The Ideal Hinge Axis Position to Reduce Tibial Slope in Opening‐Wedge High Tibial Osteotomy Includes Proximalization‐Extension and Internal Rotation
Bibliographic record
Abstract
PURPOSE: To evaluate the effect of the hinge axis position on the posterior tibial slope (PTS) in medial opening-wedge high tibial osteotomy. METHODS: This study included adults with medial-compartment osteoarthritis who had computed tomography (CT) scans available that were amenable to Bodycad Osteotomy software analysis. Virtual osteotomies modeling a 10-mm medial opening-wedge gap were performed. The hinge axis was rotated internally and externally and was proximalized-extended and distalized-flexed with respect to the anterior tibial cortex for 5°, 10°, 15°, and 20°. Each resultant PTS was recorded and compared with the results obtained from the true lateral hinge position and with the preoperative PTS. RESULTS: Computed tomography scans from 10 patients were used. Strong linear correlations were found with each hinge axis position change and the resultant PTS. The trend-line differences were statistically significant by single-factor analysis of variance (P < .001). The PTS decreased for an anterolateral hinge, whereas it increased for a posterolateral hinge. Linear regression analysis showed that rotating the hinge axis by 9.0° externally or angulating the hinge axis by 21.8° of distalization-flexion would result in increasing the tibial slope by 1° whereas rotating the hinge axis by 8.7° internally or angulating the hinge axis by 21.6° of proximalization-extension would decrease the tibial slope by 1°. CONCLUSIONS: Distalization-flexion and external rotation of the hinge axis position led to stepwise increases in the PTS, whereas proximalization-extension and internal rotation led to decreases in the PTS. CLINICAL RELEVANCE: Our findings suggest that when performing medial opening-wedge high tibial osteotomy and aiming to decrease the PTS, the surgeon should aim to achieve maximal internal rotation (producing an anterolateral hinge), as well as proximalization-extension, of the hinge axis. This study quantifies and provides a model for the effect of the hinge axis position for a predetermined angular correction on the PTS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".