Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104063
Frédéric Leiber-Wackenheim
Our understanding of the pathophysiology of anterior ankle impingement has steadily progressed since the princeps description almost 70 years ago. The same is true of diagnosis and treatment, which have greatly changed over time.
The present study provides an update on this pathology, addressing the following questions:
•
What definition?
•
What pathophysiology?
•
What classification?
•
What treatment strategy?
•
What results?
Anterior ankle impingement is suspected in case of anterior ankle pain reproducible by palpation and exacerbated by dorsiflexion imposed by the examiner or squatting, and Molloy’s sign. Etiologies are varied: tumoral, post-traumatic, lateral ankle instability, osteoarthritis and microtrauma. Complementary cross-sectional imaging, and especially MRI, is indispensable for identifying the cause. A dichotic classification in terms of anterolateral impingement of tissular origin and anteromedial impingement of osteophytic origin is incompatible with current pathophysiological concepts. An etiological classification, completed by a topographic classification in 3 zones, provides a better guide for treatment strategy. Tumoral or post-traumatic impingement requires a specialized team. Impingement by microtrauma associated with instability or osteoarthritis is best treated arthroscopically, for exhaustive exploration of intra-articular elements that may be implicated. Treatment consists in removing osteophytes and any pathological synovial or ligamentous soft tissue. Anterior talofibular ligament or medial collateral ligament repair may be associated. Results can be expected to be good, with clear improvement in pain and function and excellent patient satisfaction.
{"title":"Anterior ankle impingement","authors":"Frédéric Leiber-Wackenheim","doi":"10.1016/j.otsr.2024.104063","DOIUrl":"10.1016/j.otsr.2024.104063","url":null,"abstract":"<div><div>Our understanding of the pathophysiology of anterior ankle impingement has steadily progressed since the princeps description almost 70 years ago. The same is true of diagnosis and treatment, which have greatly changed over time.</div><div>The present study provides an update on this pathology, addressing the following questions:</div><div><ul><li><span>•</span><span><div>What definition?</div></span></li><li><span>•</span><span><div>What pathophysiology?</div></span></li><li><span>•</span><span><div>What classification?</div></span></li><li><span>•</span><span><div>What treatment strategy?</div></span></li><li><span>•</span><span><div>What results?</div></span></li></ul></div><div>Anterior ankle impingement is suspected in case of anterior ankle pain reproducible by palpation and exacerbated by dorsiflexion imposed by the examiner or squatting, and Molloy’s sign. Etiologies are varied: tumoral, post-traumatic, lateral ankle instability, osteoarthritis and microtrauma. Complementary cross-sectional imaging, and especially MRI, is indispensable for identifying the cause. A dichotic classification in terms of anterolateral impingement of tissular origin and anteromedial impingement of osteophytic origin is incompatible with current pathophysiological concepts. An etiological classification, completed by a topographic classification in 3 zones, provides a better guide for treatment strategy. Tumoral or post-traumatic impingement requires a specialized team. Impingement by microtrauma associated with instability or osteoarthritis is best treated arthroscopically, for exhaustive exploration of intra-articular elements that may be implicated. Treatment consists in removing osteophytes and any pathological synovial or ligamentous soft tissue. Anterior talofibular ligament or medial collateral ligament repair may be associated. Results can be expected to be good, with clear improvement in pain and function and excellent patient satisfaction.</div></div><div><h3>Level of evidence</h3><div>V, expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104063"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104065
Léonard Chatelain, Abbas Dib, Louise Ponchelet, Emmanuelle Ferrero
Introduction
Spinal deformity in adults is a major public health problem. After failure of conservative treatment, correction and fusion surgery leads to clinical and radiological improvement. However, mechanical complications and more particularly – proximal junctional kyphosis (PJK) – are common with an incidence of 10%–40% depending on the studies.
Analysis
Several risk factors have been identified and can be grouped into three categories. Among the patient-related factors, advanced age, comorbidities, osteoporosis and sarcopenia play a determining role. Among the radiological factors, changes in sagittal alignment (cranial migration of thoracolumbar inflection point, over-correction of lumbar hyperlordosis, preoperative thoracolumbar kyphosis) play a key role. Finally, the fusion technique itself may increase the risk of PJK (use of screws instead of hooks) as a surgical factor.
Prevention
Prevention happens at each phase of treatment. A patient assessment is done preoperatively to identify those at risk of PJK. Treating osteoporosis is beneficial. The surgical strategy must also be adapted: the choice of transitional implants such as sublaminar links or hooks and the use of ligament reinforcement techniques can help minimize the risk of PJK. Finally, methodical clinical and radiological follow-up will help to detect early signs of PJK and allow a surgeon to reoperate right away.
Treatment
Not all PJK requires surgical revision. Radiological monitoring and functional treatment is sometimes sufficient. However, if the patient develops pain, neurological complications or instability detected by imaging (unstable fracture, spondylolisthesis, spinal cord compression), revision surgery is necessary. It may consist of proximal extension of the fusion combined with decompression of the stenosis levels at a minimum.
Conclusion
PJK is a major challenge for surgeons. The best treatment is prevention, with a thorough analysis of risk factors leading to a well-planned and personalized surgery. Regular postoperative follow-up is essential.
