Correction of Tibiofemoral Subluxation after High Tibial Osteotomy: Prospective Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy

Objectives: High tibial osteotomy is a standard procedure indicated for early medial sided osteoarthritis in varus knees. In this study, we present the early results of high tibial open wedge osteotomy cases using beta-tricalcium phosphate as a graft substitute and Otis-c plate. Methods: Between years 2010 and 2013, 47 cases of (34F, 13 M) medial compartmental gonarthrosis with genu varum deformity treated with high tibial osteotomy, were evaluated with at least one year follow-up, preoperatively both clinically and radiologically. Clinical evaluation involved functional assessment and pain evaluation using Lysholm and visual analog scale (VAS) scores, including knee range-of-motion. Radiological evaluation included medial joint space measurements on weight bearing knee radiographs with measurements of varus angle and posterior tibial slope. Surgical procedure included standard arthroscopy followed by medial sided opening wedge osteotomy with correction of the varus deformity using β- tricalcium phosphate graft substitute and fixation of the osteotomy site using Otis-C plate and locking screws. All patients were evaluated at the end of minimum one-year follow-up period. Results: Mean age of the patients was 56,7 (50- 65) years and mean follow-up period was 24,5 (12- 44) months. Mean duration of surgery was 47,4±10.2 minutes. No case of nonunion, delayed union, neurovascular injury or iatrogenic fracture was encountered. Two cases developed deep vein thrombosis and one case developed superficial wound infection managed successfully by local debridement with retention of implants and antibiotics. Mean duration of union was 13,4±2.7 weeks. Mean preoperative and follow-up range-of-motion were measured as 131±8.9 and 129±9.1 respectively with no statistical difference. Preoperative and follow-up VAS scores showed significant difference as 7.6±1.76 and 2.3±1.08 respectively (p=0.001). Also Lysholm scores improved significantly at the end of the follow-up period (43.23±4.01 vs. 76.3±3.7 p<0,001). Radiological evaluation revealed mean correction angle of 10.84±2.70 degrees at follow-up. Mean posterior tibial slope was measured relatively unchanged (8.6±1.70° degrees preoperatively versus 8.2±2.30° follow-up). Medial joint space width measurements showed a significant increase (pre-op 3.7±1.6 mm. versus 4.6±1.32 mm. at the follow-up (p<0.001)). Conclusion: Medial opening wedge osteotomy for treatment of early medial compartment gonarthrosis in varus knees is still a valuable option. Our short term preliminary results using beta-tricalcium phosphate wedge graft substitute and Otis-c plate-screw osteosynthesis revealed satisfactory short term clinical and radiological results with acceptable complication rates.

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EARLY OUTCOMES OF HIGH TIBIAL OSTEOTOMY USING DYNAMIC AXIAL EXTERNAL FIXATOR IN MEDIAL COMPARTMENT OSTEOARTHRITIS OF KNEE.

10.36106/pijr/3100292 ◽

2021 ◽

pp. 4-8

Author(s):

T.K.Jeejesh kumar ◽

Albert Issac ◽

Puneeth K Pai ◽

Priyavrata Rajasubramanya

Keyword(s):

High Tibial Osteotomy ◽

External Fixator ◽

Functional Outcomes ◽

Medial Compartment ◽

Wedge Osteotomy ◽

Tibial Osteotomy ◽

Management Options ◽

Opening Wedge ◽

Medial Compartment Osteoarthritis ◽

Osteoarthritis Of Knee

Structured abstract:Medial compartment osteoarthritis of knee in young adults has a variety of management options. Realignment surgeries by high tibial osteotomy unload the medial joint and are gaining popularity with increasing focus on knee preservation surgeries. Medial opening wedge osteotomy is one such time tested technique with the fixation being done using internal or external fixators. Here we present the early outcomes of infra-tubercle medial opening wedge osteotomy using a dynamic axial external fixator. Methodology: A single group cohort study was conducted to assess the functional outcomes of high tibial osteotomy with a uni-axial dynamic external fixator for medial compartmental osteoarthritis in younger patient. Results:Function was assessed using knee scores at 6 months and 12 months follow-up which was 85.5 and 83.1 respectively. On bivariate analysis of pre and post-operative Knee-scores, significant improvement was noted with average being 44.2 ± 4.01 which was statistically significant p value-<0.00001. Excellent results were obtained in 15 cases (75%) and good results in 5 cases (25%). Three patients developed pin track infections and were treated with antibiotics and pin tract care. Conclusion: High tibial osteotomy using dynamic external fixator is a simple and effective option for management of medial compartment osteoarthritis in young patients with good short-term functional outcomes and low risk of infection.

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Opening-wedge high tibial osteotomy: a seven - to twelve-year study

Joints ◽

10.11138/jts/2016.4.1.006 ◽

2016 ◽

Vol 04 (01) ◽

pp. 006-011 ◽

Cited By ~ 11

Author(s):

Gennaro Pipino ◽

Pier Indelli ◽

Domenico Tigani ◽

Giuseppe Maffei ◽

Davide Vaccarisi

Keyword(s):

High Tibial Osteotomy ◽

Healing Process ◽

Surgical Techniques ◽

Long Term Results ◽

Wedge Osteotomy ◽

Consecutive Series ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy

Purpose: medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory midterm results when accurate patient selection and precise surgical techniques were applied. This study was conducted to investigate the clinical and radiographic seven- to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. Methods: we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. Results: good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. Conclusions: medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid- to long-term results. Level of evidence: Level IV, therapeutic cases series.

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Clinical Outcomes of Closing- and Opening-Wedge High Tibial Osteotomy for Treatment of Anteromedial Unicompartmental Knee Osteoarthritis

The Journal of Knee Surgery ◽

10.1055/s-0038-1668124 ◽

2018 ◽

Vol 32 (08) ◽

pp. 758-763 ◽

Cited By ~ 9

Author(s):

Jiangfeng Lu ◽

Shiyu Tang ◽

Yanru Wang ◽

Yao Li ◽

Chang Liu ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Functional Outcomes ◽

Tibial Slope ◽

Joint Space ◽

Posterior Tibial Slope ◽

Wedge Osteotomy ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Posterior Tibial

AbstractThis article compares the long-term outcomes of closing-wedge osteotomy (CWO) and opening-wedge osteotomy (OWO) in the treatment of unicompartmental medial osteoarthritis with varus deformity. This study included 79 patients who underwent high tibial osteotomy (HTO) between 2002 and 2008. Pre- and postoperative radiography and computed tomography were used to evaluate the posterior tibial slope, the patellar height, the tibiofemoral angle, and the lateral and medial tibiofemoral joint space. Pre- and postoperative severity of arthritis was assessed with the Kellgren–Lawrence grading system. Pre- and postoperative American Knee Society (AKS) score and Lysholm Knee Score (LKS) were determined to evaluate functional outcomes. The duration of follow-up was 86.1 ± 6.2 months. Postoperatively, at the most recent follow-up, there was a slight increase in the size of the medial tibiofemoral joint space after CWO and OWO, which reflected a decrease in stress on the medial compartment and manifested as a significant improvement in the AKS knee and function scores and the LKS. OWO increased the posterior tibial slope as compared with the preoperative value, while CWO reduced the posterior tibial slope. CWO and OWO for HTO resulted in similar functional outcomes. OWO was associated with patella infera and more severe patellofemoral arthritis, while CWO was associated with a greater severity of lateral tibiofemoral arthritis.

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