Lateral Closing Wedge High Tibial Osteotomy for Medial Compartment Arthrosis or Overload

Muccioli, Giulio Maria Marcheggiani; Fratini, Stefano; Cammisa, Eugenio; Vaccari, Vittorio; Grassi, Alberto; Bragonzoni, Laura; Zaffagnini, Stefano

doi:10.1016/j.csm.2019.02.002

Cited by 11 publications

(6 citation statements)

References 46 publications

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“…There are many surgical options for treating osteoarthritis (OA) of the varus knee [22], ranging from arthroscopic procedures on cartilage or meniscus to closing‐wedge (CW) or opening‐wedge (OW) high tibial osteotomy (HTO) procedures [5, 21, 24], unicompartmental knee arthroplasty (UKA) [6, 26] and total knee arthroplasty (TKA) [27].…”

Section: Introductionmentioning

confidence: 99%

Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee

Berruto

Maione

Tradati

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to analyze the long-term clinical and radiological outcomes of patients who underwent closing-wedge High Tibial Osteotomy (HTO) for the treatment of medial compartment osteoarthritis and to evaluate the conversion rate to knee arthroplasty. Methods A retrospective, non-randomized, monocentric study was performed in our Institution considering 166 patients between 1989 and 2012. The inal population was composed by 82 patients (94 knees), median age at time of operation was 53 (range 45-73) years. All patients were evaluated clinically (HSS Score, Tegner Scale, VAS and Crosby-Insall Grading) and radiographically (osteoarthritis staging, hip-knee-ankle (HKA) angle, tibial slope and metaphyseal varus). Results Mean follow-up was 11.9 ± 7.2 years. HSS Score increased signiicantly from 70.8 ± 10 to 93.2 ± 9.1 (p < 0.05) instead Tegner Scale increased from 1.3 ± 0 (range 1-4) to 2.8 ± 0.7 (range 2-6) at the last control (n.s.); VAS score signiicantly decreased from 7.9 ± 1.4 to 1.6 ± 1.1 (p < 0.05) at last follow-up. According to the Crosby-Insall Grading System, 80 patients (97.4%) reported excellent-good results. HKA angle decreased from 6.9° ± 3.5 to 2.6° ± 2.6 (p < 0.01), tibial slope decreased from 10.1° ± 1.4 to 6.8° ± 2.1 (p < 0.05) and inally the metaphyseal varus decreased from 4.2° ± 0 to 2.1° ± 1.2 (n.s.) at the last follow-up. Adverse events were reported in 4.8%. Osteotomy survivorship rate resulted 92% at 10 years, 82% at 15 years and 80% at 20 years. Sixteen revisions (9.6%) were reported at a mean period of 12.8 years. Conclusions CW-HTO is a valid option for medial osteoarthritis treatment, with successful results in both clinical and radiological outcomes. Level of evidence IV.

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Section: Introductionmentioning

confidence: 99%

Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee

Berruto

Maione

Tradati

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…In addition, in the closed osteotomy site, vascularization occurs more easily; hence, the biological bone healing ability is better than in an open osteotomy site [17]. It was reported that the consolidation time of osteotomy surfaces was shorter in CWHTOs than OWHTOs [15]. Better bone healing would thus be more favorable for later stabilization of HTO.…”

