Effect of Tibial Cut Planes and Hinge Axes on Medial Opening Wedge High Tibial Osteotomy

내측개방형 근위경골절골술의 경골절단면 및 경골개방축의 설정에 따른 영향

  • Received : 2010.04.23
  • Accepted : 2011.05.21
  • Published : 2011.08.01


In medial opening wedge high tibial osteotomy (OWHTO), researchers have reported critical problems caused by unexpected changes in the tibial posterior-slope angle. This unexpected change can be analyzed, but there is no general solution for cases with an oblique hinge axis and cut plane. We propose a general analysis model for OWHTO. We first evaluate the effects according to variation in the hinge axis and tibial cut plane and then define an ideal correction axis. This ideal axis, called the virtual tibial correction axis, is not on the tibial cut plane in general. In this paper, we also present an evaluation of feasibility of the proposed analysis model.


High Tibial Osteotomy;HTO;Tibia;Posterior Slope Angle;PSA;Simulation;Hinge Axis;Virtual Tibial Correction Axis


  1. Insall, J.N., Joseph, D.M. and Msika, C., 1984, "High Tibial Osteotomy for Varus Gonarthrosis. A Long-Term Follow-up Study," J Bone Joint Surg Am, Vol. 66, pp.1040-1048.
  2. Song, E.-K., 2004, "High Tibial Osteotomy for Osterarthritis of the Knee," J. of Korean Orthop. Assoc., Vol. 39, No.1, pp.104-107.
  3. Song, E.-K., Seon, J.-K., Park, S.-J. and Cho, N.-Y., 2009, "Open Wedge High Tibial Osteotomy with$ Aescula^{\circledR}$ Plate," J. of Korean Orthop. Assoc., Vol. 43, No. 3, pp. 391-395.
  4. Chae, D. J., Shetty, G. M., Lee, D. B., Choi, H. W., Han, S. B. and Nha, K. W., 2007, "Tibial Slope and Patellar Height After Opening Wedge High Tibia Osteotomy Using Autologous Tricortical Iliac Bone Graft," The Knee, Vol. 15, pp. 128-133.
  5. Kendoff, D., Lo, D., Goleski, P., Warkentine, B., Loughlin, P. F. O. and Pearle, A. D., 2008, "Open Wedge Tibial Osteotomies Influence on Axial Rotation and Tibial Slope," Knee Surg Sports Traumatol Arthrosc, Vol. 6, pp. 904-910.
  6. Ozalay, M., Ozkoc, G. and Circi, E., Akpınar, S., Hersekli, M. A., Uysal, M. and Cesur, N., 2008, "The Correlation of Correction Magnitude and Tibial Slope Changes Following Open Wedge High Tibial Osteotomy," Knee Surg Sports Trumatol Arthrosc, Vol. 16, pp. 948-951.
  7. Wang, J., H., Bae, J. H., Lim, H. C., Shon, W. Y., Kim, C. W. and Cho, J. W., 2009, "Medial Open Wedge High Tibial Osteotomy : The Effect of the Cortical Hinge on Posterior Tibial Slope," The American Journal of Sports Medicine, Vol. 37, No. 12, pp. 2411-2418.
  8. Hohmann, E. and Bryant, A., 2007, "Closing or Opening Wedge High Tibial osteotomy : Watch Out for the Slope," Operative Technique in Orthopaedics, Vol. 17, pp. 38-45.
  9. Noyes, F. R., Goebel, S. X. and West, J., 2005, "Opening Wedge Tibial Osteotomy : The 3-Triangle Method to Correct Axial Alignment and Tibial Slope," The American Journal of Sports Medicine, Vol. 33, No. 3, pp. 378-387.
  10. Lee, Y. S., Park, S. J., Shin, V. I., Lee, J. H., Kim, Y. H. and Song, E. K., 2009, "Achievement of Targeted Posterior Slope in the Medial Opening Wedge High Tibail Osteotomy: A Methmatical Approach," Annals of Biomedical Engineering,
  11. Suh, N. P., 1998, "Axiomatic Design Theory for Systems," Research in Engineering Design, Vol. 10, No.4, pp. 189-209.
  12. Glenn, M., 2005, "Rotation About an Arbitrary Axis in 3 Dimensions,"
  13. Craig, J. J., "Introduction to Robotics: Mechanics and Control," 3rd Edition, Addison-Wesley Publishing Company, pp. 19-24.
  14. Matsuda, Y., Ishii, Y. and Ichimura, K., 2004 "Identifying the Center of the Femoral Head Using Ultrasonography to Assess the Higher Accuracy of Femoral Extramedullary Guides in TKA," Journal of Orthopaedic Science, Vol. 9(1), pp. 6-9.