High tibial osteotomy in varus knees: indications and limits

Abstract

Abstractopening wedge high tibial osteotomy (oWHto) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for oWHto are medial compartment osteoarthritis and varus malalignment of the knee; recently oWHto has been used successfully in the treatment of double and triple varus. oWHto, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. the aim of this study is to review the literature on oWHto, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at midterm follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty).Keywords: high tibial osteotomy, knee, osteoarthritis, opening wedge, prognostic factors. IntroductionHigh tibial osteotomy (Hto) is a widely accepted procedure for treating varus alignment of the knee associated with medial compartment overload/osteoarthritis (oA). the purpose of the procedure, which may be a medial opening wedge, lateral closing wedge, dome or "en chevron" osteotomy, is to shift the mechanical axis of the lower limb from the medial to the lateral compartment, thereby reducing the load and contact area over the medial compartment. the first references to Hto date back to 1961 (1); for a long time, closing wedge high tibial osteotomy (CWHto) was the gold standard of treatment in this field. Consequently, there exist numerous studies dealing with aspects (survival and complications) of CWHto. CWHto involves fibular osteotomy, common peroneal nerve dissection, proximal tibiofibular joint disruption, and bone stock loss (2, 3). Furthermore, with this procedure it is difficult to obtain gradual correction of the axis. For these reasons, opening wedge high tibial osteotomy (oWHto) has been gaining popularity in recent years. Moreover, oWHto allows for better tuning of the osteotomy as well as triplanar and gradual correction. the literature of recent years therefore contains various papers on different aspects of oWHto: indications, surgical technique, limits and results. the aim of this study is to review the literature on oWHto, considering indications and prognostic factors, outcomes and limits of the procedure. IndicationsCorrect patient selection is mandatory for achieving good results with oWHto (4, 5). According to the literature, the factors that could influence the prognosis are: age, body mass index (BMi), grade of oA, range of motion (RoM), and associated instability. in order to gain a better understanding of the correct indications for oWHto, we have reviewed each of these factors as examined in the most recent literature.

Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis

“…If the tibia has some degree of varus deformity, the pressure on the cartilage in the medial compartment will significantly increase beyond the range of tolerance, triggering cartilage wear and inflammation and resulting in medial osteoarthritis [4, 45]. Historically, HTO was first reported by Jackson et al [46] in the 1960s. The original intention of HTO was to correct tibial varus deformity to properly transfer some stress to the lateral compartment, significantly reducing the pressure in the medial compartment and effectively preventing cartilage wear and relieving pain symptoms.…”

Therapeutic Effects Comparison and Revision Case Analysis of Unicompartmental Knee Arthroplasty and Open Wedge High Tibial Osteotomy in Treating Medial Knee Osteoarthritis in Patients Under 60 years: A 2–6‐year Follow‐up Study

“…Because the indications of UKA and OWHTO are similar 21 , the two operations were frequently compared in regard to the effects in treating MKOA. In earlier studies, UKA showed significant superiority to HTO in both outcomes and survivorship 22,23 .…”

Platelet-Rich Plasma and the Knee—Applications in Orthopedic Surgery

“…HTO is a common procedure performed to treat medial compartment OA and varus malalignment [36]. The use of PRP in HTO is quite limited with only two studies to date evaluating its effects.…”