Abstract
We reviewed 192 patients (224 knees) to assess the results of HTO in medial gonarthrosis during the period 1982–2008. Median follow-up was about 15 years for 134 females and 58 males. Among the knees, 118 had an average opening wedge for varus angle of 13° and 106 had closing wedges of 11°. Knee Society scoring before osteotomies was 68/200 for opening wedge and 81/200 for closing wedge. Modified Ahlback classification showed preoperative grades I (n = 44), II (78), III (83) and IV (19). Healing delay was 55 days for closing and 70 for opening osteotomy. Twenty-nine knees were still painful. Twenty-eight patients were revised and 19 others had complications. After opening wedge osteotomy, scoring was 101/200 and valgus angle was 2°. After closing wedge osteotomy, scoring was 94/200 and valgus angle was 4°. Global results were as follows: very good, 12%; good, 30%; fair, 31%; and poor, 27%. HTO decreases stresses on medial compartments and widens joint space. The average of 5° mechanical valgus at the time of osteotomy seems to be quite effective at the follow-up for at least ten years. Our indications are opening wedge for grades 1–3 and wide varus angle, until the age of between 65–70. Closing wedge is indicated for medium varus in younger patients.
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References
Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) A high tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 16:21–26
Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277(Suppl):7–72
Blaimont P, Burnotte J, Baillon J, Duby P (1971) Contribution à l’étude des conditions d’équilibre dans le genou normal et pathologique. Acta Orthop Belg 37:573–592
Caton J (1989) Method of measuring the height of the patella. Acta Orthop Belg 55:385–386
Coventry M (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis the knee: a preliminary report. J Bone Joint Surg 47A:984–990
Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy: a critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201
Dubrana F, Lecerf G (2008) Tibial valgus osteotomy. Rev Chir Orthop Rep Appar Mot 94S:S2–S21
Gaasbeek RDA, Nicolaas L, Rijnberg WJ, Van Loon CJM, Van Kampen A (2009) Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one year randomized controlled study. Int Orthop. doi:10.1007/s00264-009-0723-3
Gariépy R (1964) Genu varum treated by high tibial osteotomy. J Bone Jone Surg Br 46:783–784
Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15(5):597–603
Hanssen AD, Stuart MJ, Scott RD, Scudery GR (2000) Surgical options for the middle aged patient with osteoarthritis of the knee joint. Joint Bone Spine 67(6):504–508
Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Joint Surg [Am] 69:332–354
Hernigou P, Ovadia H, Goutallier D (1992) Mathematical modelling of open wedge tibial osteotomy and correction tables. Rev Chir Orthop Rep Appar Mot 78:258–263
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop 248:13–14
Jackson JP (1958) Osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 40:826
Jakob RP (1991) Instabilitätsbedingte Gonarthrose-spezielle Indicationen für Osteotomienbei der Behandlung des instabilen Kniegelenkens. In: Jakob RP, Staubli HU (eds) Kniegelenk und Kreuzbander. Springer Verlag, New York, pp 555–578
Koshino T, Tsuchiya K (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. Clinical and histological observation. Int Orthop (SICOT) 3:37–45
Koshino T, Yoshida T, Ara Y (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. The Knee 11:439–444
Lindstrand A (1999) Surgery of unicompartmental osteoarthritis of the knee. J Bone Joint Surg 4:105–111
Maquet PGJ (1984) Biomechanics of the knee: with application to the pathogenesis and the surgical treatment of osteoarthritis, 2nd edn. Springer, New York, NY
Marti RK, Verhagen RA (2001) Upper tibial osteotomy for osteoarthritis of the knee. In: Surgical techniques in orthop and trauma. Elsevier, Paris, 55-530-A-10
Odenbring S, Egund N, Hagstedt B, Larsson J, Lindstrand A, Toksvig-Larsen S (1991) Ten years results of tibial osteotomy for medial gonarthrosis. The influence of overcorrection. Archives Orthop Trauma Surg 110:103–108
Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:403–408
Rahmi M, Ouabid A, Bekkali Y, Adnane N, Garch A, Largab A (2008) Le traitement du genu varum par osteotomy de valgisation d’addition interne par cale de ciment. Rev Maroc Chir Orthop Traumato 37:21–27
Sherman C, Cabanela M (2009) Closing wedge osteotomy of the tibia and the femur in the treatment of gonarthrosis. Int Orthop. doi:10.1007/s00264-009-0883-1
Tigani D, Ferrari D, Trentani P, Barbanti-Brodano G, Trentani F (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334
Wardle EN (1962) Osteotomy of the tibia and fibula. Surg Gynecol Obstet 101:46–52
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Benzakour, T., Hefti, A., Lemseffer, M. et al. High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up. International Orthopaedics (SICOT) 34, 209–215 (2010). https://doi.org/10.1007/s00264-009-0937-4
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DOI: https://doi.org/10.1007/s00264-009-0937-4