High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis

Abstract

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39-76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18-60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5 degrees genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations.

Results of high tibial osteotomy: review of the literature

“…Asik et al [10] performed 65 open wedge osteotomies fixed with the Puddu plate. They reported significant improvement of pain and knee function at an average follow-up of 34 months.…”

Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee

“…The varus knee with unicompartmental osteoarthritis of the medial compartment has an altered limb alignment, and subsequently more load is distributed to the affected compartment. Knee arthroplasty is a good treatment option especially for generalized osteoarthritis, but it has several disadvantages, especially if only unicompartmental osteoarthritis is present or the patient is younger than 50~55 years (Asik et al, 2006). The limited lifetime, the higher infection risk, and multiresistance of bacteria have been an increasing problem (Esenkaya and Elmali, 2006).…”

O uso do plasma rico em plaquetas associado ao aspirado de medular óssea na osteotomia tibial tipo puddu

“…A osteotomia valgizante de tíbia empregando a téc-nica de adição de cunha medial é um procedimento frequente no tratamento de diversas patologias ortopé-dicas, sendo sua realização bem padronizada nos dias de hoje (18,(24)(25)(26)(27) . O plasma rico em plaquetas (PRP) possui importante ação osteoindutora, como demonstrado por diversos estudos experimentais (11,(28)(29)(30)(31) .…”

“…Diagnóstico de osteoartrose unicompartimental, deficiências ligamentares crô-nicas, ou deformidades dos membros inferiores. Foram respeitadas as indicações para osteotomia valgizante recomendadas na literatura (18)(19)(20) . Os critérios de exclusão foram: perda de seguimento, solicitação do paciente para ser excluído do estudo.…”