Good functional results following high tibial opening-wedge osteotomy of knees with medial osteoarthritis

An opening wedge osteotomy of the first metatarsal base using either iliac crest bone or the removed exostosis as a graft was used to treat metatarsus primus varus in 22 feet of 15 patients. The preoperative intermetatarsal angle averaged 15°, with the final angle averaging 8°. All osteotomies healed in 3 months with excellent cosmetic and functional results and no difference between iliac crest and exostosis grafts. We conclude that an opening wedge osteotomy of the first metatarsal base is a satisfactory method for the correction of metatarsus primus varus.

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Opening Wedge Tibial Osteotomy in Medial Osteoarthritis of Varus Knee: Is it Necessary to Graft?

Surgical Case Reports ◽

10.31487/j.scr.2021.04.02 ◽

2021 ◽

pp. 1-5

Author(s):

El Ibrahimi Abdelhalim ◽

Hatim Abid ◽

Mohammed El Idrissi ◽

Abdelmajid Elmrini

Keyword(s):

Functional Results ◽

Stage Ii ◽

Functional Score ◽

Tibial Osteotomy ◽

Varus Knee ◽

Opening Wedge ◽

Lateral Cortex ◽

Medial Osteoarthritis ◽

Large Correction ◽

Graft Interposition

Background: Opening wedge high tibial osteotomy (OWHTO) is accepted and commonly used procedure in selected patients with medial osteoathrosis in the varus knee. The aim of this study is to demonstrate that OWHTO can be performed without graft interposition to filling the osteotomy defect and we evaluate bone union, its complications (delayed or nonunion), and functional results. Materials and Methods: This is a continuous retrospective study of patients treated by OWHTO from July 2008 to August 2018. OWHTO was performed using a 4 holes wedges-plate of Puddu without interposition of graft. HKA angle was assessed preoperatively and postoperatively and at 3 months. Clinical and radiological follow-up at 6 weeks, 3 months and 6 months assessed consolidation in terms of filing the defect of the osteotomy according to the method recommended by Brosset. Results: Mean age was 53.2 years. Mean body mass index was 24, 8 and 30% of patients had BMI >30. The average varus was 171° (165°-177°); postoperatively, the HKA angle was 182° (176°-186°). Radiological union occurred on average after 3.5 months, with a minimum of 2 months and a maximum of 5. The time to union was 3.7 months for opening wedges of more than 10° and 3.4 months for opening wedges of 10° or less. 9 patients showed delayed union; in all these cases the lateral cortex was broken initially (stage II Takeuchi) with large correction>10°, 4 of them had BMI>30. The IKS knee score increased from 69 to 90 and the functional score increased 84 to 95 with 95% of patients scoring between 92 and 97. Conclusion: OWHTO without graft interposition using a wedges plate can be considered an alternative in the treatment of medial osteoarthritis of the varus knee, enabling the correction of the deformity and improvement of the clinical picture. Precautions must be taken event of large correction>10° and unstable lateral cortex fracture (stage II Takeuchi).

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Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-3988-2 ◽

2016 ◽

Vol 24 (5) ◽

pp. 1702-1709 ◽

Cited By ~ 26

Author(s):

Arne Ekeland ◽

Tor Kjetil Nerhus ◽

Sigbjørn Dimmen ◽

Stig Heir

Keyword(s):

Functional Results ◽

Wedge Osteotomy ◽

Opening Wedge

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Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0081.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 346-354

Author(s):

Arne Ekeland ◽

Tor Kjetil Nerhus ◽

Sigbjørn Dimmen ◽

Stig Heir

Keyword(s):

Survival Rates ◽

Scoring Systems ◽

Functional Results ◽

Functional Improvement ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Knee Oa ◽

One Year ◽

Sport And Recreation

Aims To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. Methods In all, 49 patients (52 knees) with a mean age of 47 years (31 to 64) underwent high tibial osteotomies (HTO), and 24 patients with a mean age of 48 years (31 to 62) low femoral osteotomies (LFO) with opening wedge technique due to medial, respectively lateral knee OA with malalignment. All osteotomies were stabilized with a Puddu plate and bone grafting performed in the same time period (2000 to 2008). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-operatively and at six months, and at one, two, five, and ten years postoperatively. The knee OA was graded according to the Ahlbäck and Kellgren-Lawrence radiological scoring systems. Results The mean angular corrections were 8.0° (4° to 12°) for the HTO and 9.6° (4° to 20°) for the LFO. Both the pre-operative KOOS and the osteoarthritic gradings were similar for the two patient groups. The five subscores of KOOS increased significantly during the postoperative period (p < 0.001 to 0.029) levelling out after one year in both groups. The KOOS subscore symptoms was significantly higher for patients with HTO than those with LFO at all follow-up times, for sport and recreation in the period one to five years, and for pain and quality of life at two to five years (p < 0.001 to 0.009). Eight HTOs (15%) and five LFOs (21%) were converted to total knee arthroplasty after mean 6.7 years (2.0 to 9.8) and 5.4 years (4.0 to 8.0) respectively. The ten-year osteotomy survival rates were 88% for the HTO and 79% for the LFO (p = 0.745). Conclusion Patients with unicompartmental knee OA improved after a corrective opening wedge osteotomy, but four of the five subscores of KOOS were significantly higher for those with medial than those with lateral OA in most of the ten-year follow-up period. Cite this article: Bone Joint Open 2020;1-7:346–354.

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Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0081.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 346-354 ◽

Cited By ~ 1

Author(s):

Arne Ekeland ◽

Tor Kjetil Nerhus ◽

Sigbjørn Dimmen ◽

Stig Heir

Keyword(s):

Survival Rates ◽

Scoring Systems ◽

Functional Results ◽

Functional Improvement ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Knee Oa ◽

One Year ◽

Sport And Recreation

Aims To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. Methods In all, 49 patients (52 knees) with a mean age of 47 years (31 to 64) underwent high tibial osteotomies (HTO), and 24 patients with a mean age of 48 years (31 to 62) low femoral osteotomies (LFO) with opening wedge technique due to medial, respectively lateral knee OA with malalignment. All osteotomies were stabilized with a Puddu plate and bone grafting performed in the same time period (2000 to 2008). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-operatively and at six months, and at one, two, five, and ten years postoperatively. The knee OA was graded according to the Ahlbäck and Kellgren-Lawrence radiological scoring systems. Results The mean angular corrections were 8.0° (4° to 12°) for the HTO and 9.6° (4° to 20°) for the LFO. Both the pre-operative KOOS and the osteoarthritic gradings were similar for the two patient groups. The five subscores of KOOS increased significantly during the postoperative period (p < 0.001 to 0.029) levelling out after one year in both groups. The KOOS subscore symptoms was significantly higher for patients with HTO than those with LFO at all follow-up times, for sport and recreation in the period one to five years, and for pain and quality of life at two to five years (p < 0.001 to 0.009). Eight HTOs (15%) and five LFOs (21%) were converted to total knee arthroplasty after mean 6.7 years (2.0 to 9.8) and 5.4 years (4.0 to 8.0) respectively. The ten-year osteotomy survival rates were 88% for the HTO and 79% for the LFO (p = 0.745). Conclusion Patients with unicompartmental knee OA improved after a corrective opening wedge osteotomy, but four of the five subscores of KOOS were significantly higher for those with medial than those with lateral OA in most of the ten-year follow-up period. Cite this article: Bone Joint Open 2020;1-7:346–354.

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