Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial
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(2020) 32:65
RESEARCH ARTICLE
Knee Surgery & Related Research
Open Access
Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial osteotomy Nobuyuki Hiraoka1,2, Shuji Nakagawa3, Eigo Otakara1,2, Hiroaki Inoue1, Kenji Takahashi1 and Yuji Arai3*
Abstract Background: Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO. Methods: The study cohort consisted of 30 patients (15 men and 15 women) who underwent hybrid CWHTO for medial compartment osteoarthritis or spontaneous osteonecrosis of the knee. Sixteen knees were fixed with a lateral locking plate (LP group), and 17 were fixed with both a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia (LPS group). The times to bone union, radiolucency, and callus formation at the osteotomy site were evaluated radiographically. Results: The mean postoperative time to radiographic confirmation of bone union was 5.5 ± 2.6 months in the LP group and 3.4 ± 1.5 months in the LPS group. Radiolucency at the osteotomy site and excess callus formation on the posterior side of the tibia were lower in the LPS group than in the LP group. Conclusions: This modified hybrid CWHTO combining a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia improves the stability of the osteotomy site and shortens the period of bone union. Keywords: Bone union, Screw fixation, Hybrid closed-wedge high tibial osteotomy, Knee osteoarthritis, Spontaneous osteonecrosis of the knee, Cannulated cancellous screw, Callus, Locking plate
Background High tibial osteotomy (HTO) is a useful surgical treatment for medial osteoarthritis (OA) of the knee and spontaneous osteonecrosis (ON) of the femur. Two main types of HTO procedures are performed most frequently: lateral closed-wedge HTO, which closes the lateral side of the tibia, and medial open-wedge HTO, which opens the medial side of the tibia [1, 2]. Medial open-wedge HTO has recently shown good clinical outcomes in patients with medial knee OA [3, 4]. However, * Correspondence: [email protected] 3 Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan Full list of author information is available at the end of the article
excess correction of the lower limbs has been associated with various complications, including OA of the patellofemoral joint, increased soft tissue tension, lateral hinge fracture, and delayed bone union [5–7]. Although closed-wedge HTO (CWHTO) can be adapted for knees with advanced varus deformity, this procedure has disadvantages such as leg shortening and lateral offset of the proximal tibia associated with the osteotomy. These drawba
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