Open-Wedge Osteotomy Using an Internal Plate Fixator in Patients With Medial-Compartment Gonarthritis and Varus Malalignment: 3-Year Results With Regard to Preoperative Arthroscopic and Radiographic Findings (original) (raw)
Related papers
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2008
The purpose of our study was to evaluate the complications, technique-related risks, and the clinical course of patients treated with high tibial osteotomy (HTO) for medial arthritis of the knee with varus malalignment. Methods: Forty-three of 46 consecutive patients (follow-up, 93.5%) treated with HTO using the TomoFix implant (Synthes, Solothurn, Switzerland) were followed-up for 24 months. Radiographic and clinical data were collected preoperatively as well as 6, 12, and 24 months after surgery using standard instruments (Lysholm and subjective International Knee Documentation Committee score). Results: Excellent and good results were achieved in 67.5% of patients. Thirty-seven patients (86.0%) reported clinical improvement at 24 months compared to preoperative status. Evaluation of the clinical course following HTO revealed a significant increase in function after 12 (P Ͻ .01) and 24 (P Ͻ .01), but not at 6 months (P ϭ .336) after surgery. A further increase was found between 12 and 24 months (P ϭ .017); 67.5% of the study population returned to their predisease sports activity level at 24 months after surgery. Except for 1 case of intra-articular fracture, no severe intraoperative complications were found. One case of nonunion that demanded additional surgery was observed. Conclusions: HTO with an open-wedge technique using the TomoFix implant seems to be a safe and efficient procedure. Our data show that postoperative recovery is long, with a majority of patients not reaching a functional end-point by 6 or 12 months. In many patients, further improvement was found after 12 months, which might be related to a removal of the implant. Level of Evidence: Level IV, therapeutic case series.
Results of High Tibial Osteotomy in Unicompartmental Osteoarthritis of kNee using Tomofix implant
IOSR Journals , 2019
HTO) High Tibial Osteotomy still has a role in the management of OA in selected cases. This procedure is ideally suited for patients with a high demand for physical activity. High tibial osteotomy is generally considered a method of prolonging the time before a knee replacement is necessary, because the benefits typically fade after eight to ten years. This procedure is typically reserved for younger patients with pain resulting from instability and malalignment. Retention of the joint always shows advantages over unicompartmental replacement, TKR replacement in active and younger patient. The proximal high tibial osteotomy (HTO) is an established procedure for the treatment of varus osteoarthritis, and can be either of the open-wedge type or closed-wedge type.HTO is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. HTO closed wedge. The classic procedure for correcting varus deformity is the -- lateral closed wedge osteotomy. of the tibia with osteotomy of the fibula. Closed wedge HTO has certain disadvantages. The risk of compartment syndrome, Peroneal nerve injuries. Fibular osteotomy cause difficulty in conversion to TKR. Because of the disadvantages of closed-wedge HTO the option of an open-wedge HTO technique gained importance and encouraging results were published by Hernigou- on HTO open wedge.
Comparative Study of Medial Opening-Wedge High Tibial Osteotomy Using 2 Different Implants
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
The purpose of this study was to perform a retrospective clinical and radiographic evaluation after openingwedge high tibial osteotomy (HTO) using a short spacer plate (Aescula; B. Braun Korea, Seoul, South Korea) and rigid long plate (TomoFix plate; Mathys, Bettlach, Switzerland) at follow-up 2 years postoperatively. Methods: We performed 94 opening-wedge HTOs with the Aescula plate (group I) and 92 HTOs with the TomoFix plate (group II). Patients underwent clinical and radiographic evaluations preoperatively and at 2 years postoperatively. Clinical evaluations were performed with Knee Society scores. Radiographic analysis included the mechanical tibiofemoral angle (mTFA) and the slope of the tibia angle with preoperative and postoperative full weightebearing anteroposterior whole-leg views, as well as anteroposterior, lateral, and Merchant views of the knee. We measured the mTFA. In addition, we evaluated the complications in each group. The follow-up period was 2 years. Results: At follow-up 2 years postoperatively, we observed an overall complication rate of 38% in group I and 26% in group II (P ¼ .083). We found plate-related complication rates of 20% in group I and 9% in group II (P ¼ .039). Plate-related complications included loss of correction, fracture of the tibial plateau, screw failure, malunion, and fracture of the lateral cortical bone. The mean mTFA was À6.0 AE 3.2 in group I and À4.6 AE 2.8 in group II preoperatively (P ¼ .262). The mean mTFA was 1.0 AE 3.1 in group I and 1.5 AE 2.3 in group II at the latest follow-up (P ¼ .034). In group I, the mean Knee Society knee score and function score were 60.0 AE 12.9 and 57.9 AE 26.8, respectively, preoperatively. They improved to 92.1 AE 8.1 and 89.0 AE 15.1, respectively, at follow-up (P ¼ .001 and P ¼ .001, respectively). In group II, the mean Knee Society knee score and function score were 57.5 AE 14.8 and 57.4 AE 22.1, respectively, preoperatively. They improved to 95.5 AE 5.4 and 95.0 AE 7.6, respectively, at follow-up (P ¼ .001 and P ¼ .001, respectively). In addition, the mean postoperative knee score and function score in group II were higher than those in group I (P ¼ .001 and P ¼ .001, respectively). Conclusions: We have shown a high plate-related complication rate and a significant loss of correction during a short-term follow-up period (2 years) after opening-wedge HTO using the new short spacer HTO plate compared with the rigid long plate. Level of Evidence: Level IV, therapeutic case series.