{"title":"Proximal junctional kyphosis above long spinal fusions","authors":"Léonard Chatelain, Abbas Dib, Louise Ponchelet, Emmanuelle Ferrero","doi":"10.1016/j.otsr.2024.104065","DOIUrl":"10.1016/j.otsr.2024.104065","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal deformity in adults is a major public health problem. After failure of conservative treatment, correction and fusion surgery leads to clinical and radiological improvement. However, mechanical complications and more particularly – proximal junctional kyphosis (PJK) – are common with an incidence of 10%–40% depending on the studies.</div></div><div><h3>Analysis</h3><div>Several risk factors have been identified and can be grouped into three categories. Among the patient-related factors, advanced age, comorbidities, osteoporosis and sarcopenia play a determining role. Among the radiological factors, changes in sagittal alignment (cranial migration of thoracolumbar inflection point, over-correction of lumbar hyperlordosis, preoperative thoracolumbar kyphosis) play a key role. Finally, the fusion technique itself may increase the risk of PJK (use of screws instead of hooks) as a surgical factor.</div></div><div><h3>Prevention</h3><div>Prevention happens at each phase of treatment. A patient assessment is done preoperatively to identify those at risk of PJK. Treating osteoporosis is beneficial. The surgical strategy must also be adapted: the choice of transitional implants such as sublaminar links or hooks and the use of ligament reinforcement techniques can help minimize the risk of PJK. Finally, methodical clinical and radiological follow-up will help to detect early signs of PJK and allow a surgeon to reoperate right away.</div></div><div><h3>Treatment</h3><div>Not all PJK requires surgical revision. Radiological monitoring and functional treatment is sometimes sufficient. However, if the patient develops pain, neurological complications or instability detected by imaging (unstable fracture, spondylolisthesis, spinal cord compression), revision surgery is necessary. It may consist of proximal extension of the fusion combined with decompression of the stenosis levels at a minimum.</div></div><div><h3>Conclusion</h3><div>PJK is a major challenge for surgeons. The best treatment is prevention, with a thorough analysis of risk factors leading to a well-planned and personalized surgery. Regular postoperative follow-up is essential.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104065"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103986
Antoine Labouyrie , Julien Dаrtus , Sophie Putman , Teddy Trouillez , Henri Migаud , Gilles Pаsquier
<div><h3>Background</h3><div>Tibio-femoral instability (TFI) due to ligament imbalance is a growing cause of revision total knee arthroplasty (TKA). The results are heterogeneous in the event of revision and literature is scarce regarding this issue particularly when use of hinge prostheses is not exclusive to manage this complication. Therefore, a retrospective investigation was conducted aiming to (1) analyze the one-year functional results, (2) determine the rate of complications after revision for TFI using posterior-stabilized or condylar constrained knees (CCK), 3) identify the factors that could influence the function outcome.</div></div><div><h3>Hypothesis</h3><div>Patients undergoing revision TKA for TFI would show an improvement in Oxford Knee Score at one year postoperative.</div></div><div><h3>Methods</h3><div>Sixty-two patients were included (40 females, 22 males) mean age 62,9 years ± 8.2 (range, 45,7–78,4). Instability was classified as instability in extension (n = 28), midflexion (n = 12), flexion (n = 12) or global (n = 15). Revisions were done because of isolated instability. Revision consisted in implant revision using a CCK (n = 42), a hinge prosthesis (n = 12) or an isolated polyethylene insert exchange (n = 8). Patients were assessed at one year by the difference between the preoperative Oxford Knee Score (OKS) and the score at one year postoperatively. The results were deemed satisfactory if the variation between preoperative OKS and one-year follow-up was greater than or equal to 5 points (Minimal Clinically Important Difference (MCID) following TKA). Complication rate and risk factors influencing the outcome were also analyzed.</div></div><div><h3>Results</h3><div>Of the 62 patients, 59 could be assessed at one year using postoperative OKS (one death at 0.66 years from unrelated reason, and two had repeated revision within one year postoperative [1 aseptic loosening and 1 Co-Cr allergy]). Preoperative OKS was 15.5 points ± 7.1 (range, 2–37), rising to 28.9 points ± 8.7 (range, 11–45) at follow-up. The mean OKS improvement was 13.4 points ± 10.3 (range, -8 to 33) (p < 0.001) and 47 patients (79.6%) reached the MCID at follow-up. Female gender was associated with a worse evolution of OKS (-5.8, 95% CI: −11.26 to −0.34 (p = 0.038)). In contrast, there was no significant difference in the evolution of the OKS according to the type of TFI in extension or in flexion, in midflexion or global (p = 0.5). Likewise, there was no significant difference in the evolution of the OKS between RTKA using CCK, hinged prosthesis or isolated polyethylene insert exchange (p = 0.3). There was no recurrence of instability at final follow-up (3.04 years ± 1.5 (range, 0.66–6.25)). Revision for instability did not drive to stiffness since mean flexion prior to RTKA was 116 ° ± 13 ° (range, 90 ° to 130 °) versus 116.7 ° ± 12 ° (range, 90 ° to 130 °) at follow-up. Fourteen patients (22.6%) experienced postoperative complications, including 3 revi
{"title":"Rate of complications and short-term Functional Results of Revision Total Knee Arthroplasty for Tibio-femoral Instability: do stability and range of motion are restored in 62 revisions","authors":"Antoine Labouyrie , Julien Dаrtus , Sophie Putman , Teddy Trouillez , Henri Migаud , Gilles Pаsquier","doi":"10.1016/j.otsr.2024.103986","DOIUrl":"10.1016/j.otsr.2024.103986","url":null,"abstract":"<div><h3>Background</h3><div>Tibio-femoral instability (TFI) due to ligament imbalance is a growing cause of revision total knee arthroplasty (TKA). The results are heterogeneous in the event of revision and literature is scarce regarding this issue particularly when use of hinge prostheses is not exclusive to manage this complication. Therefore, a retrospective investigation was conducted aiming to (1) analyze the one-year functional results, (2) determine the rate of complications after revision for TFI using posterior-stabilized or condylar constrained knees (CCK), 3) identify the factors that could influence the function outcome.</div></div><div><h3>Hypothesis</h3><div>Patients undergoing revision TKA for TFI would show an improvement in Oxford Knee Score at one year postoperative.