Skip to main content
Online ISSN: 2723-7826 | Print ISSN: 2723-7818
State of The Art

High Tibial Osteotomy: State of the art

DOI: https://doi.org/10.46355/hipknee.v4i2.155

Abstract

The number of cases handled by PJI is projected to rise in the coming years. The diagnosis of PJI relies on evaluating microbiology, inflammatory response, and pathology. However, the accuracy of the diagnosis is compromised by previous exposure to antimicrobial agents, the possibility of contamination, and the lack of specificity of inflammatory markers. Although new testing methods, such as molecular techniques, hold the potential for a swift diagnosis, they are constrained by the risk of contamination and the absence of susceptibility results. Interestingly, emerging synovial fluid markers exhibit promise as an additional tool in diagnosing PJI. The management of each PJI case, both in terms of surgery and antimicrobial treatment, requires an individualized assessment. It is imperative to conduct high-quality studies that aim to determine the most effective route and duration of antimicrobial treatment for each surgical approach. This review provides an overview of the diagnostic tests and treatment options for prosthetic joint infection, offering a practical approach to managing this complex clinical condition.

References

  1. Di Matteo B, Tarabella V, Filardo G, Viganò A, Tomba P, Marcacci M. John Rhea Barton: The birth of osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(9):1957-1962. doi:10.1007/s00167-013-2387-1
  2. Sabzevari S, Ebrahimpour A, Mostafa ;, Roudi K, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. Vol 4.; 2016. http://abjs.mums.ac.irtheonlineversionofthisarticleabjs.mums.ac.ir
  3. Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res. 2012;24(2):61-69. doi:10.5792/ksrr.2012.24.2.61
  4. Smith JO, Wilson AJ, Thomas NP. Osteotomy around the knee: Evolution, principles and results. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(1):3-22. doi:10.1007/s00167-012-2206-0
  5. Krych AJ, Hevesi M, Desai VS, Camp CL, Stuart MJ, Saris DBF. Learning From Failure in Cartilage Repair Surgery: An Analysis of the Mode of Failure of Primary Procedures in Consecutive Cases at a Tertiary Referral Center. Orthop J Sports Med. 2018;6(5). doi:10.1177/2325967118773041
  6. Dean CS, Liechti DJ, Chahla J, Moatshe G, LaPrade RF. Clinical Outcomes of High Tibial Osteotomy for Knee Instability: A Systematic Review. Orthop J Sports Med. 2016;4(3). doi:10.1177/2325967116633419
  7. Brinkman JM, Lobenhoffer P, Agneskirchner JD, et al. Osteotomies around the knee PATIENT SELECTION, STABILITY OF FIXATION AND BONE HEALING IN HIGH TIBIAL OSTEOTOMIES. J Bone Joint Surg. doi:10.1302/0301-620X.90B12
  8. Santoso MB, Wu L. Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. J Orthop Surg Res. 2017;12(1). doi:10.1186/s13018-017-0552-9
  9. Goodell PB, Johansen PM, Bartels DW, Sherman SL, Amanatullah DF. Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS Rev. 2023;11(3). doi:10.2106/JBJS.RVW.22.00127
  10. Gademan MGJ, Hofstede SN, Vliet Vlieland TPM, Nelissen RGHH, Marang-Van de Mheen PJ. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord. 2016;17(1):1-11. doi:10.1186/s12891-016-1325-z
  11. Adie S, Harris I, Chuan A, Lewis P, Naylor JM. St George Hospital, Sydney, NSW. 3 South Western Sydney Clinical School. (2). doi:10.5694/mja2.12109â–ªPublished
  12. Liu X, Chen Z, Gao Y, Zhang J, Jin Z. High Tibial Osteotomy: Review of Techniques and Biomechanics. J Healthc Eng. 2019;2019. doi:10.1155/2019/8363128
  13. Thomas A, Round J. Basic principles of lower limb deformity correction. Surgery (Oxford). 2023;41(4):255-261. doi:10.1016/J.MPSUR.2023.02.015
  14. Luís NM, Varatojo R. Radiological assessment of lower limb alignment. EFORT Open Rev. 2021;6(6):487-494. doi:10.1302/2058-5241.6.210015
  15. Deakin AH, Basanagoudar PL, Nunag P, Johnston AT, Sarungi M. Natural distribution of the femoral mechanical–anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee. 2012;19(2):120-123. doi:10.1016/J.KNEE.2011.02.001
  16. Lobenhoffer P, van Heerwarden R, Staubli A, Jakob R. Osteotomies around the Knee, Indication-Planning-Surgical Techniques Using Plate Fixators. (Lobenhoffer PP, van Heerwaarden RJ, Staubli AE, Jakob RP, Galla M, Agneskirchner JD, eds.). Georg Thieme Verlag; 2013. doi:10.1055/b-0034-9881
  17. Wolcott M, Traub S, Efird C. High tibial osteotomies in the young active patient. Int Orthop. 2010;34(2 SPECIAL ISSUE):161-166. doi:10.1007/s00264-009-0944-5