Section: Discussionmentioning

confidence: 99%

Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients

Song

Yoon²,

Kim³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the incidence of correction loss and survival rate between closed-wedge and open-wedge high tibial osteotomies (CWHTO and OWHTO, respectively) in patients with osteopenic and normal bone. Methods Retrospective review was conducted for 115 CWHTOs and 119 OWHTOs performed in osteopenic patients [− 2.5 < Bone mineral density (BMD) T scores ≤ − 1] and 136 CWHTOs and 138 OWHTOs performed in normal patients (BMD T score > − 1) from 2012 to 2019. Demographics were not diferent between CW-and OWHTOs in osteopenic and normal patients (n.s., respectively). Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated pre-and postoperatively (2 weeks after HTO). The occurrence of hinge fractures was investigated using radiographs taken on the operation day. The correction change was calculated as the last follow-up value minus postoperative MPTA. Correction loss was deined when the correction change was ≥ 3°. The survival rate (failure: correction loss) was investigated. Results There were no signiicant diferences in the pre and postoperative MA, MPTA, PTS, and value changes between CW-and OWHTOs in osteopenic and normal patients (n.s., respectively); the incidence of unstable hinge fractures also did not difer signiicantly (CWHTO vs. OWHTO = 7 vs. 7.6% in osteopenic patients; 2.9 vs. 3.6% in normal patients; n.s., respectively). The average correction change (CWHTO = − 0.6°, OWHTO = − 1.3°, p = 0.007), incidence of correction loss (CWHTO = 1.7%, OWHTO = 9.2%, p = 0.019), and 5-year survival rates (CWHTO = 98.3%, OWHTO = 90.8%, p = 0.013) difered signiicantly in osteopenic patients; there were no signiicant diferences in these results in normal patients (n.s., respectively). Conclusion CWHTO was more advantageous than OWHTO regarding the correction loss in osteopenic patients. Intra-and postoperative care that consider poor bone quality will be required when performing OWHTOs in osteopenic patients. Level of evidence III.

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“…An osteotomy of the fibula was performed at the fibular neck, with bone removal to allow for compression of the osteotomy site. Internal fixation was accomplished with a Krakcow staple [16].…”

Section: Methodsmentioning

confidence: 99%

Satisfactory long‐term outcomes for combined anterior cruciate ligament reconstruction and lateral closing wedge high tibial osteotomy

Agostinone

Lucidi

Fabbro

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose A combined anterior cruciate ligament (ACL) reconstruction and high tibial osteotomy (HTO) is considered a valuable treatment in young patients afected by symptomatic medial osteoarthritis and ACL deiciency. However, only a few studies have investigated the outcomes of this procedure, especially in the long term. Therefore, the aim of this study is to report clinical and radiographic outcomes of ACL reconstruction and lateral closing wedge HTO at a mean of 14 years of follow-up. Methods Patients were prospectively evaluated pre-operatively, after 6.5 ± 2.7 years and 14.3 ± 2.2 years. Patient-reported outcome measures (PROMs) were collected, knee laxity was assessed through KT-1000 arthrometer, and limb alignment and knee osteoarthritis were evaluated on long-cassette radiographs. Survivorship of the surgical procedure was calculated through the Kaplan-Meier method. Results 32 patients were initially enrolled and completed the mid-term evaluation (6.5 ± 2.7 years), and 23 patients (72%) were available for the inal evaluation at 14.3 ± 2.2 years after surgery. Statistically signiicant improvement was found for all the clinical scores (VAS, WOMAC, Tegner, subjective IKDC, objective IKDC) between the pre-operative status and the mid-term follow-up (p < .001). VAS, subjective IKDC and objective IKDC showed no statistically signiicant diferences (p > .05) between the mid-term and the inal follow-up; a signiicant decrease of WOMAC (p < .05) and Tegner (p < .001) was found from mid-term to inal follow-up. Signiicant progression of osteoarthritis was found for all the knee compartments. The survivorship was 95.7% at 5 years, 82.6% at 10 years, and 72.8% at 15 years. Conclusions Combined ACL reconstruction and lateral closing wedge HTO showed satisfactory clinical outcomes and survivorship at a mean of 14 years follow-up. Level of evidence IV.

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Lateral Closing Wedge High Tibial Osteotomy for Medial Compartment Arthrosis or Overload

Cited by 11 publications

References 46 publications

Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee

Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee

Closed-wedge high tibial osteotomy is more advantageous to maintain the correction than open-wedge high tibial osteotomy in osteopenic patients

Satisfactory long‐term outcomes for combined anterior cruciate ligament reconstruction and lateral closing wedge high tibial osteotomy

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