</div></div><div><h3>Methods</h3><div>Sixty-two patients were included (40 females, 22 males) mean age 62,9 years ± 8.2 (range, 45,7–78,4). Instability was classified as instability in extension (n = 28), midflexion (n = 12), flexion (n = 12) or global (n = 15). Revisions were done because of isolated instability. Revision consisted in implant revision using a CCK (n = 42), a hinge prosthesis (n = 12) or an isolated polyethylene insert exchange (n = 8). Patients were assessed at one year by the difference between the preoperative Oxford Knee Score (OKS) and the score at one year postoperatively. The results were deemed satisfactory if the variation between preoperative OKS and one-year follow-up was greater than or equal to 5 points (Minimal Clinically Important Difference (MCID) following TKA). Complication rate and risk factors influencing the outcome were also analyzed.</div></div><div><h3>Results</h3><div>Of the 62 patients, 59 could be assessed at one year using postoperative OKS (one death at 0.66 years from unrelated reason, and two had repeated revision within one year postoperative [1 aseptic loosening and 1 Co-Cr allergy]). Preoperative OKS was 15.5 points ± 7.1 (range, 2–37), rising to 28.9 points ± 8.7 (range, 11–45) at follow-up. The mean OKS improvement was 13.4 points ± 10.3 (range, -8 to 33) (p < 0.001) and 47 patients (79.6%) reached the MCID at follow-up. Female gender was associated with a worse evolution of OKS (-5.8, 95% CI: −11.26 to −0.34 (p = 0.038)). In contrast, there was no significant difference in the evolution of the OKS according to the type of TFI in extension or in flexion, in midflexion or global (p = 0.5). Likewise, there was no significant difference in the evolution of the OKS between RTKA using CCK, hinged prosthesis or isolated polyethylene insert exchange (p = 0.3). There was no recurrence of instability at final follow-up (3.04 years ± 1.5 (range, 0.66–6.25)). Revision for instability did not drive to stiffness since mean flexion prior to RTKA was 116 ° ± 13 ° (range, 90 ° to 130 °) versus 116.7 ° ± 12 ° (range, 90 ° to 130 °) at follow-up. Fourteen patients (22.6%) experienced postoperative complications, including 3 revi","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103986"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103949
Grégoire Micicoi , Francesco Grasso , Lukas Hanak , Kristian Kley , Raghbir Khakha , Merwane Ayata , Jean-Marie Fayard , Matthieu Ollivier
<div><h3>Purpose</h3><div>Patient-specific cutting guides are increasingly used in the field of osteotomies around the knee and can improve the accuracy of planned correction and more specifically in the case of double-level osteotomy (DLO). The purpose of this study was to analyse the accuracy of postoperative coronal alignment after DLO using patient-specific cutting guides techniques (PSI) compared to conventional techniques.</div><div>The secondary objective was to compare the functional results between the two groups at short-term follow-up.</div></div><div><h3>Hypothesis</h3><div>The accuracy of global correction (HKA angle) is better with patient-specific cutting guides compared to conventional techniques for double-level osteotomy</div></div><div><h3>Methods</h3><div>This multicentric comparative retrospective study included 53 patients (mean age: 53.8 ± 5.2 years, male/female: 44/9) who underwent a DLO for knee varus malalignment. The coronal correction accuracy (as expressed by the difference between postoperative angular values and preoperative targeted correction) was compared between techniques using patient-specific cutting guides (PSI group, n = 27) or conventional techniques (n = 26) for the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA). Postoperatively, the global alignment expressed by the hip-knee-ankle angle and the joint line obliquity were compared between groups. The postoperative functional results for KOOS and UCLA activity scale score were also compared at a mean follow-up of 1.7 years (1.0–3.1 years).</div></div><div><h3>Results</h3><div>No difference was observed for the postoperative global alignment between the PSI and the conventional groups (Δ = 0.6 °, <em>p</em> = 0.11) neither for the postoperative posterior proximal tibial angle (Δ = 1.6°, <em>p</em> = 0,99) or the joint line obliquity (Δ = 0.3°, <em>p</em> = 0,17). In the coronal plane, the postoperative MPTA was lower in the PSI group (Δ = 2.3°, <em>p</em> < 0.001) as well as the postoperative LDFA (Δ = 0.9°, <em>p</em> = 0.01).</div><div>Concerning correction accuracy in the coronal plane, the results showed a significant higher accuracy of the planned correction in the PSI group compared to the conventional group for MPTA (2.2 ± 0.2 versus 0.8 ± 0.7, Δ = 1.5 °, <em>p</em> < 0.001) and LDFA (1.3 ± 1.0 versus 0.6 ± 0.9, Δ = 0.7°, <em>p</em> < 0.001).</div><div>No improvement difference was observed between the conventional group and the PSI group respectively for the KOOS symptoms (<em>p</em> = 0.12), the KOOS Pain (<em>p</em><span> = 0,57), the KOOS activities of daily living (</span><em>p</em> = 0.61), the KOOS sport/rec (<em>p</em><span> = 0.65), or for the KOOS Quality of Life (</span><em>p</em> = 0.99) neither for the UCLA (<em>p</em> = 0.97).</div></div><div><h3>Conclusions</h3><div>This study suggests that the use of custom-made cutting guides improves the accuracy of planned correction in double-level osteotom
{"title":"Double-level osteotomy for varus knees using patient-specific cutting guides allow more accurate correction but similar clinical outcomes as compared to conventional techniques","authors":"Grégoire Micicoi , Francesco Grasso , Lukas Hanak , Kristian Kley , Raghbir Khakha , Merwane Ayata , Jean-Marie Fayard , Matthieu Ollivier","doi":"10.1016/j.otsr.2024.103949","DOIUrl":"10.1016/j.otsr.2024.103949","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-specific cutting guides are increasingly used in the field of osteotomies around the knee and can improve the accuracy of planned correction and more specifically in the case of double-level osteotomy (DLO). The purpose of this study was to analyse the accuracy of postoperative coronal alignment after DLO using patient-specific cutting guides techniques (PSI) compared to conventional techniques.</div><div>The secondary objective was to compare the functional results between the two groups at short-term follow-up.</div></div><div><h3>Hypothesis</h3><div>The accuracy of global correction (HKA angle) is better with patient-specific cutting guides compared to conventional techniques for double-level osteotomy</div></div><div><h3>Methods</h3><div>This multicentric comparative retrospective study included 53 patients (mean age: 53.8 ± 5.2 years, male/female: 44/9) who underwent a DLO for knee varus malalignment. The coronal correction accuracy (as expressed by the difference between postoperative angular values and preoperative targeted correction) was compared between techniques using patient-specific cutting guides (PSI group, n = 27) or conventional techniques (n = 26) for the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA). Postoperatively, the global alignment expressed by the hip-knee-ankle angle and the joint line obliquity were compared between groups. The postoperative functional results for KOOS and UCLA activity scale score were also compared at a mean follow-up of 1.7 years (1.0–3.1 years).