  18. Bentley G, ed. European Surgical Orthopaedics and Traumatology : The EFORT Textbook. Springer Reference; 2014.
  19. Savarese E, Bisicchia S, Romeo R, Amendola A. Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner. Journal of Orthopaedics and Traumatology. 2011;12(1):1-17. doi:10.1007/s10195-010-0120-0
  20. Khakha RS, Bin Abd Razak HR, Kley K, van Heerwaarden R, Wilson AJ. Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: Indications, surgical technique and outcomes. J Clin Orthop Trauma. 2021;23. doi:10.1016/j.jcot.2021.101618
  21. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.
  22. Kang BY, Lee DK, Kim HS, Wang JH. How to achieve an optimal alignment in medial opening wedge high tibial osteotomy? Knee Surg Relat Res. 2022;34(1). doi:10.1186/s43019-021-00130-2
  23. Kolb W, Guhlmann H, Windisch C, Kolb K. High Tibial Open-Wedge Osteotomy-New Techniques and Early Results. www.intechopen.com
  24. Atkinson HF, Birmingham TB, Schulz JM, et al. High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition. Knee Surgery, Sports Traumatology, Arthroscopy. 2022;30(3):1065-1074. doi:10.1007/s00167-021-06516-9
  25. 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). doi:10.1186/s13018-019-1333-4
  26. Pape D, Rupp S. Preoperative Planning for High Tibial Osteotomies. Oper Tech Orthop. 2007;17(1):2-11. doi:10.1053/j.oto.2006.09.007
  27. Cofaru NF, Roman MD, Cofaru II, Oleksik VS, Fleaca SR. Medial opening wedge high tibial osteotomy in knee osteoarthritis—a biomechanical approach. Applied Sciences (Switzerland). 2020;10(24):1-20. doi:10.3390/app10248972
  28. Lee YS, Kim MG, Byun HW, Kim SB, Kim JG. Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. 2015;23(3):846-851. doi:10.1007/s00167-013-2700-z
  29. Sivertsen EA, Vik J, Meland ASV, Nerhus TK. The Dugdale planning method for high tibial osteotomies underestimates the correction angle compared to the Miniaci method. Knee Surgery, Sports Traumatology, Arthroscopy. 2023;31(4):1507-1514. doi:10.1007/s00167-021-06663-z
  30. Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS. 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. doi:10.5792/ksrr.16.052
  31. Guy S, Khakha R, Ollivier M. Anterior Closing-Wedge High Tibial Osteotomy Using Patient-Specific Cutting Guide in Chronic Anterior Cruciate Ligament–Deficient Knees. Arthrosc Tech. 2022;11(9):e1605-e1612. doi:10.1016/j.eats.2022.05.006
  32. Dragosloveanu S, Cristea S, Dragosloveanu C, Street B. Maedica-a Journal of Clinical Medicine The Effect of High Tibial Osteotomy on the Posterior Tibial Slope. Vol 9.; 2014.
