A novel biplanar medial opening-wedge high tibial osteotomy: the Z-shaped technique. A case series at 7.2 years follow-up

Journal of Orthopaedics and Traumatology

Manuel Giovanni Mazzoleni¹  Andrea Fidanza¹  Massimo Angelozzi¹  Vittorio Calvisi¹  Alessio Giannetti¹  Filippo Maria Nicola Randelli²  Marcello Presutti³  Pietro Palumbo⁴  Remo Goderecci⁵ 

[1] Department of Life, Health and Environmental Sciences, Unit of Orthopaedics and Traumatology, University of L’Aquila, Piazzale Salvatore Tommasi 1, Blocco 11, 67100, L’Aquila (AQ), Italy;Hip Department (CAD) Gaetano Pini - CTO Orthopedic Institute, University of Milan, Milan (MI), Italy;Unit of Orthopaedic Surgery, “Casa Di Cura Villa Esther”, Bojano (Cb), Italy;Unit of Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria - Ospedali Riuniti, Foggia (FG), Italy;Unit of Orthopaedics and Traumatology, “G. Mazzini” Civil Hospital of Teramo, ASL 4 Teramo, Piazza Italia 1, 64100, Teramo, Italy;

关键词: Osteoarthritis;    Unicompartmental knee osteoarthritis;    High tibial osteotomy;    HTO;    Medial opening-wedge high tibial osteotomy;    MOWHTO;    Modified biplanar osteotomy;    Z-shaped osteotomy;    Puddu plate;    Knee;   

DOI  :  10.1186/s10195-021-00617-4

来源: Springer

【 摘 要 】

BackgroundHigh tibial osteotomy (HTO) provides reliable and good long-term results, if performed with correct indications, but different techniques and types of fixation have been described. The purpose of this study is to present a novel modified biplanar medial opening-wedge (MOW) HTO technique where the osteotomies are performed in a Z-shaped fashion, and to present the medium-term clinical and radiographic results.Materials and methodsWe present a case series of 75 patients (80 knees) with mean age of 45.8 years, affected by isolated medial knee osteoarthritis and symptomatic varus knee malalignment, who underwent novel biplanar Z-shaped MOWHTO. Clinical and radiological outcomes were collected, retrospectively before surgery and at median follow-up of 7.2 years (95% CI 5.6–9.2 months) after surgery. Clinical results and satisfaction were assessed by visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Likert scale. Radiological assessment involved the evaluation of the medial proximal tibial angle (MPTA), tibial slope (TS), Caton–Deschamps index, and knee osteoarthritis grade according to Ahlbäck classification. Pre- and postoperative results were compared using the two-tailed t-test or Wilcoxon’s test of independent samples for paired data or nonparametric analog. P < 0.05 was considered significant.ResultsAt medium-term follow-up, Z-shaped MOWHTO showed a survival rate of 95 ± 1.7% with failure occurring in four knees due to symptom recurrence and osteoarthritis progression. No perioperative complications were observed (intraarticular fracture, delayed union or nonunion, and neurological injury). Mean bone healing time was 12 weeks. Clinical scores showed significant improvement at last follow-up and a good grade of satisfaction. MPTA increased significantly, while Caton–Deschamps index decreased significantly. No significant TS increase was found.ConclusionsModified biplanar Z-shaped MOWHTO is a safe and reliable technique that offers satisfactory clinical and radiological medium-term outcomes with low knee arthroplasty conversion rate. The unique three-dimensional geometrical conformation potentially provides a favorable environment for bone healing, increased anteroposterior and rotational stability, and safer opening-wedge loading force application with low lateral hinge fracture risk.Level of evidenceLevel IV, retrospective observational case series study.Trial registration The study protocol was approved by the Internal Review Board of our Institution (authorization number 54/2019, 20 November 2019).

【 授权许可】

CC BY