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A Novel Safety Device For Bicortical Fixation In Medial-opening Wedge High Tibial Osteotomy Reduces Correction Loss And Promotes Bone Union

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A Novel Safety Device For Bicortical Fixation In Medial-opening Wedge High Tibial Osteotomy Reduces Correction Loss And Promotes Bone Union

Syunya Otani, MD, PhD, JAPAN Masafumi Itoh, MD, PhD, JAPAN Umito Kuwashima, MD, PhD, JAPAN Junya Itou, MD, PhD, JAPAN Ken Okazaki, MD, PhD, JAPAN

Tokyo Women's Medical University, Shinjuku, Tokyo, JAPAN

2025 Congress ePoster Presentation 2025 Congress Not yet rated

Anatomic Location

Knee

Treatment / Technique

Osteotomy

Diagnosis / Condition

Osteoarthritis

Diagnosis Method

X-ray

Summary: A novel device for bicortical fixation of distal screws in MOWHTO significantly enhances bone union and reduces correction loss, indicating it as a preferred method to improve patient outcomes and minimize complications.

Introduction

Medial-opening wedge high tibial osteotomy (MOWHTO) is a widely accepted surgical procedure for treating varus deformity in patients with knee osteoarthritis. However, complications such as neurovascular injury during distal screw drilling remain a concern. To address this, we have developed a novel device designed to prevent injury to the contralateral neurovascular bundle and enable safe bicortical fixation of all four distal screws. While bicortical fixation is theoretically superior in providing stability, its effect on postoperative outcomes compared to a mixed method with some monocortical screws is not well established. This study aims to evaluate the influence of the distal screw fixation method on bone union and correction loss following MOWHTO.

Methods

We conducted a retrospective analysis of 77 knees in 73 consecutive patients who underwent MOWHTO at our institution between August 2019 and August 2023. Patients were divided into two groups: the Bi group, where all four distal screws were bicortically fixed, and the Mono group, where two screws were monocortically fixed. We assessed bone union at 3 months and correction loss of the medial proximal tibial angle (MPTA) at 1 year postoperatively. Multivariate regression analysis was used to evaluate the impact of screw fixation method, opening width, and body mass index (BMI) on correction loss. Statistical significance was determined using the unpaired t-test and Fisher’s exact test, with a p-value of <0.05 considered significant.

Results

The Bi group demonstrated significantly better bone union at 3 months postoperatively compared to the Mono group (p = 0.005). Additionally, the correction loss at 1 year was significantly smaller in the Bi group (p = 0.0005), with only 1 case (3%) exhibiting a loss of more than 1°, compared to 8 cases (25%) in the Mono group (p<0.05). Furthermore, there were no cases in the Bi group with correction loss exceeding 2°, while the Mono group had 2 cases (6%). Multivariate analysis confirmed that the bicortical fixation method was a significant factor contributing to improved bone union and reduced correction loss.

Conclusion

The novel safety device allowing for secure bicortical fixation of all distal screws in MOWHTO significantly promotes bone union and reduces correction loss, demonstrating its clinical efficacy. Our findings suggest that bicortical fixation, facilitated by this new device, should be considered as a preferred method in MOWHTO to optimize patient outcomes and minimize complications. Further studies with larger sample sizes and longer follow-up periods are warranted to confirm these results.

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Support Instruments Provide Remarkable Stability in Medial Closed Wedge Distal Femoral Osteotomy -A Finite Element Analysis- ePoster Presentation Umito Kuwashima, MD, PhD, JAPAN Masafumi Itoh, MD, PhD, JAPAN Junya Itou, MD, PhD, JAPAN Ken Okazaki, MD, PhD, JAPAN
Mid-Term Outcome Analysis Between Isolated Hto V/S Hto Combined With Arthroscopy In Medial Compartment Oa Knee - A Comparative Study ePoster Presentation Arun Gr, MBBS,MS,FASM, INDIA
Tibial Slope Variation After Opening Wedge High Tibial Osteotomy While No Change in Closing Wedge Technique ePoster Presentation Robert Ferrer-Rivero, MD, SPAIN Oriol Pujol, MD, SPAIN Josep Ferrer-Rivero, MD, SPAIN Gabriel Oliver, MD, PhD, SPAIN
Influence of Preoperative Bone Marrow Lesions on Postoperative Cartilage Improvement After Open Wedge High Tibial Osteotomy ePoster Presentation Kosuke Kawamura, MD, JAPAN Eiji Sasaki, MD, PhD, JAPAN Takahiro Tsushima, MD, PhD, JAPAN Yuka Kimura, MD, PhD, JAPAN Yukiko Sakamoto, MD, PhD, JAPAN Eiichi Tsuda, Prof., JAPAN Yasuyuki Ishibashi, MD, JAPAN
DOUBLE LEVEL OSTEOTOMY FOR THE MANAGEMENT OF SEVERE VARUS MALALIGNMENT (ABOVE 15 DEGREES). CLINICAL AND RADIOGRAPHIC FOLLOW-UP AT TWO YEARS. ePoster Presentation Rodolfo Morales-Avalos, MD, PhD., MEXICO Luis Miguel Pacheco-Garcia, MD, PhD., MEXICO
Relationship Between Proximal Tibio-Fibular Overlap And Lower Limb Torsion In An Asian Population ePoster Presentation Ashton Tan, MBBS, SINGAPORE Xinyu Tao, MBBS, SINGAPORE Don Koh, MBBS, BSc, MRCS, MMED, SINGAPORE Kong Hwee Lee, MBBS, FRCS (Ortho), SINGAPORE Hamid Rahmatullah Bin Abd Razak, MBBS, FRCSEd (Ortho), FRCSGlasg (Tr & Orth), FAMS, SINGAPORE Junwei Soong, MBBS, MRCS (Edin), MMED (Ortho), FRCS (Edin), SINGAPORE
The Benefits Of A Percutaneous Supplemental Screw To Reinforce The Hinge Of A Medial Open Wedge Tibial Osteotomy ePoster Presentation Hsuan‑Hsiao Ma, MD, TAIWAN En-Rung Chiang, MD, PhD, TAIWAN
The Impact Of Medial Opening Wedge High Tibial Osteotomy On Patellar Height And Tibial Tubercle – Trochlear Groove Distance: Prospective Analysis Of 54 Consecutive Cases. ePoster Presentation Coral Castillejo Iniesta, MD, SPAIN Giacomo Dal Fabbro, MD, AUSTRALIA Margherita Bonaiuti, PhD, ITALY Claudio Belvedere, PhD, ITALY Alberto Leardini, DPhil, ITALY Fabio Norvillo, ITALY Alberto Grassi, PhD, ITALY Stefano Zaffagnini, MD, Prof., ITALY Fulvia Taddei, ENG, ITALY

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A Novel Safety Device For Bicortical Fixation In Medial-opening Wedge High Tibial Osteotomy Reduces Correction Loss And Promotes Bone Union

A Novel Safety Device For Bicortical Fixation In Medial-opening Wedge High Tibial Osteotomy Reduces Correction Loss And Promotes Bone Union

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A Novel Safety Device For Bicortical Fixation In Medial-opening Wedge High Tibial Osteotomy Reduces Correction Loss And Promotes Bone Union

A Novel Safety Device For Bicortical Fixation In Medial-opening Wedge High Tibial Osteotomy Reduces Correction Loss And Promotes Bone Union

Introduction

Methods

Results

Conclusion