No significant change in tibial torsion despite hinge fracture after high tibial osteotomy using patient‐specific instruments
Luca Maddaloni, Lukas Jud, Lukas Fischer, Lazaros Vlachopoulos, Sandro F. FucenteseAbstract
Purpose
Medial open wedge high tibial osteotomy (MOW‐HTO) is an established treatment option for medial knee osteoarthritis or overload. However, using the conventional technique, unintended postoperative changes of the tibial torsion angle (TTA) were observed, potentially leading to secondary patellofemoral or gait disorders. This study aimed to investigate postoperative TTA changes after MOW‐HTO performed with patient‐specific instruments (PSI), with particular attention to the influence of hinge fracture.
Methods
All patients who underwent MOW‐HTO from October 2014 to December 2024 were included retrospectively. Pre‐ and postoperative radiographs and computed tomography (CT) were used to screen for HF and changes in TTA, posterior tibial slope (PTS), hip‐knee‐ankle angle (HKA) and opening wedge distance (OWD) were measured.
Results
One hundred and eighteen knees were included, in which 52 HF (44.1%) were detected and classified according to Takeuchi (type I: n = 40, type II = 11, type III = 1). Overall, TTA showed no significant change from pre‐ to postoperative (25.1° ± 8.5°, 25.0° ± 8.6°, p = 0.727). HF group showed no significant change in TTA (24.3° ± 8.6°, 24.2° ± 9.0°, p = 0.803). Furthermore, HF group has significantly larger OWD values than patients in the no HF group (no HF group: 7.4 mm ± 2.1 mm, HF group: 9.2 mm ± 2.9 mm, p < 0.001). PTS changed significantly in the HF group (no HF group: 0.3° ± 1.9°, HF group: 2.0° ± 2.6°, p < 0.001).
Conclusion
No significant change in TTA was observed in MOW‐HTO performed with a PSI system consisting of an osteotomy guide followed by a reduction guide. TTA also remained stable in cases with a hinge fracture.
Level of Evidence
Level III.