High tibial osteotomy for valgus and varus deformities of the knee

Abstract

In 53 patients with a mean age of 38 (17-73) years, 71 high tibial osteotomies were performed. Twenty-three patients had no radiological signs of osteoarthrosis (Ahlbäck grade 0), whereas 26 patients had primary and 22 patients secondary osteoarthritis. Follow-up was 10.5 (5.8-16.6) years. The patients without radiological osteoarthrosis achieved almost exclusively good or very good scores using the Lysholm-Gillquist (96%) and the Insall scale (83%). By contrast, only 29% of the patients with radiological osteoarthritis achieved good or very good scores. Whether the patient had primary or secondary osteoarthrosis was of no influence. Neither was the preoperative axial deviation.Résumé Chez 53 patients, d'âge moyen 38 (17-73) ans, 71 ostéotomies hautes du tibia ont été éffectuées. Vingttrois malades n'avaient pas de signes radiologiques d'arthrose (Ahlbäck grade 0), alors que 26 malades avaient une arthrose primaire et 22 une arthrose secondaire. Le suivi était de 10.5 (5.8-16.6) années. Les malades sans arthrose radiologique ont atteints presque exclusivement des bons ou très bons scores selon les échelles de Lysholm-Gillquist (96%) et d' Insall (83%). Par contraste, seulement 29% des malades avec arthrose radiologique ont atteints de bons ou très bons scores. Le caractère primaire ou secondaire de l'arthrose et la déviation axiale préopératoire n'avaient aucune influence.

Stability of medial opening wedge high tibial osteotomy: a failure analysis

“…We could find no correlation between preoperative value of anatomical axis and postoperative complications. This is consistent with previous publications by Leutloff et al [15].…”

The influence of alignment on the musculo-skeletal loading conditions at the knee

“…Such activities are of great interest, since they result, due to muscle activity, in forces that are higher than those seen in patients who are in a static standing position [3,8,20]. Furthermore, the clinical outcome of high tibial osteotomies based on the correction of the static deformity alone is characterised by unpredictable longterm results [22], and there seems to be no consensus on whether a deformity should be corrected to a physiologically normal alignment or if an over-correction is required [27].…”

“…It is assumed that in patients with deformities at the knee, which might have either resulted from a traumatic event [28,29] or a disease [9], the mal-alignment of the mechanical axes of femur and tibia leads to excessive loading of the structures at the knee [25,34]. High tibial osteotomies are surgical procedures to treat unicompartmental osteoarthritis in cases of mal-alignment of the proximal tibia [13,27]. Whilst a major goal of the procedure is the recreation of a physiologically normal joint-loading environment [13,31], little is known about the in vivo musculo-skeletal loading conditions at the knee that result from such interventions.…”

Osteotomy About the Knee – Applications, Techniques, and Results

“…More favorable outcomes have been reported in patients with early radiographic staging of their disease. 48 Physical examination should reveal localized joint-line tenderness; meniscal pathology should be ruled out if an isolated osteotomy is planned. The patellofemoral joint should be painless.…”