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

The results in 53 knees that had been treated by proximal tibial opening-wedge osteotomy for large varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of ten years (range, 8-12 years). We used a porous betatricalcium phosphate (β-TCP) wedge because it is resorbable and osteoinductive. All osteotomies were completely consolidated and complete osseointegration of the remnant of the β-TCP wedge took place. However, after a mean maximum follow-up of ten years none of the cases showed complete resorption. After ten years, 40 (81%) of the 53 knees had an excellent or good result, and in 13 knees there was recurrent pain for which six had an arthroplasty. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the knees that had a hip-knee-ankle angle of 183-186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the three knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow. Therefore, proximal tibial osteotomy is a very suitable operation even for patients who have gonarthrosis of the medial compartment and a large varus deformity. Although, a rigidly standardised and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy, and this exact alignment is difficult to obtain for patients with large varus deformity.

Section: Discussionmentioning

confidence: 95%

Opening wedge tibial osteotomy for large varus deformity with CeraverTM resorbable beta tricalcium phosphate wedges

Hernigou

Roussignol

Flouzat-Lachaniette

et al. 2009

“…Specific intraoperative complications are a concern with osteotomies around the knee. These include intra-articular fractures, intra-articular screw placement, overcorrection, undercorrection, and violation of the opposite cortex resulting in instability of the osteotomy [30]. Failure to relieve pain and conversion to total knee arthroplasty can be considered long-term complications.…”

Section: Complicationsmentioning

confidence: 99%

High tibial osteotomies in the young active patient

Wolcott

Traub

Efird

2010

Unicompartmental changes in the knee of a young athlete remains a difficult and controversial problem in orthopaedics. Excessive premature loading of articular cartilage, most often the result of a knee injury, has been shown to result in increased degenerative changes and pain in the younger patient. Instability may also contribute to the degeneration of cartilage and must therefore be considered in the treatment of osteoarthritis in the young adult. High tibial osteotomy has been described as a treatment option for malalignment in the older, less active adult and has shown promising results in a younger, more active population. Osteotomies for instability are more controversial and should be considered in more complex injury patterns.

“…Other advantages of the MOWHTO may include a more precise three-dimensional correction, avoidance of changes in the proximal morphology of the tibia, enhancement of bone stock and the possibility of correcting large deformities [16]. The disadvantages of the MOWHTO are fracture of the proximal tibia lateral aspect and the development of a potentially unstable construction and implant failure [14,18]. These problems can be avoided with proper selection of the patient, surgical technique and the implant material or bone graft to be used to fill the osteotomy defect.…”

Section: Introductionmentioning

confidence: 99%

Bone allograft provides bone healing in the medial opening high tibial osteotomy

Šantić¹,

Tudor²,

Šestan³

et al. 2009

Various materials are used to fill osteotomy defects created in the medial opening wedge high tibial osteotomy (MOWHTO). Our hypothesis was that a bone allograft would provide the osteotomy site bone healing within the expected time. We performed the MOWHTO using a cancellous bone allograft in 310 knees in 284 patients between 2000 and 2005.Internal fixation was achieved with a T-profile AO plate. Preoperative and postoperative radiographic measurements were taken and statistically processed. All patients were followed up for a period ranging from three to eight years, or 5.9 years on average. Implanted cancellous bone allografts ≤9 mm healed within 12 weeks in 90% of cases. With the properly selected patient and surgical technique, use of a cancellous bone allograft in MOWHTO represents a satisfactory choice in providing bone healing.