The Technique and Complications of Upper Tibial Osteotomy

Jackson, J. P.; Waugh, W.

doi:10.1302/0301-620x.56b2.236

Cited by 104 publications

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“…Osteotomies to correct both angular and rotational deformity at the proximal and distal tibia have also been described [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Some studies have questioned the safety of proximal tibial osteotomies due to an increased incidence of peroneal nerve palsy, vascular injury, and compartment syndrome [4,6,18,19]. Krengel and Staheli [4] reviewed 52 tibial derotation osteotomies by 14 different surgeons and reported a complication rate of 13% (5 of 39 patients) in proximal osteotomies versus 0% (0 of 13 patients) in distal osteotomies, with complications including two cases each of compartment syndrome and peroneal nerve palsy and one case of deep infection.…”

Section: Introductionmentioning

confidence: 99%

Proximal tibial derotation osteotomy for torsion of the tibia: A review of 43 cases

Walton

Liu

Farrow

et al. 2012

Journal of Children's Orthopaedics

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Purpose Persistent tibial torsion in the older child can be treated with a derotation osteotomy. Distal tibial osteotomy has been recommended due to concerns of peroneal nerve palsy, vascular injury, and compartment syndrome with a proximal tibial osteotomy. However, an osteotomy in the proximal tibia may achieve union more rapidly and skin issues, as described for distal tibial osteotomies, are less likely. This study investigates the safety and efficacy of proximal tibial derotation osteotomies. Methods We retrospectively reviewed 43 tibiae in 25 consecutive children with persistent tibial torsion treated with a proximal tibial derotation osteotomy between 1991 and 2006. Patients with concomitant varus or valgus osteotomies were excluded. Diaphyseal fibular osteotomies were performed in five patients, while all patients had a prophylactic anterior compartment fasciotomy. Results The mean age at surgery was 10.4 ± 4.0 years and the mean follow-up was 3.2 ± 3.5 years. Patients with internal tibial torsion had a mean preoperative thigh-foot angle (TFA) of -14°± 6°and a mean postoperative TFA of 8°± 4°. Patients with external tibial torsion had a mean preoperative TFA of 38°± 9°and a mean postoperative TFA of 7°± 5°. The overall mean correction was 26°± 9°. Major postoperative complications occurred in 4 patients (9%), including one peroneal nerve palsy which resolved, one delayed union requiring revision surgery, and two patients with mild postoperative valgus deformities. Conclusions Proximal tibial derotation osteotomy with an anterior compartment fasciotomy is a reliable method for treating tibial torsion with an acceptable complication rate. Given the larger bony surface area and improved soft tissue envelope, proximal tibial derotation osteotomy can be considered as an alternative to a distal tibial derotation osteotomy.

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Section: Introductionmentioning

confidence: 99%

Proximal tibial derotation osteotomy for torsion of the tibia: A review of 43 cases

Walton

Liu

Farrow

et al. 2012

Journal of Children's Orthopaedics

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“…[5][6][7][8][9][10] Tibial osteotomy is best indicated for young patients with early osteoarthritic changes, good range of motion and no ligamentous laxity. 11,12 However, significant relief can be obtained for active patients over the age of 60 with initial patellofemoral osteoarthritis who can sustain at least 70° of motion.…”

Section: Introductionmentioning

confidence: 99%

Measurement of tibial slope angle after medial opening wedge high tibial osteotomy: case series

et al. 2009

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CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING:Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, Brazil. METHODS:Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS:There was an average increase in tibial slope angle after surgery of 2.38° (95% confidence interval: ± 0.73°). There was no correlation (r = -0.28) between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13).CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis. RESUMO CONTEXTO E OBJETIVO:No passado, alterações no ângulo de inclinação ântero-posterior do planalto tibial (AIAPPT), conhecido como "slope", não eram levadas em consideração no planejamento e avaliação das osteotomias, e o sucesso da osteotomia proximal tibial era relacionado ao grau de correção do ângulo femoro-tibial e ao alinhamento obtido. O objetivo foi mensurar a alteração no AIAPPT após a osteotomia proximal de abertura de cunha medial da tíbia e verificar o efeito da variação angular do AIAPPT sobre os resultados clínicos. TIPO DE ESTUDO E LOCAL: MÉTODOS:Foram incluídos 28 pacientes, e um total de 31 joelhos. Foi mensurado o AIAPPT baseado no eixo anatômico proximal tibial na radiografia lateral da tíbia no pré e no pós-operatório. A avaliação clínica foi realizada através do escore de Lysholm para joelho. RESULTADOS:Houve um aumento do AIAPPT após a cirurgia em média de 2,38° (± 0,73°; intervalo de confiança, IC 95%). Não houve correlação (r = -0,28) entre os resultados obtidos pelo escore de Lysholm pós-operatório e a diferença do AIAPPT pós e pré-operatório (P = 0,13).CONCLUSÃO: A osteotomia valgizante da tíbia proximal com cunha de abertura medial levou a um pequeno aumento no AIAPPT. Não houve correlação entre o aumento do slope tibial e os resultados clínicos a curto prazo após a osteotomia proximal da tíbia. Outros estudos clínicos são necessários para comprovar se uma osteotomia de extensão ou de flexão pode trazer benefício ao paciente com artrose unicompartimental do joelho.

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“…In 1958, Jackson reported the value of tibial osteotomy in the treatment of pain in osteoarthritis of the knee [19,20]. Since then various types of osteotomy have been described, all of which aim to correct deformity and reduce the excessive load-bearing through the medial compartment.…”

Section: Introductionmentioning

confidence: 99%

Long term evaluation of high tibial valgus osteotomy

Valentí

Calvo

Lopez

et al. 1990

International Orthopaedics

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SUMMARYWe present a long term evaluation of 100 high valgus tibial osteotomies with a mean follow up of 11 years. Knees with slight or moderate osteoarthritis had the best results. Slight overcorrection was beneficial, but gross overcorrection was not. There were few complications and the overall long term results were good. RÉSUMÉNous présentons une évaluation à long terme de cent ostéotomies de valgisation de l'extrémité supérieure du tibia, avec un recul moyen de 11 ans. Ce sont les genoux atteints d'arthrose minime ou modérée qui ont eu les meilleurs résultats. Les hypercorrections légères ont été bénéfiques mais non les hypercorrections excessives. Il n'y a eu que peu de complications et dans l'ensemble les résultats à long terme ont été bons.

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The Technique and Complications of Upper Tibial Osteotomy

Cited by 104 publications

References 0 publications

Proximal tibial derotation osteotomy for torsion of the tibia: A review of 43 cases

Proximal tibial derotation osteotomy for torsion of the tibia: A review of 43 cases

Measurement of tibial slope angle after medial opening wedge high tibial osteotomy: case series

Long term evaluation of high tibial valgus osteotomy

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