Is there a difference in bony stability at three months postoperatively between opening-wedge high tibial osteotomy and opening-wedge distal tuberosity osteotomy?
{"title":"Is there a difference in bony stability at three months postoperatively between opening-wedge high tibial osteotomy and opening-wedge distal tuberosity osteotomy?","authors":"Suguru Koyama , Keiji Tensho , Kazushige Yoshida , Hiroki Shimodaira , Daiki Kumaki , Yusuke Maezumi , Hiroshi Horiuchi , Jun Takahashi","doi":"10.1016/j.asmart.2024.10.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To compare the initial postoperative stability of opening-wedge high tibial osteotomy (HTO) and opening-wedge distal tuberosity osteotomy (DTO) and investigate the factors that influence initial stability.</div></div><div><h3>Methods</h3><div>Patients with the same operative indications who underwent HTO (n = 51) and DTO (n = 55) were included. Demographic and preoperative radiographic data (weight-bearing line percentage [%WBL], femoral-tibial angle [FTA], medial proximal tibial angle [MPTA], posterior tibial slope and correction angle), and postoperative computed tomography (CT) scan data (initial postoperative stability [12 weeks postoperative], and hinge fracture [1 and 12 weeks postoperatively], and hinge length, flange thickness, flange length, axial flange osteotomy angle, sagittal flange osteotomy angle [1 week postoperatively]) were statistically analyzed. As a subgroup analysis, HTO and DTO patients were divided into Stable and Unstable groups respectively based on postoperative CT at 12 weeks; demographic and radiological data were compared.</div></div><div><h3>Results</h3><div>Patients with DTO was significantly younger (median [range]; 59 [22, 73] vs 64 [45, 75], P = 0.02) and had a smaller preoperative deformity (%WBL: median [range]; 28.9 [12.8, 46.0] vs 24.3 [4.9, 44.3], P < 0.01, FTA: median [range]; 179.0 [173.0, 183.0] vs 180.0 [172.5, 186.2], P < 0.01, MPTA: median [range]; 84.0 [79.0, 87.1] vs 83.0 [78.2, 86.5], P = 0.04) and smaller correction angles (median [range]; 9 [6, 12] vs 10 [7, 15], P < 0.01). Postoperative CT data showed that DTO was associated with significantly more unstable cases (stable/unstable: 31/24 vs. 39/12, P = 0.02) and hinge fractures (none/1/2/3: 24/25/3/3 vs. 36/12/1/2, P < 0.01) and shorter hinge (median [range]; 27.8 [14.7, 43.4] vs 32.6 [22.5, 44.0], P < 0.01) than HTO. The Unstable DTO group had significantly shorter hinges (median [range]; 23.2 [14.7, 33.9] vs 31.1 [15.2, 43.4], P < 0.01) and thicker flanges (median [range]: 15.2 [9.0, 24.8] vs. 11.0 [6.8, 13.8], P < 0.01) than the stable group. The other data were not significantly different between the two groups.</div></div><div><h3>Conclusion</h3><div>DTO resulted in less initial postoperative stability than HTO. The risk factors for initial instability in DTO were a short hinge and thick flange.</div></div>","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":"39 ","pages":"Pages 1-8"},"PeriodicalIF":1.5000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214687324000268","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
To compare the initial postoperative stability of opening-wedge high tibial osteotomy (HTO) and opening-wedge distal tuberosity osteotomy (DTO) and investigate the factors that influence initial stability.
Methods
Patients with the same operative indications who underwent HTO (n = 51) and DTO (n = 55) were included. Demographic and preoperative radiographic data (weight-bearing line percentage [%WBL], femoral-tibial angle [FTA], medial proximal tibial angle [MPTA], posterior tibial slope and correction angle), and postoperative computed tomography (CT) scan data (initial postoperative stability [12 weeks postoperative], and hinge fracture [1 and 12 weeks postoperatively], and hinge length, flange thickness, flange length, axial flange osteotomy angle, sagittal flange osteotomy angle [1 week postoperatively]) were statistically analyzed. As a subgroup analysis, HTO and DTO patients were divided into Stable and Unstable groups respectively based on postoperative CT at 12 weeks; demographic and radiological data were compared.
Results
Patients with DTO was significantly younger (median [range]; 59 [22, 73] vs 64 [45, 75], P = 0.02) and had a smaller preoperative deformity (%WBL: median [range]; 28.9 [12.8, 46.0] vs 24.3 [4.9, 44.3], P < 0.01, FTA: median [range]; 179.0 [173.0, 183.0] vs 180.0 [172.5, 186.2], P < 0.01, MPTA: median [range]; 84.0 [79.0, 87.1] vs 83.0 [78.2, 86.5], P = 0.04) and smaller correction angles (median [range]; 9 [6, 12] vs 10 [7, 15], P < 0.01). Postoperative CT data showed that DTO was associated with significantly more unstable cases (stable/unstable: 31/24 vs. 39/12, P = 0.02) and hinge fractures (none/1/2/3: 24/25/3/3 vs. 36/12/1/2, P < 0.01) and shorter hinge (median [range]; 27.8 [14.7, 43.4] vs 32.6 [22.5, 44.0], P < 0.01) than HTO. The Unstable DTO group had significantly shorter hinges (median [range]; 23.2 [14.7, 33.9] vs 31.1 [15.2, 43.4], P < 0.01) and thicker flanges (median [range]: 15.2 [9.0, 24.8] vs. 11.0 [6.8, 13.8], P < 0.01) than the stable group. The other data were not significantly different between the two groups.
Conclusion
DTO resulted in less initial postoperative stability than HTO. The risk factors for initial instability in DTO were a short hinge and thick flange.
期刊介绍：
The Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology (AP-SMART) is the official peer-reviewed, open access journal of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) and the Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). It is published quarterly, in January, April, July and October, by Elsevier. The mission of AP-SMART is to inspire clinicians, practitioners, scientists and engineers to work towards a common goal to improve quality of life in the international community. The Journal publishes original research, reviews, editorials, perspectives, and letters to the Editor. Multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines will be the trend in the coming decades. AP-SMART provides a platform for the exchange of new clinical and scientific information in the most precise and expeditious way to achieve timely dissemination of information and cross-fertilization of ideas.
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