A simple formula to control posterior tibial slope during proximal tibial osteotomies

Background: High tibial osteotomy surgery is a widely successful joint-preserving procedure which alters the hip-knee-ankle axis which can delay the progression of osteoarthritis; however, conventional osteotomy surgical procedures do not adequately control the posterior tibial slope.This study aimed to determine the key variables influencing posterior tibial slope during high tibial osteotomy and provide a simple means of implementing the findings during pre-operative planning. Methods: A virtual cohort of twenty-eight proximal tibia geometries of knee osteoarthritis patients was used in the study. Firstly, absolute posterior tibial slope values were contrasted using anatomical and posterior mechanical axis measurement approaches. Secondly, the influence of variables affecting posterior tibial slope change during osteotomy surgery was investigated using 3D preoperative planning surgical simulation and analytical modelling.Findings: There was a poor correlation (R2 = 0.38) between the different clinical measurements of posterior tibial slope; with an average of 7.0 +/- 1.3 degrees and 14.8 +/- 2.2 degrees respectively.An analytical solution for the change in posterior tibial slope was derived based on the hinge axis angle and the osteotomy opening angle. For three different opening angles (6 degrees, 9 degrees and 12 degrees) and seven different hinge axis orientations (- 30 degrees to +30 degrees), the results obtained were identical for the analytical model and the 3D preoperative planning.Interpretation: This study determined that the key variables affecting posterior tibial slope during high tibial osteotomy are the osteotomy opening angle and the hinge axis orientation. The derived formula provides a simple means of determining the change in posterior tibial slope resulting from a particular surgical approach.