  33. Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res. 2012;24(2):61-69. doi:10.5792/ksrr.2012.24.2.61
  34. Ruzbarsky JJ, Arner JW, Dornan GJ, Provencher MT, Vidal AF. Tibial Slope Can Be Maintained During Medial Opening-Wedge Proximal Tibial Osteotomy With Sagittally Oriented Hinge, Posterior Plate Position, and Knee Hyperextension: A Cadaveric Study. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2021;37(7):2181-2188. doi:10.1016/j.arthro.2021.01.065
  35. Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H. Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy. Orthop J Sports Med. 2016;4(2). doi:10.1177/2325967116630748
  36. Bin S Il, Kim HJ, Ahn HS, Rim DS, Lee DH. Changes in Patellar Height After Opening Wedge and Closing Wedge High Tibial Osteotomy: A Meta-analysis. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2016;32(11):2393-2400. doi:10.1016/j.arthro.2016.06.012
  37. Kim HJ, Shin JY, Lee HJ, Park KH, Jung CH, Kyung HS. The patellofemoral joint does not deteriorate clinically after open-wedge high tibial osteotomy. Orthopaedics and Traumatology: Surgery and Research. 2021;107(4). doi:10.1016/j.otsr.2021.102907
  38. Huizinga MR, Brouwer RW, Van Raaij TM. High tibial osteotomy: Closed wedge versus combined wedge osteotomy. BMC Musculoskelet Disord. 2014;15(1). doi:10.1186/1471-2474-15-124
  39. Marcheggiani Muccioli GM, Fratini S, Cammisa E, et al. Lateral Closing Wedge High Tibial Osteotomy for Medial Compartment Arthrosis or Overload. Clin Sports Med. 2019;38(3):375-386. doi:10.1016/j.csm.2019.02.002
  40. Ferner F, Lutter C, Dickschas J, Strecker W. Medial open wedge vs. lateral closed wedge high tibial osteotomy - Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. Int Orthop. 2019;43(6):1379-1386. doi:10.1007/s00264-018-4155-9
  41. Gaasbeek RDA, Sonneveld H, Van Heerwaarden RJ, Jacobs WCH, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: A new technique. Knee. 2004;11(6):457-461. doi:10.1016/j.knee.2004.02.002
  42. Gaasbeek RDA, Sonneveld H, Van Heerwaarden RJ, Jacobs WCH, Wymenga AB. Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: A new technique. Knee. 2004;11(6):457-461. doi:10.1016/j.knee.2004.02.002
  43. Akiyama T, Osano K, Mizu-Uchi H, et al. Distal Tibial Tuberosity Arc Osteotomy in Open-Wedge Proximal Tibial Osteotomy to Prevent Patella Infra. Arthrosc Tech. 2019;8(6):e655-e662. doi:10.1016/j.eats.2019.02.011
  44. Peng H, Ou A, Huang X, et al. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg. 2021;13(5):1465-1473. doi:10.1111/os.13021
  45. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J. Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg. 2019;139(4):519-527. doi:10.1007/s00402-018-3068-9
  46. Iseki T, Onishi S, Kanto M, et al. Double-level osteotomy for severe varus osteoarthritic knees can prevent change in leg length and restore physiological joint geometry. Knee. 2021;31:136-143. doi:10.1016/j.knee.2021.04.011
  47. Saito H, Yonekura A, Saito K, et al. A new double level osteotomy procedure to restore a joint line and joint angles in severe varus osteoarthritis. - Double level osteotomy associated with tibial condylar valgus osteotomy (DLOTO) -. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2021;24:9-13. doi:10.1016/j.asmart.2020.11.001
  48. Elbardesy H, McLeod A, Ghaith HS, Hakeem S, Housden P. Outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. A systematic review. SICOT J. 2022;8. doi:10.1051/sicotj/2022009
  49. Coakley A, McNicholas M, Biant L, Tawy G. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee. 2023;40:97-110. doi:10.1016/j.knee.2022.11.007
  50. Müller M, Strecker W. Arthroscopy prior to osteotomy around the knee? Arch Orthop Trauma Surg. 2008;128(11):1217-1221. doi:10.1007/s00402-007-0398-4
  51. Rozkydal Z, Kura V, Ondrusek S. The arthroscopic debridement in the management of osteoarthritis of the knee joint by high tibial osteotomy. Bratisl Lek Listy. 2003;104(11):362-366.
  52. Friemert B, Oberländer Y, Danz B, et al. MRT versus Arthroskopie Bei Der Diagnostik von Chondralen Läsionen Des Kniegelenkes. Kann Die MRT Die Arthroskopie Ersetzen? Eine Prospektive Studie.
