Medial Opening-Wedge High Tibial Osteotomy for Medial Compartment Arthrosis/Overload

Day, Molly A.; Wolf, Brian R.

doi:10.1016/j.csm.2019.02.003

Cited by 19 publications

(20 citation statements)

References 29 publications

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“…In the carefully selected, young, active patient with coronal plane malalignment in the setting of isolated medial compartment arthrosis or cartilage damage, the medial opening wedge osteotomy has given the surgeon a mean to provide pain relief, increased quality of life, and longevity of activity without relegating the patient to a partial or total knee arthroplasty. 14,22 .…”

Section: Resultsmentioning

confidence: 99%

Osteotomies for the Management of Medial Compartment Defects of the Knee

et al. 2020

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For nearly three-quarters of a century the proximal tibia osteotomy has been used as an effective treatment for cartilage injuries of the knee. Over this same timeframe several advancements have been made in our diagnostic, preoperative planning, and technical execution of this procedure. As such, good-to-excellent short-, mid-, and long-term outcomes have been reported. Since its inception, the most important step in deciding on this procedure is identifying the ideal candidate. This candidate should be a young patient (<55 years old), active, with isolated medial compartment arthrosis without significant comorbidities. With appropriate patient selection and careful preoperative planning, the patient should achieve excellent results and high satisfaction.

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Section: Resultsmentioning

confidence: 99%

Osteotomies for the Management of Medial Compartment Defects of the Knee

et al. 2020

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“…As desvantagens da cunha de abertura: criação de um defeito ósseo, que, dependendo do tamanho, necessita o uso de enxerto ósseo, risco de pseudoartrose, possibilidade de perda da correção devido ao colapso da síntese, maior tempo sem carga e maior atenção ao slope tibial. 3,4,[6][7][8] A técnica foi descrita pela primeira vez em 1961 por Jackson et al 9 entretanto só se tornou popular a partir de 1965 quando Coventry 10 promoveu a técnica para tratamento da OA medial associada a deformidade em varo. Desde então, ocorreram inúmeros avanços quanto à técnica, fixação e seleção dos pacientes, com diminuição das complicações e melhores resultados.…”

Section: Introductionunclassified

“…Desde então, ocorreram inúmeros avanços quanto à técnica, fixação e seleção dos pacientes, com diminuição das complicações e melhores resultados. 3,4,[6][7][8] A OTA visa diminuir a carga no compartimento afetado e transferi-la para o compartimento sadio, corrigindo a deformidade angular e promovendo a melhora sintomática do joelho afetado. [1][2][3]7,8 Diante das excelentes taxas de sobrevida da OTA [11][12][13][14][15][16][17][18][19] e dos riscos potenciais da ATJ, como afrouxamento, desgaste do material ou fraturas periprotéticas em pacientes praticantes de atividade de alto impacto, 20 é recomendável optarse pela primeira em adultos jovens.…”

Section: Introductionunclassified

“…The disadvantages of the opening wedge technique include the creation of a bone defect (which, depending on its size, may need a bone graft), risk of pseudarthrosis, potential loss of correction due to synthetic collapse, and a longer period of time in which load is not allowed; moreover, this procedure requires greater attention to the tibial slope. 3,4,[6][7][8] The technique was introduced by Jackson et al 9 in 1961, but it only became popular in 1965, when Coventry 10 promoted it for treating medial OA with varus deformity. Since then, there have been countless advances in the technique, fixation, and selection of patients, leading to reduced complications and better outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Since then, there have been countless advances in the technique, fixation, and selection of patients, leading to reduced complications and better outcomes. 3,4,[6][7][8] High tibial osteotomy aims to decrease the load in the involved compartment and transfer it to the healthy compartment, correcting the angular deformity and promoting symptomatic improvement of the affected knee. [1][2][3]7,8 Because of the excellent HTO survival rates [11][12][13][14][15][16][17][18][19] and the potential TKA risks, such as loosening, material wear or periprosthetic fractures in subjects practicing high impact activities, 20 HTO is recommended for young adults.…”

Section: Introductionmentioning

confidence: 99%

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Retorno ao esporte após osteotomia tibial alta com método de cunha de abertura

Nicolini

Christiano

Abdalla

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar o retorno ao esporte em pacientes jovens e ativos praticantes de alguma modalidade esportiva submetidos a osteotomia tibial alta (OTA) com o método de cunha de abertura. Métodos Foram analisados prospectivamente 12 pacientes submetidos ao procedimento de OTA utilizando-se método de cunha de abertura. Todos os pacientes estavam afastados do esporte. Foram utilizados os escores Lysholm, questionário International Knee Documentation Committee (IKDC, na sigla em inglês), escala analógica de dor e nível de retorno em comparação ao período pré-operatório. O tempo médio de seguimento foi de 12 meses. Resultados Um paciente retornou ao esporte em nível muito abaixo do pré-operatório, oito pacientes retornaram em nível pouco abaixo, dois pacientes retornaram no mesmo nível e um paciente retornou em nível acima. Conclusão A OTA com uso do método de cunha de adição como forma de tratamento para osteoartrose medial isolada demonstra resultados clínicos e funcionais favoráveis e permite o retorno ao esporte.

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High survivorship and low complication rate in a single‐centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow‐up of 13 years

Mabrouk,

Risebury,

Yasen

2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single‐centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient‐reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively.MethodsA prospectively maintained single‐centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2, were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow‐up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score‐Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ‐5D, which is a standardised measure of health‐related quality of life. All lower limb alignment measurements were recorded pre‐ and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5‐ and 10‐year survivorship were recorded.ResultsA total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from −5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow‐up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10‐year survivorship was 97.2% and 91.9%, respectively.ConclusionMOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis.Level of EvidenceLevel IV, retrospective cohort study.

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Medial Opening-Wedge High Tibial Osteotomy for Medial Compartment Arthrosis/Overload

Cited by 19 publications

References 29 publications

Osteotomies for the Management of Medial Compartment Defects of the Knee

Osteotomies for the Management of Medial Compartment Defects of the Knee

Retorno ao esporte após osteotomia tibial alta com método de cunha de abertura

High survivorship and low complication rate in a single‐centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow‐up of 13 years

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