Abstract
Introduction
Open wedge high tibial osteotomy (OWHTO) is an operation by the proper load re-distribution in the treatment for medial uni-compartmental arthritis of the knee joint. However, for the proper load re-distribution, stable fixation is mandatory. For the stable fixation, plate should be contoured to the bony surface and screws should be inserted from the central area of the medial side to the hinge area of the lateral side in the proximal fragment because most failures occur at the relatively lesser supported lateral hinge area. Therefore, the purpose of this study was to evaluate the screw insertion angle and orientation that is inserted to the direction of the lateral hinge with an anatomical plate that is post-contoured with a surface geometry of the proximal tibia after the OWHTO. The hypothesis of this study was that the position and orientation would be different according to the correction degree (median value 10 mm) and surgical technique (uni-planar vs bi-planar).
Materials and Methods
Thirty-one uni-planar and thirty-eight bi-planar osteotomies were evaluated. Postoperative CT data obtained after OWHTO were used for the 3D reconstruction of the proximal tibia. Anterior dimension (L1) and posterior dimension (L2) of the proximal tibia were measured in sagittal plane from tibial spine. Screw insertion points using four holes were even distributed using L1 and L2 value. As screw insertion angle was set from four holes to lateral hinge of the ‘Safe Zone’. Those four angles were measured in the axial and coronal plane. These were compared according to the correction degree and surgical technique.
Results
Anterior AP dimension ‘L1'and posterior AP dimension ‘L2'were measured 24.0 ± 3.7 mm, 22.6 ± 3.1 mm. Angulations of screw from respectively screw hole to lateral hinge were measured 11.3 ± 1.7°, 3.5 ± 1.3°, 3.1 ± 1.5°, and 9.5 ± 1.1° in the axial plane and 81.5 ± 6.0°, 101.5 ± 2.6°, 90.8 ± 3.7°, and 99.2 ± 2.8° in coronal plane, respectively. None of the comparisons were statistically different, regardless of the correction degree and operative technique (Table1).
Conclusions
Range of screw angulation showed regular pattern according to the site of the screw hole and it was not different, regardless of the correction degree and operative technique. This study provided range of the screw angulation by the anatomical surface modeling. Future study would give additional benefit for the optimal screw angle and stability such as finite element analysis or other methods.
