High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up

Abstract

We reviewed 192 patients (224 knees) to assess the results of HTO in medial gonarthrosis during the period 1982-2008. Median follow-up was about 15 years for 134 females and 58 males. Among the knees, 118 had an average opening wedge for varus angle of 13 degrees and 106 had closing wedges of 11 degrees. Knee Society scoring before osteotomies was 68/200 for opening wedge and 81/200 for closing wedge. Modified Ahlback classification showed preoperative grades I (n = 44), II (78), III (83) and IV (19). Healing delay was 55 days for closing and 70 for opening osteotomy. Twenty-nine knees were still painful. Twenty-eight patients were revised and 19 others had complications. After opening wedge osteotomy, scoring was 101/200 and valgus angle was 2 degrees. After closing wedge osteotomy, scoring was 94/200 and valgus angle was 4 degrees. Global results were as follows: very good, 12%; good, 30%; fair, 31%; and poor, 27%. HTO decreases stresses on medial compartments and widens joint space. The average of 5 degrees mechanical valgus at the time of osteotomy seems to be quite effective at the follow-up for at least ten years. Our indications are opening wedge for grades 1-3 and wide varus angle, until the age of between 65-70. Closing wedge is indicated for medium varus in younger patients.

Opening wedge high tibial osteotomy: navigation system compared to the conventional technique in a controlled clinical study

“…High tibial osteotomy (HTO) has been an established treatment option for young and active patients with unicompartmental osteoarthritis (OA) of the knee since the 1960s [1][2][3][4]. The mechanical leg axis is one important factor influencing the mechanical load distribution in the knee joint.…”

Opening-Wedge High Tibial Osteotomy: Review of 100 Consecutive Cases

“…This survivorship number is consistent with numbers reported by other authors. [47][48][49][50][51][52] As expected, the need for arthroplasty was associated with longer follow-up periods. 37 Surprisingly, osteotomy fixation with a smaller plate with only 4 screws was associated with increased postoperative pain even after correction for follow-up length (the senior author predominantly used the smaller plate early in the study).…”

Evaluation of Satisfaction Levels of Patients Undergoing High Tibial Osteotomy

“…For instance, in the study of Benzakour, in which 23 patients needed arthroplasty, he stated that revision was performed for 37 patients due to some reasons, such as the need for osteotomy, removal of implant, and infection (11). In the series of Efe et al (13), with 199 diseases and a mean followup time of 9.6 years, the number of cases with progression to arthroplasty was found to be 36.…”

“…Gstöttner, who examined the data of 134 patients having been exposed to lateral closed wedge osteotomy, reported a rate of returning to arthro- 4-year-follow-up period, this rate was evaluated to be 39.6% for the same patients (1). Benzakour reported the number of those returning to arthroplasty as 23 in a series including 192 cases, with a mean follow-up duration of 15 years (11). In the series of Madan et al (12), including 68 cases, arthroplasty was needed in 16 patients (23.5%) in approximately 3.7 years.…”