Radiographs of 110 patients who had undergone 120 high tibial osteotomies (60 closed-wedge, 60 open-wedge) were assessed for posterior tibial slope before and after operation, and before removal of the hardware. In the closed-wedge group the mean slope was 5.7 degrees (SD 3.8) before and 2.4 degrees (SD 3.9) immediately after operation, and 2.4 degrees (SD 3.4) before removal of the hardware. In the open-wedge group, these values were 5.0 degrees (SD 3.7), 7.7 degrees (SD 4.3) and 8.1 degrees (SD 3.9) respectively, when stabilised with a non-locking plate, and 7.7 degrees (SD 3.5), 9.4 degrees (SD 4.1) and 9.1 degrees (SD 3.8), when stabilised with a locking plate. The reduction in slope (-2.7 degrees (SD 4.1)) in the closed-wedge group and the increase (+2.5 degrees (SD 3.4), in the open-wedge group was significantly different before and after operation (p = 0.002, p = 0.003). In no group were the changes in slope directly after operation and before removal of the hardware significant (p > 0.05). There was no correlation between the amount of correction in the frontal plane and the post-operative change in slope. Posterior tibial slope decreases after closed-wedge high tibial osteotomy and increases after an open-wedge procedure because of the geometry of the proximal tibia. The changes in the slope are stable over time, emphasising the influence of the operative procedure rather than of the implant.

No abstract

According to current generally accepted theories, analysis of the shape of a bone provides clues to the stresses acting upon it. Although many investigations have ensured that understanding of the lower limb is relatively advance, knowledge relating to the upper limb, and particularly to the scapula, is still far from complete. We have therefore endeavoured to interpret the shape of this bone morphometrically. To this end various scapular parameters have been standardised and statistically analysed, and the results examined both from the functional and the clinical points of view. Our investigation has established that, as in the case of the long bones, the form of the scapula is dependent upon both height and sex. Assessment of the architecture of the subacromial space and its possible parameters of influence have also demonstrated that the size of this space is essentially dependent upon the height of the subject and the size of the acromial and scapulospinal angles. A short distance between the acromion and the upper edge of the glenoid cavity and a small glenoid-spinal angle can be regarded from a functional point of view as factors predisposing to the development of the impingement syndrome. We have also been able to show that certain constant structural features produce an optimal distribution of the forces acting upon the scapula. In particular, the relationship of the supporting pillars (the lateral border and the spine) of this bone to one another appears to represent the expression of an ideal adaptation to the action of those forces.

No abstract

We reviewed retrospectively the results in patients who had undergone one hundred and four high tibial lateral osteotomies. The operations were all performed between 1985 and 1993. Each one of fifty men and forty nine women demonstrated a varus deformity of the knee with a coexistent medial osteoarthritis. Results were reviewed in 49 patients (62 knees) with an average follow-up of 10.2 years (range 6-14 years). Of the remaining 42 patients, 8 were lost to follow-up, 10 had died, and 24 were subsequently treated with total knee arthroplasty at an average 4.7 years after having had a high tibial osteotomy. Clinical results were evaluated using the Hospital for Special Surgery Score (HSS) and the Knee Society Score. Radiographs were systematically analysed to evaluate osteoarthritis and leg axis. Forty four (90 per cent) of the forty nine patients stated the results met their expectations and given the same circumstances, they would have the operation once again. In these patients the knee score results were excellent. The same patients had excellent HSS and Knee Society Scores. Five patients (10 per cent) had a poor result and twenty four patients were treated later by total knee arthroplasty because of pain. The following factors set these patients apart from those with more favorable results: previous arthroscopic debridement, obesity, lateral knee osteoarthritis, insufficient valgus correction, and an age of more than 55 years. High tibial valgus osteotomy provides good pain relief and improved function in carefully selected patients. Our results support this conclusion.