Five- to ten-year outcome following medial opening-wedge high tibial osteotomy with rigid plate fixation in combination with an artificial bone substitute

Abstract

Between 2003 and 2007, 99 knees in 77 patients underwent opening wedge high tibial osteotomy. We evaluated the effect of initial stable fixation combined with an artificial bone substitute on the mid- to long-term outcome after medial opening-wedge high tibial osteotomy (HTO) for medial compartmental osteoarthritis or spontaneous osteonecrosis of the knee in 78 knees in 64 patients available for review at a minimum of five years (mean age 68 years; 49 to 82). The mean follow-up was 6.5 years (5 to 10). The mean Knee Society knee score and function score improved from 49.6 (SD 11.4, 26 to 72) and 56.6 (SD 15.6, 5 to 100) before surgery to 88.1 (SD 12.5, 14 to 100) and 89.4 (SD 15.6, 5 to 100) at final follow-up (p < 0.001) respectively. There were no significant differences between patients aged ≥ 70 and < 70 years. The mean standing femorotibial angle was corrected significantly from 181.7° (SD 2.7°, 175° to 185°) pre-operatively to 169.7° (SD 2.4°, 164° to 175°) at one year's follow-up (p < 0.001) and 169.6° (SD 3.0°, 157° to 179°) at the final follow-up (p = 0.69 vs one year). Opening-wedge HTO using a stable plate fixation system combined with a bone substitute is a reliable procedure that provides excellent results. Although this treatment might seem challenging for older patients, our results strongly suggest that the results are equally good.

Comparative Study of Opening-Wedge High Tibial Osteotomy With and Without a Combined Computed Tomography–Based and Image-Free Navigation System

“…In addition, outliers and normal ranges of FTA were defined as angles of >175 or <165 and 175 or !165 , respectively, whereas outliers and normal ranges of TPS were defined as angles of >2.5 or <À2.5 and 2.5 or !À2.5 , respectively, these values having been derived from our previously published results. 5,19 Data were checked for a normal distribution with the Shapiro-Wilk test. Differences between the groups were determined by 2-tailed t test for continuous variables with a normal distribution (preoperative height, FTA, WBL ratio, and AKS knee score; postoperative change in AKS function score, change in Lysholm score, operative time, fluoroscopy time, FTA, WBL ratio, change in TPS, and coronal and sagittal osteotomy plane angles), by the Mann-Whitney test for continuous variables without a normal distribution (preoperative age, weight, body mass index, arc of motion, AKS function score, and Lysholm score; postoperative arc of motion, AKS knee and function scores, Lysholm score, and change in AKS knee score), and by the Pearson c 2 test (preoperative sex and side of knee; postoperative incidence of lateral cortical hinge fracture, outliers of FTA, change in TPS, and rate of normal range in both planes) or Fisher exact probability test (preoperative diagnosis; postoperative outliers in both planes) for nominal variables.…”

“…After closed-wedge high tibial osteotomy and opening-wedge high tibial osteotomy (OWHTO), accurate lower leg alignments were reported to be crucial for the midterm and long-term clinical outcomes in young and middle-aged patients with medial compartment knee osteoarthritis (OA) and patients with osteonecrosis in the medial condyle. [1][2][3][4][5] Undercorrection leads to progression of medial joint arthritis and patient dissatisfaction, whereas overcorrection results in cosmetic complaints, patellar subluxation, patella baja, and rapid degeneration of the lateral cartilage. [6][7][8] The change in tibial posterior slope (TPS) in the sagittal plane was also reported to influence the knee kinematics and stability in laboratory studies.…”

Biomechanical Analysis of a Novel Wedge Locking Plate in a Porcine Tibial Model

“…Medial open wedge high tibial osteotomy (OWHTO) is a well-established method for the treatment of medial unicompartmental osteoarthritis of the knee, which has shown good mid- and long-term results 1). Several factors for good results have been suggested, including the correct indication, adequate correction angle, standardized rehabilitation protocols, and the quality of internal fixation 23).…”

The UK Knee Osteotomy Registry (UKKOR)

“…As surgical techniques for osteotomy have evolved the previous long term follow-up studies now analyse the results of already outdated procedures [11]. Emerging papers using modern osteotomy techniques report encouraging survivorship [12]. There is clearly a requirement to provide robust evidence of patient outcomes [13] using modern techniques, as justification for knee osteotomy against surgical alternatives.…”