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

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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EVALUATION OF FUNCTIONAL RESULTS OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL OSTEOARTHRITIS VARUS KNEE

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2017/5 ◽

2017 ◽

Vol 4 (1) ◽

pp. 24-33

Author(s):

Shyam Sundar Bakki ◽

Nageswara Rao Yennapu ◽

Ravi Teja Kolluru ◽

Vamsi Krishna Kurmana

Keyword(s):

High Tibial Osteotomy ◽

Functional Results ◽

Tibial Osteotomy ◽

Varus Knee ◽

Opening Wedge ◽

Unicompartmental Osteoarthritis ◽

Wedge High Tibial Osteotomy

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EVALUATION OF OUTCOME OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL KNEE OSTEOARTHRITIS

10.36106/ijsr/2404839 ◽

2020 ◽

pp. 1-4

Author(s):

R. N. Shewale ◽

Ketan J. Khatri

Keyword(s):

Knee Osteoarthritis ◽

Functional Outcome ◽

High Tibial Osteotomy ◽

Medial Compartment ◽

Functional Score ◽

Tibial Osteotomy ◽

Knee Score ◽

Opening Wedge ◽

Wedge High Tibial Osteotomy ◽

The Mean

Background: Osteoarthritis is often found in weight-bearing joints, the knee being the most common site. Most patients of symptomatic osteoarthritis of knee are associated with varus malalignment that is causative or contributory to painful arthritis. Correcting the malalignment of the knee relieves symptoms by transferring the functional load to the unaffected compartment. The goal of the treatment is to relieve medial compartment knee pain and slow down the arthritic progression. We report the outcome of a simple technique of medial opening wedge high tibial osteotomy in treating the medial compartment osteoarthritis of the knee. Materials and method: A prospective interventional study was carried out over a period of 2 years from November 2017 to October 2019 in a sample size of randomly selected 41 patients having unilateral knee osteoarthritis. All patients after a proper preoperative assessment underwent high tibial osteotomy and the outcome was evaluated using knee society scoring system. Results: The age of the patients ranged from 40 – 65 years with a mean age of 51 years, 13 were males and 28 were females showing female predominance (68.2%). The mean knee score and the mean functional score of the patients before surgery were 60 and 61.95 respectively and post operatively at the end of 6 months the knee score and functional score was 77 and 80.53 respectively. By the end of 6 months out of 41 patients, 12 patients (29.2%) had excellent functional outcome, 18 patients (43.90%) had good functional outcome, 09 patients (21.95%) had fair functional outcome while only 02 patients (04.87%) had poor functional outcome. Conclusions: The present study shows that HTO is a good option in isolated medial compartment OA of knee. Significant increase in the knee score and functional score was found after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Success of high tibial osteotomy relies on appropriate patient selection, proper osteotomy type and precise surgical technique.

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Opening wedge high tibial osteotomy as treatment for chronic multiple ligament injuries in the varus knee: the rationale of treatment and early results

The Egyptian Orthopaedic Journal ◽

10.4103/1110-1148.208912 ◽

2016 ◽

Vol 51 (3) ◽

pp. 223

Author(s):

Adham Elgeidi ◽

AbdElrahman Elganainy ◽

Farouk Youssef

Keyword(s):

High Tibial Osteotomy ◽

Tibial Osteotomy ◽

Varus Knee ◽

Ligament Injuries ◽

Opening Wedge ◽

Early Results ◽

Wedge High Tibial Osteotomy

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Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00466 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0046

Author(s):

Carola Pilone ◽

Federico Verdone ◽

Roberto Rossi ◽

Davide Bonasia ◽

Federica Rosso

Keyword(s):

Prognostic Factors ◽

Regression Model ◽

High Tibial Osteotomy ◽

Womac Score ◽

Tibial Osteotomy ◽

Varus Knee ◽

Inclusion Criteria ◽

Opening Wedge

Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]

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The Effect of Lateral Cortex Disruption and Repair on the Stability of the Medial Opening Wedge High Tibial Osteotomy

The American Journal of Sports Medicine ◽

10.1177/0363546505275488 ◽

2005 ◽

Vol 33 (10) ◽

pp. 1552-1557 ◽

Cited By ~ 68

Author(s):

Bruce S. Miller ◽

William O. P. Dorsey ◽

Cari R. Bryant ◽

John C. Austin

Keyword(s):

High Tibial Osteotomy ◽

Torsional Stiffness ◽

Osteotomy Site ◽

Axial Stiffness ◽

Control Group ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Lateral Cortex ◽

Wedge High Tibial Osteotomy ◽

Tibial Cortex

Background Medial opening wedge high tibial osteotomy is gaining popularity as a treatment option for medial compartment degenerative disease in the young, active patient. One of the potential technical pitfalls of this procedure is inadvertent disruption of the lateral tibial cortex during distraction at the osteotomy site. Purpose (1) To investigate the effect of lateral cortex disruption on stability during medial opening wedge high tibial osteotomy and (2) to evaluate 3 different methods of repair of the disrupted lateral cortex. Study Design Controlled laboratory study. Methods A total of 50 validated replicate tibias were evaluated in a medial opening wedge high tibial osteotomy model. Specimens were divided into 5 groups: (1) control, or intact lateral cortex (n = 10); (2) disrupted lateral cortex (n = 10); (3) lateral cortex repaired with 1 staple (n = 10); (4) lateral cortex repaired with 2 staples (n = 10); and (5) lateral cortex repaired with a periarticular plate and screws (n = 10). Specimens were placed in compression and torsion under physiologic loads, and stiffness and micromotion were calculated. Results Disruption of the lateral cortex resulted in a 58% reduction in axial stiffness and a 68% reduction in torsional stiffness compared to control specimens (P<. 05). Disruption of the lateral cortex also resulted in increased micromotion at the osteotomy site. All 3 methods of repair of the lateral cortex restored stiffness and micromotion values to those of the control group (P<. 05). Conclusions Instability at the osteotomy site may contribute to the high rate of delayed union or nonunion associated with medial opening wedge high tibial osteotomy. Repair of the lateral tibial cortex by each of these techniques restored stability to the osteotomy site in this replicate tibia model and might be effective in clinical use. However, more studies are needed to further explore the relationship between lateral cortex disruption and patient outcomes in the clinical setting before definitive conclusions can be drawn.

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