Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MAO Yanjie , HE Axiang , ZHOU Ying , CHEN Yanan , LIU Yaru , YU Xiaowei , ZHANG Xianlong ,  LIU Wanjun

Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, P. R. China;

Corresponding author：

LIU Wanjun, Email: LYliuwanjun@126.com

Keywords：

Medial open-wedge high tibial osteotomy; knee; osteoarthritis; tibia fibular angle; femoral fibular angle; lower limb alignment

DOI：

10.7507/1002-1892.202108128

Video：

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Objective To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). Methods A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m², with an average of 26.7 kg/m². Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson’s test. According to the median BMI of patients (25.81 kg/m²), the patients were allocated into high BMI group (>25.81 kg/m², n=10) and low BMI group (≤25.81 kg/m², n=10), and the influencing factors of WBL ratio was analyzed by linear regression. Results There was no significant difference between pre- and post-operation in LDFA and JLCA (P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio (P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference (t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference (t=1.760, P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group (P<0.05), but X was not an influential factor of Y in the high BMI group (P>0.05). Conclusion Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m².

Citation： MAO Yanjie, HE Axiang, ZHOU Ying, CHEN Yanan, LIU Yaru, YU Xiaowei, ZHANG Xianlong, LIU Wanjun. Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(1): 58-64. doi: 10.7507/1002-1892.202108128 Copy

1.	Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 2001, 286(2): 188-195.
2.	陈伟, 陈百成, 王飞, 等. 应用不同方法治疗膝关节骨性关节炎的对比研究. 河北医科大学学报, 2015, 36(5): 600-602.
3.	Sethi G, Aljawadi A, Elmajee M, et al. Determination of the postoperative limb alignment following a high tibial osteotomy in patients with uni-compartmental knee osteoarthritis, review article. J Orthop, 2020, 18: 53-57.
4.	Yoon SD, Zhang G, Kim HJ, et al. Comparison of cable method and miniaci method using picture archiving and communication system in preoperative planning for open Wedge high tibial osteotomy. Knee Surg Relat Res, 2016, 28(4): 283-288.
5.	Han SB, Kim HJ, Lee DH. Effect of computer navigation on accuracy and reliability of limb alignment correction following open-Wedge high tibial osteotomy: A meta-analysis. Biomed Res Int, 2017, 2017: 3803457. doi: 10.1155/2017/3803457.
6.	Kim MK, Ko BS, Park JH. The proper correction of the mechanical axis in high tibial osteotomy with concomitant cartilage procedures-a retrospective comparative study. J Orthop Surg Res, 2019, 14(1): 281. doi: 10.1186/s13018-019-1333-4.
7.	Krettek C, Miclau T, Grun O, et al. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury, 1998, 29 Suppl 3: C29-39.
8.	Wang L, Fallavollita P, Brand A, et al. Intra-op measurement of the mechanical axis deviation: an evaluation study on 19 human cadaver legs. Med Image Comput Comput Assist Interv, 2012, 15(Pt 2): 609-616.
9.	Saleh M, Harriman P, Edwards DJ. A radiological method for producing precise limb alignment. J Bone Joint Surg (Br), 1991, 73(3): 515-516.
10.	Hankemeier S, Hufner T, Wang G, et al. Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc, 2006, 14(10): 917-921.
11.	Chang J, Scallon G, Beckert M, et al. Comparing the accuracy of high tibial osteotomies between computer navigation and conventional methods. Computer Assisted Surgery, 2017, 22(1): 1-8.
12.	Yang JC, Chen CF, Luo CA, et al. Clinical experience using a 3D-printed patient-specific instrument for medial opening Wedge high tibial osteotomy. Biomed Res Int, 2018, 2018: 9246529. doi: 10.1155/2018/9246529.
13.	Wang JH, Shin JM, Kim HH, et al. Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy. Int Orthop, 2017, 41(1): 85-92.
14.	Chaouche S, Jacquet C, Fabre-Aubrespy M, et al. Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. Int Orthop, 2019, 43(12): 2757-2765.
15.	Cerciello S, Ollivier M, Corona K, et al. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2020. doi: 10.1007/s00167-020-06253-5.
16.	Kubota M, Ohno R, Sato T, et al. The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2410-2416.
17.	赵晨, 张兵, 朱鹏, 等. 改良单平面截骨及下肢力线矫正在胫骨高位截骨术的应用. 中华关节外科杂志 (电子版), 2019, 13(3): 302-308.
18.	Sabharwal S, Zhao C. Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg (Am), 2008, 90(1): 43-51.
19.	Jang KM, Lee JH, Cho IY, et al. Intraoperative fluoroscopic assessment of limb alignment is a reliable predictor for postoperative limb alignment in biplanar medial opening-wedge high tibial osteotomy. J Arthroplasty, 2017, 32(3): 756-760.
20.	Brouwer RW, Jakma TS, Brouwer KH, et al. Pitfalls in determining knee alignment: a radiographic cadaver study. J Knee Surg, 2007, 20(3): 210-215.

1. Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 2001, 286(2): 188-195.
2. 陈伟, 陈百成, 王飞, 等. 应用不同方法治疗膝关节骨性关节炎的对比研究. 河北医科大学学报, 2015, 36(5): 600-602.
3. Sethi G, Aljawadi A, Elmajee M, et al. Determination of the postoperative limb alignment following a high tibial osteotomy in patients with uni-compartmental knee osteoarthritis, review article. J Orthop, 2020, 18: 53-57.
4. Yoon SD, Zhang G, Kim HJ, et al. Comparison of cable method and miniaci method using picture archiving and communication system in preoperative planning for open Wedge high tibial osteotomy. Knee Surg Relat Res, 2016, 28(4): 283-288.
5. Han SB, Kim HJ, Lee DH. Effect of computer navigation on accuracy and reliability of limb alignment correction following open-Wedge high tibial osteotomy: A meta-analysis. Biomed Res Int, 2017, 2017: 3803457. doi: 10.1155/2017/3803457.
6. Kim MK, Ko BS, Park JH. The proper correction of the mechanical axis in high tibial osteotomy with concomitant cartilage procedures-a retrospective comparative study. J Orthop Surg Res, 2019, 14(1): 281. doi: 10.1186/s13018-019-1333-4.
7. Krettek C, Miclau T, Grun O, et al. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury, 1998, 29 Suppl 3: C29-39.
8. Wang L, Fallavollita P, Brand A, et al. Intra-op measurement of the mechanical axis deviation: an evaluation study on 19 human cadaver legs. Med Image Comput Comput Assist Interv, 2012, 15(Pt 2): 609-616.
9. Saleh M, Harriman P, Edwards DJ. A radiological method for producing precise limb alignment. J Bone Joint Surg (Br), 1991, 73(3): 515-516.
10. Hankemeier S, Hufner T, Wang G, et al. Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc, 2006, 14(10): 917-921.
11. Chang J, Scallon G, Beckert M, et al. Comparing the accuracy of high tibial osteotomies between computer navigation and conventional methods. Computer Assisted Surgery, 2017, 22(1): 1-8.
12. Yang JC, Chen CF, Luo CA, et al. Clinical experience using a 3D-printed patient-specific instrument for medial opening Wedge high tibial osteotomy. Biomed Res Int, 2018, 2018: 9246529. doi: 10.1155/2018/9246529.
13. Wang JH, Shin JM, Kim HH, et al. Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy. Int Orthop, 2017, 41(1): 85-92.
14. Chaouche S, Jacquet C, Fabre-Aubrespy M, et al. Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort. Int Orthop, 2019, 43(12): 2757-2765.
15. Cerciello S, Ollivier M, Corona K, et al. CAS and PSI increase coronal alignment accuracy and reduce outliers when compared to traditional technique of medial open wedge high tibial osteotomy: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2020. doi: 10.1007/s00167-020-06253-5.
16. Kubota M, Ohno R, Sato T, et al. The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2410-2416.
17. 赵晨, 张兵, 朱鹏, 等. 改良单平面截骨及下肢力线矫正在胫骨高位截骨术的应用. 中华关节外科杂志 (电子版), 2019, 13(3): 302-308.
18. Sabharwal S, Zhao C. Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg (Am), 2008, 90(1): 43-51.
19. Jang KM, Lee JH, Cho IY, et al. Intraoperative fluoroscopic assessment of limb alignment is a reliable predictor for postoperative limb alignment in biplanar medial opening-wedge high tibial osteotomy. J Arthroplasty, 2017, 32(3): 756-760.
20. Brouwer RW, Jakma TS, Brouwer KH, et al. Pitfalls in determining knee alignment: a radiographic cadaver study. J Knee Surg, 2007, 20(3): 210-215.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy

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