The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction: One hundred and eight patients with varus gonarthrosis were treated with high tibial osteotomy (HTO) in 2001. Fifty one patients received an open wedge osteotomy by using the 'Puddu' plate and 57 patients received a Coventry-type closing wedge osteotomy. For both groups the follow-up examination period was 22.5 months (253-1009 days). Material and Methods: To evaluate the study, radiological and subjective criteria as well as the Lysholm and the Tegner Activity Score were used. Altogether 84 % of the patients were included in the follow-up examination study. Results: In both groups a significant improvement of both scores were achieved. Both methods obtained safe and reproducible results for the correction considering the different operation techniques. There were no differences in outcome between the two methods. Satisfactory results were also achieved for early arthrosis of the femoropatellar and the lateral compartment. Conclusion: Open and closed wedge HTOs obtain significant improvement in patients with medial osteoarthritis of the knee. Using the right technique is very important for good results. For stabilization of the medial ligament we recommend the open wedge osteotomy. The patient should be informed about the routine removal of the metal plate.
SICOT-J
Introduction: High tibial medial open-wedge valgus osteotomy (HTO) is a well-established procedure for unicompartimental medial osteoarthritis of the young and active patient. However, the influence of cartilage defects of the lateral compartment on the total outcome remains obscure.Methods: From 2005 to 2012, a total of 63 patients underwent HTO for medial osteoarthritis of the knee at a single university orthopaedic center. Baseline data as well as intraoperative findings, including the grade and location of cartilage lesions, were evaluated retrospectively. Two groups were formed regarding the integrity of the lateral tibiofemoral compartment as measured by the Outerbridge score (group A: no lateral cartilage defects, group B: mild to moderate lateral cartilage defects). Functional outcome was assessed using the Knee and Osteoarthritis Outcome Score (KOOS), including its five subscores.Results: Comparing pre- and postoperative data, we identified an overall benefit of the HTO pro...
Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee
Knee Surgery, Sports Traumatology, Arthroscopy, 2020
Purpose The purpose of this study was to analyze the long-term clinical and radiological outcomes of patients who underwent closing-wedge High Tibial Osteotomy (HTO) for the treatment of medial compartment osteoarthritis and to evaluate the conversion rate to knee arthroplasty. Methods A retrospective, non-randomized, monocentric study was performed in our Institution considering 166 patients between 1989 and 2012. The final population was composed by 82 patients (94 knees), median age at time of operation was 53 (range 45-73) years. All patients were evaluated clinically (HSS Score, Tegner Scale, VAS and Crosby-Insall Grading) and radiographically (osteoarthritis staging, hip-knee-ankle (HKA) angle, tibial slope and metaphyseal varus). Results Mean follow-up was 11.9 ± 7.2 years. HSS Score increased significantly from 70.8 ± 10 to 93.2 ± 9.1 (p < 0.05) instead Tegner Scale increased from 1.3 ± 0 (range 1-4) to 2.8 ± 0.7 (range 2-6) at the last control (n.s.); VAS score significantly decreased from 7.9 ± 1.4 to 1.6 ± 1.1 (p < 0.05) at last follow-up. According to the Crosby-Insall Grading System, 80 patients (97.4%) reported excellent-good results. HKA angle decreased from 6.9° ± 3.5 to 2.6° ± 2.6 (p < 0.01), tibial slope decreased from 10.1° ± 1.4 to 6.8° ± 2.1 (p < 0.05) and finally the metaphyseal varus decreased from 4.2° ± 0 to 2.1° ± 1.2 (n.s.) at the last follow-up. Adverse events were reported in 4.8%. Osteotomy survivorship rate resulted 92% at 10 years, 82% at 15 years and 80% at 20 years. Sixteen revisions (9.6%) were reported at a mean period of 12.8 years. Conclusions CW-HTO is a valid option for medial osteoarthritis treatment, with successful results in both clinical and radiological outcomes. Level of evidence IV.
Injury, 2003
High Tibial Osteotomy (HTO) is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. The classic procedure for correcting varus deformity is the lateral closed wedge osteotomy of the tibia with osteotomy of the fibula. The disadvantages of this technique are well known. Open wedge osteotomy from the medial sideeliminates the risk of compartment syndrome and peroneal nerve injuries. A new fixation device (TomoFix™) with an adapted surgical technique allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts.
