The effect of closed- and open-wedge high tibial osteotomy on tibial slope

Abstract

Radiographs of 110 patients who had undergone 120 high tibial osteotomies (60 closed-wedge, 60 open-wedge) were assessed for posterior tibial slope before and after operation, and before removal of the hardware. In the closed-wedge group the mean slope was 5.7 degrees (SD 3.8) before and 2.4 degrees (SD 3.9) immediately after operation, and 2.4 degrees (SD 3.4) before removal of the hardware. In the open-wedge group, these values were 5.0 degrees (SD 3.7), 7.7 degrees (SD 4.3) and 8.1 degrees (SD 3.9) respectively, when stabilised with a non-locking plate, and 7.7 degrees (SD 3.5), 9.4 degrees (SD 4.1) and 9.1 degrees (SD 3.8), when stabilised with a locking plate. The reduction in slope (-2.7 degrees (SD 4.1)) in the closed-wedge group and the increase (+2.5 degrees (SD 3.4), in the open-wedge group was significantly different before and after operation (p = 0.002, p = 0.003). In no group were the changes in slope directly after operation and before removal of the hardware significant (p > 0.05). There was no correlation between the amount of correction in the frontal plane and the post-operative change in slope. Posterior tibial slope decreases after closed-wedge high tibial osteotomy and increases after an open-wedge procedure because of the geometry of the proximal tibia. The changes in the slope are stable over time, emphasising the influence of the operative procedure rather than of the implant.

Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee

“…Inappropriate alteration of the sagittal inclination can compromise the normal knee kinematics (El-Azab et al, 2008). Previous data showed that increasing the posterior slope aids in decreasing stress on the posterior cruciate ligament (Lobenhoffer et al, 2004).…”

Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?

“…Achieving overcorrection with a high tibial osteotomy (HTO) is important for achieving long-term success in the treatment of unicompartmental arthrosis [6,42]. Although the closing wedge osteotomy can be used to correct malalignment, the technique has several limitations [1,3,6,9]. These include the inability to adjust alignment without additional surgery and shortening results from removal of bone segments.…”

“…More recently, the medial opening wedge osteotomy has gained popularity as another option to avoid the complications associated with the closing wedge technique. This technique also requires acute correction and no ability to correct any residual deformity [7,9].…”

Consenso SECOT artrosis femorotibial medial

“…No obstante, las alteraciones que producen las osteotomías en la pendiente tibial obligan a conocer el estado de los ligamentos cruzados para decidirnos por una u otra técnica. La osteotomía de sustracción disminuye la caída del platillo tibial, mientras que la de adición la aumenta 73 . Hemos encontrado consenso en lo referente a la indicación de la prótesis unicompartimental: mayores de 50 años con artrosis limitada en el compartimento medial y que no deben indicarse exclusivamente al paciente joven.…”