High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up

Abstract

On three occasions we have reviewed a series of knees after high tibial osteotomy for osteoarthritis: 99 were reviewed at one to two years; 81 at a mean of 5.7 years; and 65 at a mean of 11.9 years. At one to two years and at 5.7 years over 50% were good and over 75% acceptable. At 11.9 years, 43% were good and 60% acceptable. We determined the mechanical axis through the knee in maximum varus and maximum valgus; significantly better results were found if a mean angulation of 3 degrees to 7 degrees of valgus had been achieved at operation. We also measured intercondylar distances under varus and valgus stress, and found no significant lateral compartment narrowing. The best results were seen in knees with pre-operative grade I or grade II osteoarthritis and valgus deviation after osteotomy.

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

“…While there was a trend toward a great need for tibial tubercle osteotomy or quadriceps snip for exposure in the lateral closing wedge group, there was no increase in operative time or complications in this group. Previous work describing the outcomes of TKA following HTO is has demonstrated poorer outcome in those who have undergone prior osteotomy [11,15,24]. Intraoperative complications have been noted to be increased in this population.…”

Results of high tibial osteotomy: review of the literature

“…Ivarsson et al [26] performed 99 lateral closing wedge HTO, fixed with staples and immobilized in a cast. They reported 75% of good and acceptable outcomes at 5.7 years and 60% at 11.9 years.…”

“…Some conditions are related to poor outcomes and these include: severe articular destruction (III or more according to the Ahlbäck classification) [1,22,26], undercorrection [1,26,32,33,39] or overcorrection [32], advanced age [22,24,33], patellofemoral arthrosis [35], noticeably decreased range of motion [33], previous arthroscopic débridements [33], joint instability [36], loss of correction [36] and lateral tibial thrust [33]. On the other hand, a slight valgus correction is associated with better results [26,33,36].…”

“…On the other hand, a slight valgus correction is associated with better results [26,33,36]. Body mass index is a controversial factor.…”

“…The review of the literature shows that some conditions are correlated with a poorer prognosis and these include: (1) severe articular destruction (III or more according to the Ahlbäck classification) [1,22,26], (2) advanced age [22,24,33], (3) patellofemoral arthrosis [35], (4) markedly decreased range of motion [33], (5) previous arthroscopic débridements [33], (6) joint instability [35] and (7) lateral tibial thrust [33].…”