  53. Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S. Cartilage repair procedures associated with high tibial osteotomy in varus knees: Clinical results at 11years’ follow-up. Knee. 2014;21(2):445-450. doi:10.1016/j.knee.2013.11.013
  54. Wu J, Zhao B, Luo W, et al. Arthroscopy combined with high tibial osteotomy promotes cartilage regeneration in osteoarthritis. Journal of Orthopaedic Surgery. 2023;31(1). doi:10.1177/10225536231165357
  55. Zhao B, Xiao Q, Liu B. Effects of High Tibial Osteotomy Combined with Arthroscopy on Pain and Inflammation Markers in Patients with Medial Knee Osteoarthritis. Journal of Investigative Surgery. 2022;35(4):891-897. doi:10.1080/08941939.2021.1931576
  56. Ding T, Tan Y, Tian X, et al. Patellar Height after High Tibial Osteotomy of the Distal Tibial Tuberosity: A Retrospective Study of Age Stratification. Comput Math Methods Med. 2022;2022. doi:10.1155/2022/7193902
  57. Gooi S, Chan C, Tan M, Lim A, Satkunanantham K, Hui J. Patella height changes post high tibial osteotomy. Indian J Orthop. 2017;51(5):545-551. doi:10.4103/ortho.IJOrtho_214_17
  58. Ren YM, Tian MQ, Duan YH, Sun YB, Yang T, Hou WY. Distal tibial tubercle osteotomy can lessen change in patellar height post medial opening wedge high tibial osteotomy? A systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1). doi:10.1186/s13018-022-03231-0
  59. Nha KW, Kim HJ, Ahn HS, Lee DH. Change in Posterior Tibial Slope after Open-Wedge and Closed-Wedge High Tibial Osteotomy. American Journal of Sports Medicine. 2016;44(11):3006-3013. doi:10.1177/0363546515626172
  60. Iseki T, Onishi S, Kanto R, et al. Increased posterior slope and coronal inclination of the tibial joint line after opening wedge high tibial osteotomy may induce mucoid degeneration of the anterior cruciate ligament: A case report. Journal of ISAKOS. 2022;7(6):214-218. doi:10.1016/j.jisako.2022.08.006
  61. Kwon OJ, Kim JM, Bin S Il, Lee BS, Yoon GW, Kwon YH. Morphologic MRI changes of the anterior cruciate ligament are associated with an increase in the medial tibial plateau bony slope after medial opening wedge high tibial osteotomy in a non-injured ACL population. Orthopaedics and Traumatology: Surgery and Research. 2019;105(7):1369-1375. doi:10.1016/j.otsr.2019.08.005
  62. Ogawa H, Matsumoto K, Akiyama H. Effect of increased posterior tibial slope on the anterior cruciate ligament status in medial open wedge high tibial osteotomy in an uninjured ACL population. Orthopaedics and Traumatology: Surgery and Research. 2019;105(6):1085-1091. doi:10.1016/j.otsr.2019.05.003
  63. Aalderink KJ, Shaffer M, Amendola A. Rehabilitation Following High Tibial Osteotomy. Clin Sports Med. 2010;29(2):291-301. doi:10.1016/j.csm.2009.12.005
  64. Screpis D, Piovan G, Baldini M, et al. Higher activity level after opening wedge high tibial osteotomy compared to medial unicompartimental knee arthroplasty in a selected cohort of advanced age: A propensity score-matched analysis. Knee. 2023;40:183-191. doi:10.1016/j.knee.2022.11.006
  65. Kuwashima U. High tibial osteotomy: The past, present, and future. Journal of Joint Surgery and Research. 2023;1(1):103-107. doi:10.1016/j.jjoisr.2023.03.001
  66. Kumagai K, Fujimaki H, Yamada S, Nejima S, Matsubara J, Inaba Y. Changes of synovial fluid biomarker levels after opening wedge high tibial osteotomy in patients with knee osteoarthritis. Osteoarthritis Cartilage. 2021;29(7):1020-1028. doi:10.1016/j.joca.2021.03.013
  67. Kucirek NK, Anigwe C, Zhang AL, Ma CB, Feeley BT, Lansdown DA. Complications after high tibial osteotomy and distal femoral osteotomy are associated with increasing medical comorbidities and tobacco use. Knee Surgery, Sports Traumatology, Arthroscopy. 2022;30(12):4029-4045. doi:10.1007/s00167-022-06865-z
  68. Wei C, Xie W, Zhang W, et al. New insight into the current study of high tibial osteotomy: A bibliometric analysis. Medicine (United States). 2022;101(37):E30357. doi:10.1097/MD.0000000000030357