</div></div><div><h3>Results</h3><div>No difference was observed for the postoperative global alignment between the PSI and the conventional groups (Δ = 0.6 °, <em>p</em> = 0.11) neither for the postoperative posterior proximal tibial angle (Δ = 1.6°, <em>p</em> = 0,99) or the joint line obliquity (Δ = 0.3°, <em>p</em> = 0,17). In the coronal plane, the postoperative MPTA was lower in the PSI group (Δ = 2.3°, <em>p</em> < 0.001) as well as the postoperative LDFA (Δ = 0.9°, <em>p</em> = 0.01).</div><div>Concerning correction accuracy in the coronal plane, the results showed a significant higher accuracy of the planned correction in the PSI group compared to the conventional group for MPTA (2.2 ± 0.2 versus 0.8 ± 0.7, Δ = 1.5 °, <em>p</em> < 0.001) and LDFA (1.3 ± 1.0 versus 0.6 ± 0.9, Δ = 0.7°, <em>p</em> < 0.001).</div><div>No improvement difference was observed between the conventional group and the PSI group respectively for the KOOS symptoms (<em>p</em> = 0.12), the KOOS Pain (<em>p</em><span> = 0,57), the KOOS activities of daily living (</span><em>p</em> = 0.61), the KOOS sport/rec (<em>p</em><span> = 0.65), or for the KOOS Quality of Life (</span><em>p</em> = 0.99) neither for the UCLA (<em>p</em> = 0.97).</div></div><div><h3>Conclusions</h3><div>This study suggests that the use of custom-made cutting guides improves the accuracy of planned correction in double-level osteotom","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103949"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103956
Matthieu Ehlinger , Wiayo Azoti , Lil Le Crom , Samuel Berthe , Matthieu Ollivier , Henri Favreau , Mekki Tamir , Nadia Bahlouli
Introduction
Valgus high tibial osteotomy (HTO) is indicated for managing isolated medial knee osteoarthritis in a young patient with a metaphyseal deformity of the proximal tibia. In a medial opening HTO, maintaining the integrity of the lateral hinge is crucial for ensuring proper healing and correction retention. Using a locked plate to stabilize an HTO is common practice, allowing for earlier weight-bearing. The objective of this study was therefore to measure and track the mechanical load distribution on a locked fixation plate and the lateral hinge of an HTO using a finite element (FE) model simulating single-leg stance loading.
Hypothesis
The working hypothesis was that during weight-bearing, the plate and the lateral hinge absorb stress asymmetrically, predominantly on the plate.
Material and methods
A numerical model of an HTO stabilized with a locked plate was developed based on the actual geometry of a healthy proximal tibia (using Autodesk Fusion 360 and Altair HyperWorks software). In this finite element simulation of loading, a mesh convergence study was conducted to optimize the accuracy of the numerical model results. The primary outcome measure was the maximum stress value in the affected areas (Von Mises stress, in MPa) of the plate and the lateral hinge.
Results
The maximum stress intensity in the plate was approximately 20.29 MPa. The maximum stress intensity in the bony hinge was about 5.6 MPa. The results of the mesh convergence study for the hinge and the plate enabled defining the most suitable model for future FE studies: a 4 mm mesh for all model elements except for the high-stress area in the plate and the hinge, which were meshed with a 0.7 mm element size. This adaptation provided greater precision in the study.
Discussion
There is a distribution and allocation of stress both on the plate and the hinge, underlining the significance of the plate and the absolute necessity of preserving the hinge. Predictably, the plate absorbs the majority of the load, more than three times that of the hinge.
Conclusion
The hypothesis is confirmed; however, additional studies would be necessary to validate these numerical results: an experimental component on instrumented cadaveric bones, as well as comparative studies of different fixation plates.
{"title":"Analysis of load distribution on the plate and lateral hinge of a valgus opening high tibial osteotomy during weight-bearing: a finite element analysis","authors":"Matthieu Ehlinger , Wiayo Azoti , Lil Le Crom , Samuel Berthe , Matthieu Ollivier , Henri Favreau , Mekki Tamir , Nadia Bahlouli","doi":"10.1016/j.otsr.2024.103956","DOIUrl":"10.1016/j.otsr.2024.103956","url":null,"abstract":"<div><h3>Introduction</h3><div>Valgus<span><span> high tibial osteotomy (HTO) is indicated for managing isolated medial </span>knee osteoarthritis<span> in a young patient with a metaphyseal deformity of the proximal tibia. In a medial opening HTO, maintaining the integrity of the lateral hinge is crucial for ensuring proper healing and correction retention. Using a locked plate to stabilize an HTO is common practice, allowing for earlier weight-bearing. The objective of this study was therefore to measure and track the mechanical load distribution on a locked fixation plate and the lateral hinge of an HTO using a finite element (FE) model simulating single-leg stance loading.</span></span></div></div><div><h3>Hypothesis</h3><div>The working hypothesis was that during weight-bearing, the plate and the lateral hinge absorb stress asymmetrically, predominantly on the plate.</div></div><div><h3>Material and methods</h3><div>A numerical model of an HTO stabilized with a locked plate was developed based on the actual geometry of a healthy proximal tibia (using Autodesk Fusion 360 and Altair HyperWorks software). In this finite element simulation of loading, a mesh convergence study was conducted to optimize the accuracy of the numerical model results. The primary outcome measure was the maximum stress value in the affected areas (Von Mises stress, in MPa) of the plate and the lateral hinge.</div></div><div><h3>Results</h3><div>The maximum stress intensity in the plate was approximately 20.29 MPa. The maximum stress intensity in the bony hinge was about 5.6 MPa. The results of the mesh convergence study for the hinge and the plate enabled defining the most suitable model for future FE studies: a 4 mm mesh for all model elements except for the high-stress area in the plate and the hinge, which were meshed with a 0.7 mm element size. This adaptation provided greater precision in the study.</div></div><div><h3>Discussion</h3><div>There is a distribution and allocation of stress both on the plate and the hinge, underlining the significance of the plate and the absolute necessity of preserving the hinge. Predictably, the plate absorbs the majority of the load, more than three times that of the hinge.</div></div><div><h3>Conclusion</h3><div>The hypothesis is confirmed; however, additional studies would be necessary to validate these numerical results: an experimental component on instrumented cadaveric bones, as well as comparative studies of different fixation plates.</div></div><div><h3>Level of Evidence</h3><div>V, expert opinion; controlled laboratory study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103956"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103995
Pierre Martinot , Alexandre Baujard , Julien Dartus , Xavier Demondion , Julien Girard , Henri Migaud
Introduction
Several surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate.
