Biplanar Open-Wedge High Tibial Osteotomy with Locking Plate for Treatment of Osteoarthritic Varus Knee

Abstract

Aim: To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat unicompartmental knee arthritis with varus deformity in active lifestyle patients. Patients and Method: 48 patients (19 females) with monocompartmental gonarthrosis of the knee combined with varus malalignment, 41 with bilateral affection and 7 cases with unilateral gonarthritis (total 89 knees). Mean age: 53 years (range from 42 to 61 years). They were treated and followed from June 2010 to May 2014 (35 months). Biplanar opening high tibial osteotomy technique was used and fixed by low profile locked T-plate (21 cases) and low profile anatomical proximal tibial plate (27cases). Pre-operative mean varus deformity was 16.5˚ (9˚-19˚). We utilized Lysholm score and Knee Society Score for evaluation of preoperative and follow-up data. Results: The average correction angle was 11.50 ± 2.50˚ (7˚-19˚). Preoperative posterior tibial slope was 8.04˚ ± 1.30˚ and at last follow-up 9.15˚ ± 1.60˚, respectively (p = 0.437). The joint space distance increased from 4.05 ± 1.30 mm to 4.83 ± 1.33 mm (p < 0.001). The average time to complete bone union was 14.69 ± 1.5 weeks. There were no cases of delayed union or non-union. No major complications like broken plate, nerve injury, or blood vessel injury occurred. No progression of degenerations developed in the three compartments of the knee at final follow-up. The mean score on the Lysholm-Gillquist knee functional scoring scale was 45.5 ± 21.7 preoperatively, and it improved to 77.0 ± 23.9 (p < 0.001). There was no obvious difference in the range of motion before and after operation. The average knee score improved from 51.19 ± 11.82 to 93.49 ± 5.

The effects on joint functions of biplanar distal tubercle open-wedge high tibial osteotomy: A prospective study

“…In 2 different studies where the mean TCA was 11.5°, good clinical and radiological results were reported. [2,24] Although no cutoff value of the TCA value could be determined to show the effect on knee functions in the current study, it could be possible with greater numbers of patients in future studies. Consistent with the literature, a significant clinical and functional increase was determined after DT-BOWHTO, and a decrease in osteoarthritis and pain, and therefore, no patient required conversion to TKA.…”

“…Osteoarthritis in the medial compartment of the knee joint and associated varus malalignment is extremely commonly seen. [1,2] High tibial osteotomy (HTO) is a treatment option that protects the knee joint and corrects the mechanical axis and load balance. [1] By slowing down the progression of osteoarthritis with HTO, the need for total knee arthroplasty (TKA) is postponed, [2,3] and by reducing the pain formed in the joint, long-term increases are provided in joint functions.…”

“…[1] By slowing down the progression of osteoarthritis with HTO, the need for total knee arthroplasty (TKA) is postponed, [2,3] and by reducing the pain formed in the joint, long-term increases are provided in joint functions. [1,2] Early weight-bearing after HTO allows patients to return to daily activities and sports at a high rate. [4,5] HTO methods applied from the proximal tibial region are defined as 2 types; open-wedge HTO (OWHTO) and closed-wedge HTO.…”

“…[4,5] HTO methods applied from the proximal tibial region are defined as 2 types; open-wedge HTO (OWHTO) and closed-wedge HTO. [1,2,6] OWHTO has become more widely used in recent years as it provides more clear angular correction in both the sagittal and coronal planes, creates less peroneal nerve damage, and better clinical and functional results are obtained. [7] However, it may cause patellofemoral (PF) arthritis as the patella height and the PF joint biomechanics are altered.…”

“…[1,2] High tibial osteotomy (HTO) is a treatment option that protects the knee joint and corrects the mechanical axis and load balance. [1] By slowing down the progression of osteoarthritis with HTO, the need for total knee arthroplasty (TKA) is postponed, [2,3] and by reducing the pain formed in the joint, long-term increases are provided in joint functions. [1,2] Early weight-bearing after HTO allows patients to return to daily activities and sports at a high rate.…”