Long term evaluation of high tibial valgus osteotomy

Valentí, J.R.; Calvo, Rafael; Lopez, Roberto Gabriel L.; Cañadell, J.

doi:10.1007/bf00182642

Cited by 34 publications

(26 citation statements)

References 14 publications

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“…Long-term results of HTO show a progressive deterioration, although there is a discrepancy between good clinical function and a poor radiological appearance [7,15,22,24,25]. The amount of correction remains a matter of controversy.…”

Section: Discussionmentioning

confidence: 99%

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Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age

Papachristou¹,

Plessas²,

Sourlas³

et al. 2006

International Orthopaedics (SICOT)

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We have investigated, in a prospective study, the outcome of a valgus osteotomy of the tibia in patients less than 60 years of age with arthrosis of the medial compartment and a varus angle of no more than 177.7°. Included in the study were 44 high tibial osteotomies (HTO) performed in 42 patients from 1981 until 1996. There were 35 females (2 bilateral) and 7 males, with an average age of 51 years (range: 30-60 years). Only patients in the first three grades, according to Ahlback's classification, were included. During a mean follow-up period of 10 years (range: 5-17 years), all but 2 patients experienced pain relief. The average loss of postoperative correction at 10 years was 2.4°. The average postoperative Hospital for Special Surgery Knee Rating System score (HSSK) for patients with excellent or good results was 83.5 points. Survivorship analysis showed a success rate of 80% and 66% at 10 and 15 years respectively, and over 52.8% at 17 years of follow-up. HTO results in redistribution of the main stresses towards normal levels, although normal values are never attained. This is probably the reason why patients experienced good results only in the medium term.Résumé Nous avons réalisé une étude prospective sur le devenir des ostéotomies tibiales de valgisation chez les patients de moins de 60 ans, présentant une arthrose du compartiment médial du genou et un varus qui était toujours inférieur à 177,7°. Nous avons inclus dans cette étude 44 ostéotomies tibiales proximales, réalisées chez 42 patients de 1981 à 1996 (35 sujets féminins don't 2 ostéotomies bilatérales et 7 sujets masculins). L'âge moyen était de 51 ans (entre 30 et 60). Seuls les patients présentant une lésion classée dans les trois premiers grades de la classification d'Ahlback ont été inclus. Après un suivi moyen de 10 ans (entre 5 et 17 ans), tous les patients ont été revus sauf deux. La perte de correction à 10 ans était de 2,4°. Le score HSSK était de 83,5 points (excellents et bons résultats), la courbe de survie a été de 80% à 10 ans et 66% à 15 ans, 52,8% à 17 ans. L'évolution de l'ostéotomie tibiale proximale montre qu'avec le temps se produit une récidive de la déformation ce qui explique de bons résultats uniquement à moyen terme.

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Section: Discussionmentioning

confidence: 99%

“…The amount of correction remains a matter of controversy. Overcorrection is recommended by a number of investigators, who have observed better results [9,17,20,25] but, overcorrection may create cosmetic problems or difficulties with future revisions. Average loss of correction in our study was 3.2°and at 10-15 years 3.7°.…”

Section: Discussionmentioning

confidence: 99%

Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age

Papachristou¹,

Plessas²,

Sourlas³

et al. 2006

International Orthopaedics (SICOT)

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“…High tibial osteotomy typically results in pain relief and improved knee function in 80-90 % of patients [3,10,21]; however, osteoarthritis progression often leads to deterioration of results with the passage of time [13,14,18,22,24]. When symptomatic progression occurs, total knee arthroplasty (TKA) is frequently performed.…”

Section: Introductionmentioning

confidence: 99%

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

Bastos

Magnussen

Duthon

et al. 2013

International Orthopaedics (SICOT)

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Purpose High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial openingwedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA. Methods A total of 141 TKA's performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment. Results The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p< 0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups. Conclusions Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.

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“…Earlier studies have shown that the long-term result depends on the degree of correction achieved after bone healing. A slight over-correction gives the best shortand long-term results (Kettelkamp et al 1976, Valenti et al 1990, Coventry et al 1993. Various techniques for fixation of the osteotomy had been described, including plaster fixation, orthoses, combinations of staples, plates and external fixation (Ivarsson and Larsson 1989, Koshino et al 1989, Miniaci et al 1989, Yasuda et al 1992, Zuegel et al 1996.…”

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confidence: 99%

Changes in osseous correction after proximal tibial osteotomy: Radiostereometry of closed- and open-wedge osteotomy in 33 patients

Magyar¹,

Lindstrand²

1999

Acta Orthopaedica Scandinavica

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Long term evaluation of high tibial valgus osteotomy

Cited by 34 publications

References 14 publications

Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age

Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age

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

Changes in osseous correction after proximal tibial osteotomy: Radiostereometry of closed- and open-wedge osteotomy in 33 patients

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