Hypothesis
Our hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases.
Patients and methods
Fifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications.
Results
At a mean follow-up of 3 years (2–10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment.
Conclusion
Due to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang.
{"title":"Acetabular revision for iliopsoas impingement: a study of 55 cases at 3 years of follow-up. Does the procedure achieve the Minimal Clinically Important Difference (MCID) in the Oxford-12 score in more than 80% of cases?","authors":"Pierre Martinot , Alexandre Baujard , Julien Dartus , Xavier Demondion , Julien Girard , Henri Migaud","doi":"10.1016/j.otsr.2024.103995","DOIUrl":"10.1016/j.otsr.2024.103995","url":null,"abstract":"<div><h3>Introduction</h3><div>Several surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate.</div></div><div><h3>Hypothesis</h3><div>Our hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases.</div></div><div><h3>Patients and methods</h3><div>Fifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications.</div></div><div><h3>Results</h3><div>At a mean follow-up of 3 years (2–10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment.</div></div><div><h3>Conclusion</h3><div>Due to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103995"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104019
Charles Pioger , Simon Marmor , Pierre-Alban Bouché , Younes Kerroumi , Luc Lhotellier , Wilfrid Graff , Antoine Mouton , Beate Heym , Valérie Zeller
Purpose
This prospective clinical cohort was undertaken to determine the long-term risks of reinfection and all-cause aseptic failure after 1-stage exchange total knee arthroplasties (TKA) in a large series of consecutive patients with periprosthetic joint infection (PJI) following TKA.
Hypothesis
One-stage exchange for chronic PJI is an effective strategy, even in a non-selected population.
Patients and methods
Non-selected patients (152 with 154 PJI) undergoing 1-stage-exchange TKA for PJI (January 2003–August 2015) were prospectively included and monitored for ≥2 years. PJI following TKA satisfying Musculoskeletal Infection Society diagnostic criteria were documented by microbiological culture results of preoperative joint aspirates and/or intraoperative samples. The cumulative incidences of total reinfections (i.e., relapses or new infections) and aseptic revisions were assessed. The mean follow-up (FU) duration was 7.5 years post-reimplantation.
Results
At the last follow-up, 35 knees had developed reinfections: 7 relapses and 28 new infections, with respective 14-year cumulative incidences of 4.8% and 20.6%. The 2-, 5- and 14-year cumulative total reinfection incidences were 12.3%, 21.3% and 24.3%, respectively. Respective 2-, 5-, 10- and 14-year aseptic component-revision incidences were 0.7%, 3.2%, 5.4% and 13.4%. Multivariate analysis retained male sex (HR 3.27, p < 0.01) and preoperative atrial fibrillation (HR 3.03; p = 0.01) as being significantly associated with greater risk of reinfection.
Conclusions
One-stage-exchange TKA with aggressive debridement for chronic PJI is apparently a valid strategy, even for non-selected patients. It was associated with a low relapse rate, prevented morbidity and avoided economic social costs of 2-stage exchange. New infections with a different microorganism were observed more frequently and occurred even after years of FU.
Level of evidence
II; Therapeutic.
目的：该前瞻性临床队列研究旨在确定大量连续性膝关节置换术（TKA）后假体周围关节感染（PJI）患者在一期置换全膝关节置换术（TKA）后再感染和全因无菌失败的长期风险：假设：对慢性PJI进行单阶段置换是一种有效的策略，即使在非选定人群中也是如此：前瞻性地纳入了因PJI而接受TKA单阶段置换术的非选定患者（152例，其中154例为PJI）（2003年1月至2015年8月），并对其进行了≥2年的监测。术前关节抽吸物和（或）术中样本的微生物培养结果证明，TKA术后PJI符合肌肉骨骼感染学会的诊断标准。评估了总再感染（即复发或新感染）和无菌翻修的累积发生率。平均随访（FU）时间为再植后7.5年：结果：在最后一次随访中，有35个膝关节发生了再感染，其中7个复发，28个新感染：结果：在最后一次随访时，有35个膝关节发生了再感染：7个复发，28个新感染，14年的累计发生率分别为4.8%和20.6%。2年、5年和14年累计再感染总发生率分别为12.3%、21.3%和24.3%。2年、5年、10年和14年的无菌组件翻修发生率分别为0.7%、3.2%、5.4%和13.4%。多变量分析保留了男性性别（HR 3.27，p 结论：男性和女性的发病率分别为0.7%、3.2%、5.4%和13.4%：对于慢性 PJI，采用积极清创的单阶段交换 TKA 显然是一种有效的策略，即使是对未经选择的患者也是如此。它的复发率低，可预防发病，并避免两阶段置换的经济和社会成本。不同微生物的新感染更为常见，甚至在使用 FU 多年后仍会发生：证据等级：II；治疗。
{"title":"One-stage exchange strategy with extensive debridement for chronic periprosthetic joint infection following total knee arthroplasty is associated with a low relapse rate in non-selected patients: a prospective single-center analysis","authors":"Charles Pioger , Simon Marmor , Pierre-Alban Bouché , Younes Kerroumi , Luc Lhotellier , Wilfrid Graff , Antoine Mouton , Beate Heym , Valérie Zeller","doi":"10.1016/j.otsr.2024.104019","DOIUrl":"10.1016/j.otsr.2024.104019","url":null,"abstract":"<div><h3>Purpose</h3><div>This prospective clinical cohort was undertaken to determine the long-term risks of reinfection and all-cause aseptic failure after 1-stage exchange total knee arthroplasties (TKA) in a large series of consecutive patients with periprosthetic joint infection (PJI) following TKA.</div></div><div><h3>Hypothesis</h3><div>One-stage exchange for chronic PJI is an effective strategy, even in a non-selected population.</div></div><div><h3>Patients and methods</h3><div>Non-selected patients (152 with 154 PJI) undergoing 1-stage-exchange TKA for PJI (January 2003–August 2015) were prospectively included and monitored for ≥2 years. PJI following TKA satisfying Musculoskeletal Infection Society diagnostic criteria were documented by microbiological culture results of preoperative joint aspirates and/or intraoperative samples. The cumulative incidences of total reinfections (i.e., relapses or new infections) and aseptic revisions were assessed. The mean follow-up (FU) duration was 7.5 years post-reimplantation.</div></div><div><h3>Results</h3><div>At the last follow-up, 35 knees had developed reinfections: 7 relapses and 28 new infections, with respective 14-year cumulative incidences of 4.8% and 20.6%. The 2-, 5- and 14-year cumulative total reinfection incidences were 12.3%, 21.3% and 24.3%, respectively. Respective 2-, 5-, 10- and 14-year aseptic component-revision incidences were 0.7%, 3.2%, 5.4% and 13.4%. Multivariate analysis retained male sex (HR 3.27, p < 0.01) and preoperative atrial fibrillation (HR 3.03; p = 0.01) as being significantly associated with greater risk of reinfection.</div></div><div><h3>Conclusions</h3><div>One-stage-exchange TKA with aggressive debridement for chronic PJI is apparently a valid strategy, even for non-selected patients. It was associated with a low relapse rate, prevented morbidity and avoided economic social costs of 2-stage exchange. New infections with a different microorganism were observed more frequently and occurred even after years of FU.</div></div><div><h3>Level of evidence</h3><div>II; Therapeutic.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104019"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104057
