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

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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Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

The Bone & Joint Journal ◽

10.1302/0301-620x.103b11.bjj-2020-2130.r2 ◽

2021 ◽

Vol 103-B (11) ◽

pp. 1686-1694

Author(s):

Hong-Yeol Yang ◽

Woo-Kyoung Kwak ◽

Sung Ju Kang ◽

Eun-Kyoo Song ◽

Jong-Keun Seon

Keyword(s):

Clinical Outcomes ◽

High Tibial Osteotomy ◽

Cartilage Repair ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Status Group ◽

Second Look ◽

Wedge High Tibial Osteotomy ◽

The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

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Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up

International Orthopaedics ◽

10.1007/s00264-017-3517-z ◽

2017 ◽

Vol 41 (10) ◽

pp. 2045-2052 ◽

Cited By ~ 7

Author(s):

Pakpoom Ruangsomboon ◽

Keerati Chareancholvanich ◽

Thos Harnroongroj ◽

Chaturong Pornrattanamaneewong

Keyword(s):

High Tibial Osteotomy ◽

The Elderly ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy

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Accuracy of Correction and Postoperative Complications Associated with a PEEK Opening Wedge High Tibial Osteotomy Implant

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00497 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0049

Author(s):

Derek Axibal ◽

Christopher Joyce ◽

Darby Houck ◽

Stephanie Logterman ◽

Rachel Frank ◽

...

Keyword(s):

Postoperative Complications ◽

High Tibial Osteotomy ◽

Senior Author ◽

Type I ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Correction Angle ◽

Medial Cortex ◽

Wedge High Tibial Osteotomy

Objectives: To evaluate the accuracy of correction angle of an all-PEEK medial opening wedge high tibial osteotomy (HTO) system, as well as determine the effect of correction angle on postoperative complications. Methods: Retrospective review was performed on patients who underwent an HTO by the senior author using an all-PEEK HTO system between 2014-2018 with a >6-month follow-up were included. Measurements were performed and classifications formulated by three senior residents and the senior author. Lateral hinge fractures (LHF) were classified according to Takeuchi classification system. Bivariate statistics were performed. Results: Thirty HTOs in 27 patients were included (50% female; age, 37.8±10.8 years). Average follow-up was 16.2±10.1 months. Average post-operative radiographic valgus correction (Δ, 5.8±2.4°) was significantly less than that of the average implant correction angle (8.1±2.3°; p<0.001), indicating an overall average under-correction of 2.3±2.1°. There were 5 failures (16.7%; defined as approximately >5° loss of planned correction) that shared a common mechanism of medial cortical failure inferior to the implant. When selecting out the construct failures, the average correction accuracy of the 25 (83.3%) non-failures (1.5±1.2°) was significantly better than the 5 (16.7%) failures (6.3±1.8°; p=0.002). Four fractures (13.3%) were identified: 3 (10%) Takeuchi type I and 1 (3.3%) type III. All type I fractures were associated with >5° planned correction loss with medial cortex buckling. Overall, 9 knees (30%) experienced minor complications: neuropathy (n=1; 3.3%), deep vein thrombosis (n=2; 6.7%), and superficial infection (n=3; 10%). Conclusion: The use of an all-PEEK medial opening wedge HTO implant is a safe and effective system, with an acceptable average under-correction of 1.5° in patients not sustaining medial cortex failure. Loss of correction was associated with medial cortex failure and Takeuchi type I LHF. This is the first description of this failure mechanism (medial cortex buckling) that is specific to this implant and technique.

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Medial opening-wedge high tibial osteotomy affects leg length whereas a lateral closing-wedge osteotomy does not: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2016-000086 ◽

2017 ◽

Vol 2 (2) ◽

pp. 75-80

Author(s):

Joong Il Kim ◽

Hyuk Soo Han ◽

Sahnghoon Lee ◽

Myung Chul Lee

Keyword(s):

Systematic Review ◽

High Tibial Osteotomy ◽

Wedge Osteotomy ◽

Tibial Osteotomy ◽

Leg Length ◽

Opening Wedge ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Wedge High Tibial Osteotomy

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Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120913531 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091353 ◽

Cited By ~ 3

Author(s):

Diego Costa Astur ◽

Joao Victor Novaretti ◽

Marcelo Lins Gomes ◽

Adilson Góes Rodrigues ◽

Camila Cohen Kaleka ◽

...

Keyword(s):

Clinical Outcomes ◽

High Tibial Osteotomy ◽

Case Series ◽

Tibial Osteotomy ◽

Meniscal Extrusion ◽

Level Of Evidence ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy ◽

Return To Activity

Background: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME. Purpose/Hypothesis: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity. It was hypothesized that MME would decrease after HTO and that patients with lower MME after surgery would have improved clinical outcomes and return to activity at short-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: This study included 66 patients who underwent HTO to correct the anatomic axis with a minimum follow-up of 2 years. MME was measured using magnetic resonance imaging preoperatively and 6 weeks after surgery (study protocol). Patients were assessed preoperatively and postoperatively with the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) score for pain, and Tegner score. Results: The mean ± SD preoperative and postoperative MME values were 3.9 ± 0.6 mm and 0.9 ± 0.5 mm, respectively. At 2 years after surgery, KOOS, pain VAS, and Tegner scores were higher than those found preoperatively ( P < .001). Patients with less than 1.5 mm of MME after surgery had better clinical outcomes and return to activity compared with patients who had MME of 1.5 mm or more ( P < .05). Conclusion: Medial opening wedge HTO decreased MME after 6 weeks and improved clinical outcomes and return to activity at a minimum 2-year follow-up. Additionally, patients with postoperative MME of less than 1.5 mm had better clinical outcomes and return to activity compared with patients who had postoperative MME of 1.5 mm or more.

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