Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy

Abstract

We analyzed the time-dependent results after Coventry osteotomy in 118 patients (129 cases) with uni-compartmental osteoarthrosis of the knee. The median follow-up was 11.6 years (range 0.7-17 years). Data were noted according to the time since surgery. Group I (> 2 years) consisted of all 129 cases, group II (> 4 years) of 41 cases and group III (> 8 years) of 15 cases. The HSS knee score (max. 100 points) improved from 33.2 +/- 20.4 (range 17-60) to 68.3 +/- 25.3 (range 30-90) in group I, to 54.7 +/- 18.9 (range 29-90) in group II and to 43.7 +/- 20.9 (range 23-85) in group III. The improvement started 4.6 +/- 7.8 months (range 0-60 months) after the operation and persisted for 4 years +/- 37.4 months (range 0-125 months). The functional knee score (max. 100 points) changed from 61.7 +/- 14.1 (range 41-70) to 71.7 +/- 13.1 (range 53-87) in group I, to 70.0 +/- 11.8 (range 54-88) in group II and to 64.2 +/- 8.0 (range 42-90) in group III. The initial loss in knee flexion was 5.6 degrees (range 0 degree-20 degrees) and for extension 1.0 degree (range -5 degrees-25 degrees). Anteroposterior ligament stability (max. 10 points) decreased from 9.2 +/- 2.1 (range 2-10) to 5.6 +/- 1.7 (range 2-9) in group III. Lateral ligament stability (max. 15 points) was relatively constant, from 12.6 +/- 1.9 (range 4-15) to 9.7 +/- 1.9 (range 2-14). Complications included one tibia fracture, one infection, six peroneus pareses, four haematomas and one pseudarthrosis. The mechanical axis was corrected to an average knee valgu2 of 5.2 degrees +/- 7.4 degrees, which deteriorated over time. Radiographic evidence of arthrosis appeared independent of the operation.

Results and Survival at Mid-term Follow-up of a Series of 15 High Tibial Lateral Closing Wedge Osteotomies in the Treatment of Unicompartimental Medial Osteoarthritis

“…The infection rate caused by closing wedge osteotomy of the proximal tibia varies from 0.8% to 10% [9][10][11][12]. With 2 (13.3%) cases of superficial infections of surgical site, our results seem less good than those of the authors cited above.…”

Complications of closing wedge high tibial osteotomy

“…Currently it appears to be gaining in popularity again and is seen to be making a resurgence. Good results have been achieved in the literature over both the medium and long term [1][2][3][4][5][6][7][8], with a gradual deterioration in function and outcome over time. All authors have emphasised the significance of appropriate patient selection and meticulous surgical technique in order to achieve optimal results.…”

“…Rates of infection range from 0.8-10.4% [2,4,5,7,8]. Most are superficial wound infections that can be treated successfully with oral antibiotics.…”

“…The incidence of deep vein thrombosis ranges from 2-5% [1,2,[4][5][6][7] in most series. However, Turner et al [10] undertook a venographic study after HTO and found the incidence to be 41%, the majority being only in the calf veins.…”

“…The rate of complications ranges widely between different series with Wu et al [8] reporting an overall rate of 5.6% whilst Naudie et al [5] had an overall rate of 34% in his series. Bettin [4], Aglietti [6], Ivarsson [2] and Sprenger [7] fared better in their series with rates of 10%, 10%, 11% and 21%, respectively. These figures do not include the failures that required conversion to knee arthroplasty.…”