Medial Opening Wedge Proximal Tibial Osteotomy: Lessons Learned from a Series of 175 Consecutive Cases

Abstract

Introduction High tibial osteotomy (HTO) is a surgical procedure aimed at inhibiting the progression of osteoarthritis of the knee joint. The aim of this study was to identify factors influencing the functional outcome after opening wedge valgus HTO. Methods A total of 175 cases (155 patients) of varus-correcting high tibial open-wedge osteotomies using the Tomofix plate were reviewed retrospectively. Patients answered the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire and 4 survey follow-up questions. Results and Discussion A total of 76 of the 155 patients studied (84 of the 175 knees) completed the KOOS questionnaire, on average 3.1 years (SD 1.8 years) after the surgery. The median scores (with median absolute deviations [MAD]) for the KOOS pain, symptoms, daily activities, sports, and quality of life sections were, respectively, 76.4 (MAD 12.5), 75.0 (MAD 14.3), 85.3 (MAD 11.8), 50.0 (MAD 25.0), and 59.4 (MAD 21.9). No cases of nonunion were observed throughout the length of the study. Identified predictors of worse outcomes were higher weight and body mass index, limited knee flexion, genu varum and tibial varus of small magnitude, active smoking status at the time of surgery, further surgery for plate removal, and some grades of chondropathy in the patellofemoral, medial tibial, and femoral compartments. Patient gender, joint obliquity and over- or undercorrection were not associated with any of the outcomes. Conclusion This study shows good results following valgus HTO that are comparable to outcomes following total knee arthroplasty, reinforcing the option of HTO as a valid alternative for total knee arthroplasty.

Impact of the Weightbearing Line on Cartilage Regeneration of the Medial Knee Compartment after Open-Wedge High Tibial Osteotomy, Based on Second-Look Arthroscopy

“…However, overcorrection or undercorrection was not associated with clinical outcomes. 28 , 29 Kanto et al 14 identified that a postoperative WBLR of 51.6% ± 8.4% improved outcomes after OWHTO among patients with knee OA who desired to continue sporting activities, producing a Tegner activity score ≥5 points after surgery. Saragaglia et al 13 proposed that a neutral knee axis should be the target alignment for patients who practice sports such as running, tennis, jogging, and football.…”

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

“…Multiple studies were published reporting on the outcomes and complications of MOWHTO [3,4,10,17,23]. Despite the fact that many of these studies are from high-volume centres, one of the repeatedly observed limitations is the relatively small sample size of these series.…”