Early Complications After High Tibial Osteotomy –A Comparison of Two Techniques

Abstract

This prospective cohort study compared opening wedge high tibial osteotomy with use of the Puddu plate and the Vitoss synthetic cancellous bone versus closing wedge high tibial osteotomy with use of the AO/ASIF L-plate, focusing on complications (nonunions, infections, loss of correction, reoperations) and patient satisfaction (visual linear analog scale). During a 10-month period, we performed high tibial osteotomy for 40 patients experiencing medial knee osteoarthritis and a varus deformity. The average follow-up was 11 months. The complication rate in patients treated with the opening wedge technique was significantly higher regarding tibial nonunion, loss of correction, and material failure. Patients in the closing wedge group were more satisfied with the postoperative result. This study found that the Puddu plate, despite 6 weeks of nonweight bearing facilitating the osseous consolidation with Vitoss cement, was not able to maintain the correction during the time required for bone healing. [J Knee Surg. 2008;21:68-74.]

Osteotomies about the Knee for Tibiofemoral Malalignment in the Athletic Patient

“…54 In a randomized study comparing the 2 techniques, at 1 year follow-up, more accurate coronal plane corrections were achieved using a lateral closing wedge technique, compared with a medial opening wedge technique, although at this short-term time point, the clinical outcome scores were not statistically different between patient groups. 7…”

“…51,54 Other possible complications described in case reports include compartment syndrome, hematoma, pseudarthrosis of the fibula, complex regional pain syndrome, and failure of osteosynthesis, with or without loss of correction. Exact frequencies are not available in the literature.…”

Comparison of closing-wedge and opening-wedge high tibial osteotomies for medial compartment osteoarthritis of knee in Asian population: Mid-term follow-up

“…The opening-wedge osteotomy with a Puddu plate was associated with a higher number of complications. In a prospective cohort study by von den Bekerom et al, 15 comparison of a lateral AO/ASIF L-plate (AO, Davos Platz, Switzerland) with a medial Puddu plate showed a higher rate of non-union, loss of correction and failure of the implant in the opening-wedge group. In our study, the results were comparable in terms of range of motion, union, amount of correction and the complication rates.…”

Complicações da osteotomia em cunha de abertura medial do joelho: estudo retrospectivo

“…Several studies have correlated lateral cortex fractures with instability and development of pseudarthrosis or loss of correction (3,10,11) . Our study found pseudarthrosis in 4.4% and joint stiffness in 6.52%, which correlated directly with the lateral cortex fracture rate and longer duration of postoperative immobilization.…”