Caroline Loiez , Eric Senneville , Barthélémy Lafon-Desmurs , Henri Migaud
Bacteriological sampling in orthopedic revision surgery for arthroplasty or internal fixation raises several questions. 1) When? And should sampling be systematic? Sampling should not be systematic in revision surgery, but only in case of suspected infection, in which case empirical antibiotic regimen should be systematically implemented. 2) How? Which tissues, how many and what transport? Only deep samples, preferably taken without ongoing antibiotic therapy, allow reliable interpretation of results. The optimal number of intra-operative samples is 5, or 3 if the laboratory uses seeding in aerobic and anaerobic vials. Samples should be transported to the laboratory within 2 h, at room temperature. 3) What conclusions can be drawn, using what references? There are several classifications, leading to divergent interpretation. The EBJIS (European Bone and Joint Infection Society) classification showed the best sensitivity in a multicenter study. 4) What duration of antibiotic washout before revision, and how to proceed if it cannot be achieved? The antibiotic-free period before sampling should be 14 days, or 21 days in case of prior treatment by cyclins, clindamycin, rifampicin or drugs with a very long half-life such as lipoglycopeptides, except when surgical intervention is required urgently. 5) How to deal with microbiological sampling and antibiotic prophylaxis at the time of revision surgery? Pursuing prophylactic antibiotic therapy during bone and joint implant revision does not greatly impair the value of intra-operative sampling. However, evidence of benefit of continuing antibiotic prophylaxis during revision arthroplasty is lacking. 6) What samples for atypic infection? Atypic micro-organisms (mycobacteria, fungi, etc.) require specific screening, guided by the clinical context and discussed before sampling is carried out.
{"title":"Bacteriological sampling in revision surgery: When, how, and with what therapeutic impact?","authors":"Caroline Loiez , Eric Senneville , Barthélémy Lafon-Desmurs , Henri Migaud","doi":"10.1016/j.otsr.2024.104057","DOIUrl":"10.1016/j.otsr.2024.104057","url":null,"abstract":"<div><div>Bacteriological sampling in orthopedic revision surgery for arthroplasty or internal fixation raises several questions. 1) When? And should sampling be systematic? Sampling should not be systematic in revision surgery, but only in case of suspected infection, in which case empirical antibiotic regimen should be systematically implemented. 2) How? Which tissues, how many and what transport? Only deep samples, preferably taken without ongoing antibiotic therapy, allow reliable interpretation of results. The optimal number of intra-operative samples is 5, or 3 if the laboratory uses seeding in aerobic and anaerobic vials. Samples should be transported to the laboratory within 2 h, at room temperature. 3) What conclusions can be drawn, using what references? There are several classifications, leading to divergent interpretation. The EBJIS (European Bone and Joint Infection Society) classification showed the best sensitivity in a multicenter study. 4) What duration of antibiotic washout before revision, and how to proceed if it cannot be achieved? The antibiotic-free period before sampling should be 14 days, or 21 days in case of prior treatment by cyclins, clindamycin, rifampicin or drugs with a very long half-life such as lipoglycopeptides, except when surgical intervention is required urgently. 5) How to deal with microbiological sampling and antibiotic prophylaxis at the time of revision surgery? Pursuing prophylactic antibiotic therapy during bone and joint implant revision does not greatly impair the value of intra-operative sampling. However, evidence of benefit of continuing antibiotic prophylaxis during revision arthroplasty is lacking. 6) What samples for atypic infection? Atypic micro-organisms (mycobacteria, fungi, etc.) require specific screening, guided by the clinical context and discussed before sampling is carried out.</div></div><div><h3>Level of evidence</h3><div>V; expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104057"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103925
Grégoire Micicoi , Matthieu Ollivier , Nicolas Bouguennec , Cécile Batailler , Nicolas Tardy , Goulven Rochcongar , Jean-Marie Fayard
<div><h3>Introduction</h3><div>Tibial correction is often performed during a valgus-producing osteotomy<span><span><span><span> for genu varum. However, overcorrection and the creation of a joint line obliquity (JLO) have been associated with unfavorable functional outcomes after </span>high tibial osteotomy (HTO). The aims of this study were to analyze: 1) the corrections obtained after HTO; 2) the rationale behind the indication per the European Society for </span>Sports Traumatology Surgery and </span>Arthroscopy (ESSKA) recommendations; and 3) the correlation between the postoperative corrections obtained and functional outcomes.</span></div></div><div><h3>Hypothesis</h3><div>A significant number of patients who underwent an isolated HTO did not present an “ideal” theoretical indication based on the preoperative angles and correction targets to be performed.