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Extreme Hinge Axis Positions are Necessary to Achieve Posterior Tibial Slope Reduction with Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

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Extreme Hinge Axis Positions are Necessary to Achieve Posterior Tibial Slope Reduction with Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Erica Swartwout, BA, UNITED STATES Hugo Robichaud, CANADA Anil S. Ranawat, MD, UNITED STATES Atul F. Kamath, MD, UNITED STATES

Hospital for Special Surgery, New York, New York, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Bones

Diagnosis / Condition

Arthritis

Treatment / Technique

Osteotomy

Summary: The mean hinge axis position for slope-neutral osteotomy was 102.6 ± 8.3 relative to the PCA. For smaller corrections in the coronal plane, more extreme hinge axis positions were necessary to achieve higher magnitudes of PTS reduction.

Background

Both coronal- and sagittal-plane knee malalignment can increase the risk of ligamentous injuries and the progression of degenerative joint disease. High tibial osteotomy can achieve multiplanar correction, but determining the precise hinge axis position for osteotomy is technically challenging.

Purpose

To create computed tomography (CT)–based patient-specific models to identify the ideal hinge axis position angle and the amount of maximum opening in medial opening wedge high tibial osteotomy (MOWHTO) required to achieve the desired multiplanar correction.
Study Design: Descriptive laboratory study.

Methods

A total of 10 patients with lower extremity CT scans were included. Baseline measurements including the mechanical tibiofemoral angle (mTFA) and the posterior tibial slope (PTS) were calculated. Virtual osteotomy was performed to achieve (1) a specified degree of PTS correction and (2) a planned degree of mTFA correction. The mean hinge axis position angle for MOWHTO to maintain an anatomic PTS (no slope correction) was 102.6 ± 8.3 relative to the posterior condylar axis (PCA). Using this as the baseline correction, the resultant hinge axis position and maximum opening were then calculated for each subsequent osteotomy procedure.

Results

For 5.0 of mTFA correction, the hinge axis position was decreased by 6.8 , and the maximum opening was increased by 0.49 mm for every 1 of PTS correction. For 10.0 of mTFA correction, the hinge axis position was decreased by 5.2 , and the maximum opening was increased by 0.37 mm for every 1 of PTS correction. There was a significant difference in the trend-line slopes for hinge axis position versus PTS correction (P ¼ .013) and a significant difference in the trend-line intercepts for maximum opening versus PTS correction (P < .0001).

Conclusion

The mean hinge axis position for slope-neutral osteotomy was 102.6 ± 8.3 relative to the PCA. For smaller corrections in the coronal plane, more extreme hinge axis positions were necessary to achieve higher magnitudes of PTS reduction.

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Extreme Hinge Axis Positions are Necessary to Achieve Posterior Tibial Slope Reduction with Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Extreme Hinge Axis Positions are Necessary to Achieve Posterior Tibial Slope Reduction with Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Background

Purpose

Methods

Results

Conclusion

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Extreme Hinge Axis Positions are Necessary to Achieve Posterior Tibial Slope Reduction with Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Extreme Hinge Axis Positions are Necessary to Achieve Posterior Tibial Slope Reduction with Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Background

Purpose

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content