Tibial Osteotomy for Osteoarthritis of the Knee

Jackson, J. P.; Waugh, W.

doi:10.1177/003591576005301026

Cited by 72 publications

(82 citation statements)

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“…High tibial osteotomy for osteoarthritis of the knee was first described by Jackson in 1958 [24]. Maquet and Tjörnstrand [33,49] reported a widening of the joint space and a reduction of subchondral bone sclerosis after tibial osteotomy, which was supported by Akamatsu et al recently [1].…”

Section: Introductionmentioning

confidence: 92%

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

Schultz

Göbel

1999

Knee Surgery, Sports Traumatology, Arthroscopy

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In this prospective study high tibial osteotomy for medial gonarthrosis was performed in 95 patients (105 knee joints). The patients underwent simultaneously diagnostic and operative arthroscopic surgery of the knee joint. A follow-up arthroscopic examination could be performed in 75 patients (85 knee joints) at the time of implant removal. In group 1 (20 knee joints), the osteotomy was performed after diagnostic arthroscopy without arthroscopic operation of the knee joint. The fixation of the osteotomy was accomplished by staples, postoperative plaster fixation and physiotherapy. In group 2 (20 knee joints), osteotomy was performed without additional operative arthroscopy after diagnostic arthroscopy, internal fixation by AOT-plate, no external fixation postoperatively and physiotherapy. In group 3 (22 knee joints), osteotomy was performed with additional operative arthroscopy (Pridie drilling), internal fixation by AOT-plate no external fixation postoperatively no external fixation, physiotherapy and continuous passive motion. In group 4 (23 knee joints), osteotomy was performed with additional operative arthroscopy (abrasio-arthroplasty), internal fixation by AOT-plate, no external fixation postoperatively, physiotherapy and continuous passive motion. All patients underwent arthroscopic examination of the knee with cartilage biopsies taken from three different regions of the femoral condyle during the same operative session as the osteotomy. At follow-up arthroscopy cartilage biopsies were taken from the same regions. There was no great difference in clinical outcome after 1 year between all groups. Arthroscopy as well as routine and electron microscopy showed better cartilage regeneration in groups 3 and 4. Groups 1 and 2 showed only regeneration isles, sometimes not well fixed to the underlying bone, while in groups 3 and 4 cartilage regeneration was thicker and more stable, sometimes covering all of the pre-existing erosions. Therefore, we recommend osteotomy of the tibia for osteoarthritis together with operative arthroscopy in the same operative session.

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Section: Introductionmentioning

confidence: 92%

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

Schultz

Göbel

1999

Knee Surgery, Sports Traumatology, Arthroscopy

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“…Jackson [11] first defined the upper tibial end and lower femoral end osteotomy in degenerative osteoarthritis in 1958. Later in 1965, Coventry [1] modified the previous techniques and defined the lateral closing wedge osteotomy proximal to the tibial tubercle.…”

Section: Introductionmentioning

confidence: 99%

Proximal tibia medial open-wedge osteotomy using plates with wedges: early results in 58 cases

Esenkaya

Elmalı

2006

Knee Surg Sports Traumatol Arthrosc

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We evaluated in this study indications, surgical technique, and results of wedge plates for fixation in proximal tibia medial opening wedge osteotomy. Fifty-eight knees in 56 consecutive patients (9 men, 47 women; mean age 52 years; ranging between 36 and 66 years) with medial compartment osteoarthrosis were treated with proximal tibia medial open-wedge osteotomy. For fixation, plates which were designed by the first author and which support the osteotomy surface with wedge-shaped projections were used. The plates were either rectangular in shape with two or four holes or had an inverse "L" shape with four holes, and had bearing metal wedges of varying heights from 5 to 15 mm. Tricortical (n=8) and bicortical (n=43) iliac bone autografts and allografts (n=7) were used. The average follow-up time was 21 months (ranging between 6 and 44 months). The mean preoperative tibiofemoral angle was 4.6 degrees varus (0 degrees -11 degrees ) while it was 5.6 degrees valgus (2 degrees -11 degrees ) postoperatively. The mean preoperative HSS score was 58 (range 51-75) and it was found 89 (range 79-96) postoperatively. As complications, lateral tibial plateau fracture in 5 knees (8.6%) and lateral cortex fracture in 15 knees (25.8%) were encountered during surgery. Deep vein thrombosis in two cases (3.4%) and nonfatal pulmonary embolism in one case (1.7%), delayed wound healing in two knees (3.4%), and delayed union as well as breakdown of a distal screw in one knee (1.7%) were encountered postoperatively. In conclusion, using wedge plates for fixation of proximal tibia medial opening wedge osteotomy in the treatment of medial osteoarthritis with unicompartmental involvement of the knee, provides adequate stabilization to allow early movement for functional rehabilitation and keeps the obtained correction level.

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“…Jackson and Waugh [9] first described high tibial osteotomy and Coventry [3] popularized this technique by publishing long-term results. Later various modifications of high tibial ostreotomies were described.…”

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confidence: 99%

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis

Aşık

Şen

Kiliç

et al. 2006

Knee Surg Sports Traumatol Arthrosc

118

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In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39-76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18-60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5 degrees genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations.

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Tibial Osteotomy for Osteoarthritis of the Knee

Cited by 72 publications

References 0 publications

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

Proximal tibia medial open-wedge osteotomy using plates with wedges: early results in 58 cases

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis

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