Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy

Abstract

The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan–Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [ Orthopedics . 2020;43(5):303–314.]

Effect of bone morphology of the tibia plateau on joint line convergence angle in medial open wedge high tibial osteotomy

“…In addition, OA is generally diagnosed in knees with greater than Kellgren-Lawrence grade 2, although 34% of the knees in this study had Kellgren-Lawrence grade 1. However, previous studies have also included Kellgren-Lawrence grade 1 knees in their cohorts [ 3 , 6 ]. Fourth, there were some cases with small correction in terms of ΔMPTA.…”

“…Accurate alignment correction is necessary in high tibial osteotomy (HTO). However, it has been reported that only about 50–85% of knee joints are in target alignment after HTO [ 1 – 6 ]. Although many factors contribute to intraoperative correction errors [ 4 , 7 ], change in joint line convergence angle (JLCA) is particularly difficult to predict, especially in patients with a large preoperative JLCA (e.g., > 3 degrees) [ 3 , 8 ].…”

Soft-Tissue Management and Neurovascular Protection During Opening-Wedge High Tibial Osteotomy

“…Tibial plateau fractures following OW-HTO has an incidence that ranges from about 1% to 11%. 11 This usually occurs from an incomplete osteotomy. With our technique, we can confirm that there is no intervening soft tissue between the PTR and the posterior cortex of the tibia.…”

Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis

“…One of the most important risk factors for survival after HTO is patient age 9 , 13 , 15 , 16 , 20 , 21 , 25 , 26 , 29 – 32 . Although there is no consensus regarding the age limit for HTO, some recent studies have reported no age restriction for successful outcomes after HTO 7 , 22 , 23 , 33 , 34 .…”

“…As more HTO procedures are being performed, many studies have investigated the risk factors, especially patient variables, affecting failure after surgery 8 – 21 . Although Brinkmean et al defined the age of ideal patients for HTO as 40–60 years 3 , the age indications for HTO is expanded due to improvements in surgical methods and implant design.…”