</div></div><div><h3>Materials and methods</h3><div><span>This multicenter study included 289 isolated HTOs. Demographic and morphometric<span> data were anonymized and compiled in a database. Preoperative radiographic parameters were compared with the ESSKA consensus recommendations on osteotomies for genu varum. The consensus defined the “ideal” indication for performing an HTO as medial tibiofemoral compartment pain with significant tibial varus deformity (medial proximal tibial angle [MPTA]</span></span> <!--><<!--> <!-->85<!--> <!-->°), no significant femoral varus deformity (lateral distal femoral angle [LDFA]<!--> <!--><<!--> <!-->90<!--> <!-->°), an expected postoperative obliquity of less than 5<!--> <span>°, and a correction resulting in moderate tibial valgus (postoperative MPTA</span> <!--><<!--> <!-->94<!--> <!-->°). The incidence of patients with an “ideal” theoretical indication for isolated HTO and those with a theoretical indication not perfectly justified by the radiographic data and preoperative planning were recorded.</div></div><div><h3>Results</h3><div>Under the ESSKA consensus criteria, 25.3% (<em>n</em> <!-->=<!--> <!-->73) of isolated HTOs, 15.6% (<em>n</em> <!-->=<!--> <span>45) of isolated femoral osteotomies, 9.3% (</span><em>n</em> <!-->=<!--> <!-->27) of double-level osteotomies, and 49.9% (<em>n</em> <!-->=<!--> <span><span>144) of cases where no osteotomy was performed due to the lack of significant extra-articular tibial and/or femoral deformity were deemed justified. The presence of a preoperative femoral deformity and the absence of an “ideal” indication for HTO did not affect the postoperative Tegner Activity Scale or the </span>Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (</span><em>p<!--> </em>><!--> <!-->0.05). A high preoperative hip-knee-ankle (HKA) angle and MPTA, which indicated less varus, were associated with a greater risk of there being no “ideal” theoretical indication for an HTO (coefficient of determination [R<sup>2</sup>]<!--> <!-->=<!--> <!-->0.19 and R<sup>2</sup> <!-->=<!--> <!-->1, respecti
{"title":"Osteotomies for genu varum: Should we always correct at the tibia? A multicenter analysis of practices in France","authors":"Grégoire Micicoi , Matthieu Ollivier , Nicolas Bouguennec , Cécile Batailler , Nicolas Tardy , Goulven Rochcongar , Jean-Marie Fayard","doi":"10.1016/j.otsr.2024.103925","DOIUrl":"10.1016/j.otsr.2024.103925","url":null,"abstract":"<div><h3>Introduction</h3><div>Tibial correction is often performed during a valgus-producing osteotomy<span><span><span><span> for genu varum. However, overcorrection and the creation of a joint line obliquity (JLO) have been associated with unfavorable functional outcomes after </span>high tibial osteotomy (HTO). The aims of this study were to analyze: 1) the corrections obtained after HTO; 2) the rationale behind the indication per the European Society for </span>Sports Traumatology Surgery and </span>Arthroscopy (ESSKA) recommendations; and 3) the correlation between the postoperative corrections obtained and functional outcomes.</span></div></div><div><h3>Hypothesis</h3><div>A significant number of patients who underwent an isolated HTO did not present an “ideal” theoretical indication based on the preoperative angles and correction targets to be performed.</div></div><div><h3>Materials and methods</h3><div><span>This multicenter study included 289 isolated HTOs. Demographic and morphometric<span> data were anonymized and compiled in a database. Preoperative radiographic parameters were compared with the ESSKA consensus recommendations on osteotomies for genu varum. The consensus defined the “ideal” indication for performing an HTO as medial tibiofemoral compartment pain with significant tibial varus deformity (medial proximal tibial angle [MPTA]</span></span> <!--><<!--> <!-->85<!--> <!-->°), no significant femoral varus deformity (lateral distal femoral angle [LDFA]<!--> <!--><<!--> <!-->90<!--> <!-->°), an expected postoperative obliquity of less than 5<!--> <span>°, and a correction resulting in moderate tibial valgus (postoperative MPTA</span> <!--><<!--> <!-->94<!--> <!-->°). The incidence of patients with an “ideal” theoretical indication for isolated HTO and those with a theoretical indication not perfectly justified by the radiographic data and preoperative planning were recorded.</div></div><div><h3>Results</h3><div>Under the ESSKA consensus criteria, 25.3% (<em>n</em> <!-->=<!--> <!-->73) of isolated HTOs, 15.6% (<em>n</em> <!-->=<!--> <span>45) of isolated femoral osteotomies, 9.3% (</span><em>n</em> <!-->=<!--> <!-->27) of double-level osteotomies, and 49.9% (<em>n</em> <!-->=<!--> <span><span>144) of cases where no osteotomy was performed due to the lack of significant extra-articular tibial and/or femoral deformity were deemed justified. The presence of a preoperative femoral deformity and the absence of an “ideal” indication for HTO did not affect the postoperative Tegner Activity Scale or the </span>Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (</span><em>p<!--> </em>><!--> <!-->0.05). A high preoperative hip-knee-ankle (HKA) angle and MPTA, which indicated less varus, were associated with a greater risk of there being no “ideal” theoretical indication for an HTO (coefficient of determination [R<sup>2</sup>]<!--> <!-->=<!--> <!-->0.19 and R<sup>2</sup> <!-->=<!--> <!-->1, respecti","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103925"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103845
Elsayed Said , Ahmed Mohamed Ahmed , Ahmad Addosooki , Hossam Ahmed Attya , Ahmad Khairy Awad , Emad Hamdy Ahmed , Hamdy Tammam
