Measuring osteotomy wedge angle is more important than measuring wedge height in open wedge osteotomies around the knee in preoperative planning

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-02-12 DOI:10.1002/ksa.12609

Julius Watrinet, Johannes Schlaich, Romed Vieider, Marco-Christopher Rupp, Julian Mehl, Sebastian Siebenlist, Armin Runer

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引用次数: 0

Abstract

Purpose

Preoperative planning for medial open wedge high tibial osteotomies (HTOs) and lateral open wedge distal femur osteotomies (DFOs) commonly uses wedge height to guide accurate correction. However, it is unclear if this parameter is influenced by intraoperative variations in osteotomy entry point or length. This study hypothesized that wedge angle remains constant during planning, while wedge height varies depending on hinge or entry points.

Methods

Whole leg radiographs of 40 patients who underwent HTO or DFO (2018–2024) were analysed using digital planning software. For each HTO and DFO case, 27 and 21 osteotomy variants were created, respectively, by altering entry and hinge points, resulting in 960 simulations. Wedge angle, wedge height and osteotomy depth were measured for each variant. Correlations and regression analyses assessed the relationships among these variables, and a mathematical formula was developed to predict wedge height from wedge angle and osteotomy depth.

Results

Wedge angle remained consistent across variants (mean deviation: 0.1 ± 0.1°), while wedge height showed variability (mean deviation: 0.7 ± 0.5 mm) influenced by entry and hinge points. Significant correlations were found between wedge height and opening angle (R = 0.83, p < 0.001) and osteotomy depth (R = 0.60, p < 0.001). Predicted wedge height closely matched actual values (R = 0.998, p < 0.001), with minimal error (−0.01 ± 0.1°).

Conclusion

This study highlights that relying solely on wedge height for osteotomy planning in HTO and DFO is insufficient due to variations in entry and hinge points. The hinge angle proved to be the most reliable parameter. Intraoperative osteotomy depth measurements can help adjust wedge height for accurate limb alignment when deviations occur.

Level of Evidence

Level V, simulation study.

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).