Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results

Abstract

PurposeTo evaluate the radiologic and functional outcomes of medial open wedge high tibial osteotomy (HTO) combined with arthroscopic procedure in patients with medial osteoarthritis.Materials and MethodsFrom June 1996 to March 2010, 26 patients (32 knees) who underwent medial open wedge osteotomy and arthroscopic operation for medial osteoarthritis were retrospectively reviewed. Measurements included hip-knee-ankle (HKA) angle, femorotibial angle, medial proximal tibial angle, posterior tibial slope angle, and Kellgren-Lawrence grade. Clinical evaluation was performed using Lysholm knee scoring scale and knee and function score of the American Knee Society.ResultsDifferences between the mean preoperative and postoperative measurements were significant in all angles including the HKA angle (−5.7° and +5.5°), femorotibial angle (−1.9° and +9.8°), and medial proximal tibial angle (82.9° and 90.5°) (p<0.05). Mean Lysholm knee scoring scale was 63.6 preoperatively and 88.7 at the last follow-up, mean Knee Society knee score was 61.2 and 86.6, and mean function score was 59.3 and 87.2, respectively. All differences were significant (p<0.05).ConclusionsMedial open wedge HTO in combination with arthroscopic procedure is an effective treatment method for medial osteoarthritis to treat varus deformity and an intra-articular lesion.

Preliminary results of high fibular osteotomy (HFO) and cartilage regeneration procedure for medial compartment osteoarthritis of knee with varus deformity

“…Biomechanically, osteoarthritis of knee occurs due to the imbalance between biological resistance and mechanical stress, and one of the important treatments is to reduce the stress to articular cartilage [11]. Osteotomy around the knee reverses the stress from the arthritic articular cartilage to normal or less arthritic articular cartilage [11], [12]. Despite unclear reasons underlying pain reduction after osteotomy, we assumed that it was due to the correction of knee mal-alignment [10].…”

“…This operation transfers the joint reaction force from medial to lateral compartment of knee, which is normal or less arthritic. HTO can halt or delay the arthritis progression and improve joint pain and patient's activity [11]. However, the rehabilitation period is very long, and entails possible complications including nerve palsy, vascular injury, non-union of osteotomy site and infection [5], [6], [7], [8].…”

Medial opening wedge high tibial osteotomy in patients with posttraumatic medial tibial plateau bone defect: A case report

“…Data regarding the favorable joint-sparing results of high tibial osteotomy has been accumulated for more than three decades in various mid- to longer-term studies [2] , [3] , [4] . Simultaneous correction of mechanical alignment and unloading of the arthritic compartment of the joint is a major goal of high tibial osteotomy [3] , [4] , [12] . In the presented cases with traumatic medial tibial plateau defect, MOWHTO was preferred over allograft bone augmentation.…”

“…We considered that medial opening wedge high tibial osteotomy (MOWHTO) was capable of treating the problem of both bone stock restoration and weight loading. MOWHTO is a common joint-sparing surgical technique with numerous good to excellent result reports [2] , [3] , [4] . Here, we report two cases which were treated using MOWHTO with femoral head allograft for the traumatic medial tibial plateau bone defect and varus deformity.…”

Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

“…Osteotomy around the knee is adopted as a primary surgical option for knees with unicompartmental osteoarthritis in patients with high activity levels. In recent years, medial opening-wedge high tibial osteotomy has been widely used for knees with varus deformity, and good treatment outcomes have been reported in the literature [1][2][3]. On the other hand, there have also been reports that describe its effects on the patellofemoral joint as a result of patella baja and arthritis [4][5][6][7][8][9][10].…”