Opening-wedge high tibial osteotomy: a seven - to twelve-year study

Abstract

Purpose: medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory midterm results when accurate patient selection and precise surgical techniques were applied. this study was conducted to investigate the clinical and radiographic seven-to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. Methods: we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. Results: good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. Conclusions: medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid-to long-term results. Level of evidence: Level iV, therapeutic cases series.

Robotic device-assisted knee extension training during the early postoperative period after opening wedge high tibial osteotomy: a case report

“…Consistent with these previous reports, the ISR of our patient decreased from 1.13 preoperatively to 0.97 postoperatively, and the position of the patella was lower after than before the surgery. Furthermore, an increased TSA due to OWHTO can cause limited knee extension ROM and knee joint pain [ 15 ], although a postoperative increase in the TSA was not observed in our patient. It is also possible that pain receptors were stimulated because OWHTO is a joint-sparing surgery that preserves biological tissue.…”

Patellofemoral Chondromalacia Does Not Influence Radiographic and Clinical Outcomes following High Tibial Osteotomy

“…Severe PF OA is known as a contraindication of HTO. 12,13 However, the effect of PF chondromalacia on the result of HTO has not been clearly revealed yet. Therefore, the present study analyzed the effect of PF chondromalacia on radiographic and clinical outcomes following HTO.…”

“…Radiographically, 96.6% of the patients obtained target correctional MTFA of 183 to 186 degree at the final follow-up visit. 12 Majima et al have assessed short-term (1 year after surgery) and long-term (10-15 years after surgery) results of 44 cases following HTO. They reported that the average knee function score was improved significantly from 59.1 points before surgery to 85.1 points at 1-year follow-up.…”

Patella Height Changes Post High Tibial Osteotomy

“…HTO has gained popularity in the treatment of isolated medial compartment osteoarthritis, especially in the younger age group. 1 5 12 By correcting the mechanical axis, it will allow redistribution of weight and hence off load the medial compartment and assist in cartilage regeneration. 13 14 However, patella baja is a well-known undesired result following HTO.…”

“…High tibial osteotomy (HTO) is a well described treatment in early medial compartmental osteoarthritis of the knee. 1 2 3 4 5 This procedure is especially useful in younger patients to offload the medial compartment of the knee by changing the mechanical axis. However, in the process of doing so, there is always a concern of the two common undesirable effects, namely, the patella height changes and posterior tibial slope (TS) changes post HTO.…”