<div><h3>Purpose</h3><div>Opening-wedge high tibial osteotomy<span> (OWHTO) requires fixation devices for stabilization of the osteotomy gap. The two most commonly used fixation devices are the Puddu and the TomoFix plates. Based on its design, each implant generates a characteristic stability profile. The aim of this randomized controlled trial (RCT) was to investigate the short-term clinical and radiological outcomes of OWHTO using the Puddu and TomoFix plating systems. We hypothesized that the TomoFix plate would achieve superior clinical and radiographic results compared to the Puddu plate.</span></div></div><div><h3>Methods</h3><div><span>A total of 60 patients were randomly allocated to undergo OWHTO either using the Puddu plate or the TomoFix plate if conservative treatment failed with symptomatic medial compartment knee osteoarthritis (OA) stage I or II according to Ahlbäck classification, and varus malalignment. All patients underwent clinical and radiological assessment preoperatively, and at 3, 6, 12, and 24</span> <span>months postoperatively. Radiological measurement of the hip-knee-ankle (HKA) angle, and posterior tibial slope (PTS) was performed. Functional assessment was carried out using the Hospital for Special Surgery Knee-Rating Scale (HSS) and the Western Ontario McMaster Universities (WOMAC) Osteoarthritis<span> Index. Patients were also evaluated for intraoperative and postoperative complications throughout the follow-up period.</span></span></div></div><div><h3>Results</h3><div>The mean angular correction was 9.6<!--> <!-->±<!--> <!-->4°, and 10.5<!--> <!-->±<!--> <!-->4.8° in the Puddu and TomoFix groups, respectively (<em>p</em> <!-->=<!--> <!-->0.488). The mean PTS change was significantly higher in the Puddu group (3.4<!--> <!-->±<!--> <!-->1.1°) compared to the TomoFix group (0.8<!--> <!-->±<!--> <!-->0.7°) (<em>p</em> <!--><<!--> <span>0.001). There was a statistically significant improvement in the mean HSS and WOMAC in both groups until one year postoperatively. Neither HSS nor WOMAC showed a statistically significant difference between the Puddu and TomoFix groups at any time during the first two postoperative years. The overall complication rate was not significantly different between the Puddu and TomoFix groups. However, the TomoFix group demonstrated higher incidence of symptomatic hardware (23% vs. 3.3%) and removal of metalwork (17% vs. 0%) than the Puddu group (</span><em>p</em> <!-->=<!--> <!-->0.023 and 0.020, respectively).</div></div><div><h3>Conclusion</h3><div>This RCT suggests that the implant choice for OWHTO has no significant impact on functional outcomes during the first 2<!--> <!-->years postoperatively. While the Puddu plate was associated with an unintentional increase in the PTS during the surgery, both implants allowed coronal and sagittal plane corrections to be preserved postoperatively. The overall complication rates were similar, but the TomoFix required more material to be removed be
{"title":"Comparison of the clinical and radiological outcomes of Puddu and TomoFix plates for medial opening-wedge high tibial osteotomy: A two-year follow-up of a randomized controlled trial","authors":"Elsayed Said , Ahmed Mohamed Ahmed , Ahmad Addosooki , Hossam Ahmed Attya , Ahmad Khairy Awad , Emad Hamdy Ahmed , Hamdy Tammam","doi":"10.1016/j.otsr.2024.103845","DOIUrl":"10.1016/j.otsr.2024.103845","url":null,"abstract":"<div><h3>Purpose</h3><div>Opening-wedge high tibial osteotomy<span> (OWHTO) requires fixation devices for stabilization of the osteotomy gap. The two most commonly used fixation devices are the Puddu and the TomoFix plates. Based on its design, each implant generates a characteristic stability profile. The aim of this randomized controlled trial (RCT) was to investigate the short-term clinical and radiological outcomes of OWHTO using the Puddu and TomoFix plating systems. We hypothesized that the TomoFix plate would achieve superior clinical and radiographic results compared to the Puddu plate.</span></div></div><div><h3>Methods</h3><div><span>A total of 60 patients were randomly allocated to undergo OWHTO either using the Puddu plate or the TomoFix plate if conservative treatment failed with symptomatic medial compartment knee osteoarthritis (OA) stage I or II according to Ahlbäck classification, and varus malalignment. All patients underwent clinical and radiological assessment preoperatively, and at 3, 6, 12, and 24</span> <span>months postoperatively. Radiological measurement of the hip-knee-ankle (HKA) angle, and posterior tibial slope (PTS) was performed. Functional assessment was carried out using the Hospital for Special Surgery Knee-Rating Scale (HSS) and the Western Ontario McMaster Universities (WOMAC) Osteoarthritis<span> Index. Patients were also evaluated for intraoperative and postoperative complications throughout the follow-up period.</span></span></div></div><div><h3>Results</h3><div>The mean angular correction was 9.6<!--> <!-->±<!--> <!-->4°, and 10.5<!--> <!-->±<!--> <!-->4.8° in the Puddu and TomoFix groups, respectively (<em>p</em> <!-->=<!--> <!-->0.488). The mean PTS change was significantly higher in the Puddu group (3.4<!--> <!-->±<!--> <!-->1.1°) compared to the TomoFix group (0.8<!--> <!-->±<!--> <!-->0.7°) (<em>p</em> <!--><<!--> <span>0.001). There was a statistically significant improvement in the mean HSS and WOMAC in both groups until one year postoperatively. Neither HSS nor WOMAC showed a statistically significant difference between the Puddu and TomoFix groups at any time during the first two postoperative years. The overall complication rate was not significantly different between the Puddu and TomoFix groups. However, the TomoFix group demonstrated higher incidence of symptomatic hardware (23% vs. 3.3%) and removal of metalwork (17% vs. 0%) than the Puddu group (</span><em>p</em> <!-->=<!--> <!-->0.023 and 0.020, respectively).</div></div><div><h3>Conclusion</h3><div>This RCT suggests that the implant choice for OWHTO has no significant impact on functional outcomes during the first 2<!--> <!-->years postoperatively. While the Puddu plate was associated with an unintentional increase in the PTS during the surgery, both implants allowed coronal and sagittal plane corrections to be preserved postoperatively. The overall complication rates were similar, but the TomoFix required more material to be removed be","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103845"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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