International Journal of Orthopaedics Sciences, 2018
Introduction: Osteoarthritis of knee joint is the most common form of arthritis, affecting a huge population of about 237 million (3.3% of the population). Among those over 60 years old, about 10% of males and 18% of females are affected. Medial compartment is a common disease, caused by additional force on the medial compartment as a result of varus malalignment. The high tibial osteotomy (HTO) is one possibility for the treatment of varus gonarthrosis. Especially for younger and active patients this method can produce long-term relief, which often significantly delays the need for knee arthroplasty. Various techniques for valgus HTOs are described. High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthrosis. Materials and Methods: This was a prospective study of 30 patients in the age group between 50 years and 70 years of medial compartment osteoarthritis of knee joint treated by opening wedge osteotomy fixed with orthofix and puddu plate. The study was conducted in the Department of Orthopaedics, SRMS IMS, Bareilly in between September 2016 to march 2018.Patients were randomly allocated in two groups by a computer generated selection system. Their functional results were analysed using knee soceity score. Results: Statistical analysis was performed to compare the demographic characteristics between two groups. The groups were compared with regards to age and sex, grade of osteoarthritis, time of consolidation and functional outcome. Majority of patients were males accounting to 73.33% n=22). Mean age of patients was 61.5years. Minimum age in this series was 52 years and maximum age in this series was 70 years. An unilateral Osteotomy was done in a single setting even when bilateral procedures were required. In our study bilateral osteotomy was done in 12 (40%) patients out of 30 patients. 18 Patients were treated unilaterally (60%).Among unilaterally treated patients majority of these were treated on right knee. Conclusion: Shorter follow-up period is the main shortcoming of our study. However, early results obtained indicate that medial open-wedge osteotomies in medial compartment osteoarthritis of knee fixed using Puddu plates and ortho fix could be done safely and effectively with considerable success with encouraging outcomes, and this technique could be a good alternative for unicompartmental total knee arthroplasty.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
The purpose of this study was to conduct a prospective outcome analysis of proximal tibial opening wedge osteotomies performed in young and middle-aged patients (aged Ͻ55 years) for the treatment of symptomatic medial compartment osteoarthritis of the knee. Methods: A consecutive series of young and middle-aged adults who underwent proximal tibial opening wedge osteotomies for symptomatic medial compartment osteoarthritis and genu varus alignment were prospectively followed up. Patients were evaluated with preoperative and postoperative modified Cincinnati Knee Scores and International Knee Documentation Committee objective knee subscores for knee effusions and the single-leg hop. Calculations were made of the preoperative and postoperative long-leg radiographic mechanical weight-bearing axis, patellar height (Insall-Salvati index), and tibial slope. A separate cohort of asymptomatic patients was used to quantify tibial plateau anatomy to provide an objective description of the lower extremity mechanical axis. Results: There were 47 patients, with a mean age of 40.5 years, with a minimum of 2 years' follow-up, who formed this patient cohort. Modified Cincinnati Knee Scores improved significantly from 42.9 preoperatively to 65.1 at a mean of 3.6 years of follow-up. Radiographic analysis of a separate cohort showed the medial tibial eminence to be located at the 41% point along the tibial plateau from medial (0%) to lateral (100%). There was a significant improvement in malalignment: the mean mechanical axis passed through the tibial plateau at 23% of the distance along the proximal tibia preoperatively versus 54% postoperatively. The Insall-Salvati index decreased from 1.03 to 0.95 (P Ͻ .05), and posterior tibial slope increased from 9.4°to 11.7°(P Ͻ .05). Of the osteotomies, 3 (6%) were considered failures, defined by revision of the osteotomy or conversion to total knee arthroplasty. Conclusions: Performing proximal tibial opening wedge osteotomies to treat symptomatic medial compartment osteoarthritis in carefully selected patients leads to a significant improvement in subjective and objective clinical outcome scores with correction of malalignment at a mean of 3.6 years postoperatively. Level of Evidence: Level IV, therapeutic case series.
The Knee, 2017
Background: To report time dependent functional improvement and predictive risk factors for failure when the load in varus knees with medial osteoarthritis is shifted from the medial to the lateral knee compartment. Methods: Forty-nine consecutive patients (52 knees), mean age 47 (31-64) years, underwent a high tibial opening-wedge valgus osteotomy stabilized with a Puddu plate and bone grafting. The patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at three and six months, one, two, five and 10 years postoperatively with a mean follow-up time of 8.3 years (2.0-10.6). Results: Mean angular correction was 8.0°(four to 12). The five subscores of KOOS increased significantly during the first year by 40-131% from preoperative values, the good results remaining throughout the 10-year follow-up for those with a surviving osteotomy. The outcome was related to the grade of preoperative osteoarthritis. Seven knees were converted to total knee arthroplasty (TKA) mean 6.2 years (two to nine) post-operatively, and had a lower KOOS preoperatively than those of surviving osteotomies. The osteotomy survival rate at five years was 94% and at 10 years 83%. Patients with KOOS subscore quality of life (QoL) b44 at the two-year follow-up had a 11.7 times higher risk for later TKA than those with QoL ≥44 (P = 0.017). Conclusion: High tibial opening-wedge osteotomy for medial knee osteoarthritis resulted in good functional recovery after one year and favorable mid-term results. It may be a good treatment option for middle-aged patients with varus knees and medial osteoarthritis in order to prevent or postpone TKA.