheblichen Morbiditat und Komplikationsrate verbunden. Wir stellen eine in vier Punkten verbesserte Methode vor: 1) die Offnung der Tibia von medial (open wedge) vermeidet die laterale Muskelablosung, die Praparation des N. Peronaus und die Fibulaosteotomie. Nur eine Osteotomie ist erforderlich und die Korrektur kann intraoperativ noch modifiziert werden. 2) eine biplanare Osteotomie verbessert die Stabilitat in der Sagitalebene erheblich und ermoglicht eine rasche Knochenheilung. 3) eine inkomplette Osteotomie mit plastischer Deformation der intakten lateralen Knochenbrucke vermeidet Frakturen und Instabilitaten auf der Lateralseite und fordert den Durchbau der Osteotomie. 4) die stabile Fixation mit einem speziellen Plattenfixateur ermoglicht eine hohe Primarstabilitat und vermeidet Korrekturverluste. Dieser Fixateur kann perkutan eingebracht werden und fuhrt auf Grund seines Designs nicht zu Irritationen von Sehnen und Bandstrukturen. Die Vorteile dieses Verfahrens bestatigen sich an einer konsekutiven Serie von 262 Fallen, in der keine Korrekturverluste und nur zwei verzogerte Osteotomieheilungen beobachtet wurden.

Die öffnende valgisierende Osteotomie der proximalen Tibia mit Fixation durch einen medialen Plattenfixateur

To evaluate electrophysiological incidence and the type of peroneal nerve lesions seen after high tibial osteotomy we conducted an electrophysiological study (electromyography and nerve conduction velocity studies) in 11 patients who were suffering from medial gonarthrosis and treated by Maquet barrel-vault type high tibial valgization osteotomy. All the patients were tested both pre- and postoperatively. Every patient was examined postoperatively for a minimum of a 6 months after surgery to eliminate spontaneously reversible lesions. Results obtained from nonoperated legs served as controls. Three patients (27%) with peroneal nerve lesions were detected electrophysiologically; one had only motor involvement, one only sensory involvement, and one both motor and sensory involvement. Clinically only one of these patients was symptomatic, and the other two were detected by electrophysiological means. Peroneal nerve lesions which may be overlooked by mild weakness and hypesthesia in the early postoperative period can be detected by electrophysiological means at a higher rate than expected. These lesions persist a relatively long time and even can be permanent despite the absence of clinical symptoms.

Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

N. Araç

Author Tools

Chat about Author

Papers

Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study