Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome

Department of Orthopaedics, HS-105, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Knee Surgery Sports Traumatology Arthroscopy (Impact Factor: 3.05). 04/2009; 17(4):390-5. DOI: 10.1007/s00167-008-0708-6
Source: PubMed


We have analysed retrospectively the influence of different sources of knee deformity on failure of closing wedge high tibial valgus osteotomy (HTO). Preoperative frontal plane varus deformities of the lower extremity, distal femur and proximal tibia, and medial convergence of the knee joint line were assessed on a standard whole leg radiograph in 76 patients. Using the logistic regression model, the probability of survival for HTO was 77% (SD 4%) at 10-years follow-up. Varus deformity of the lower extremity (< 175 degrees ), and medial convergence of the knee joint line (> 3 degrees ) were identified as preoperative risk factors for conversion to arthroplasty (P = 0.03 and P = 0.006). We found no evidence that varus inclination of the proximal tibia or distal femur influences long-term survival of HTO.

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    ABSTRACT: Our purpose was to evaluate the 3-year clinical results of patients with medial-compartment osteoarthritis of the knee and varus malalignment who underwent open-wedge high tibial osteotomy (HTO) with an internal plate fixator (TomoFix; Synthes, Solothurn, Switzerland). Clinical results are correlated with arthroscopic and radiographic findings at the time of surgery. This study included 69 patients with a minimum follow-up of 36 months who underwent open-wedge HTO for medial-compartment osteoarthritis of the knee. Knee function was assessed before surgery and at 6, 12, 24, and 36 months after HTO by use of subjective International Knee Documentation Committee and Lysholm scores. Arthroscopic findings before HTO and radiographic assessment of the metaphyseal deformity of the proximal tibia (tibial bone varus angle) were correlated with clinical outcome. A significant continuous increase in International Knee Documentation Committee score from 47.25 ± 18.71 points before surgery to 72.72 ± 17.15 points at 36 months after HTO was found (P < .001). Grade of cartilage damage of the medial compartment and partial-thickness defects of the lateral compartment did not significantly influence clinical outcome (P > .05 at all time points). The tibial bone varus angle was correlated significantly with greater improvement and better clinical outcome after HTO (P < .01). The overall complication rate of 8.6% was mostly related to surgical causes; nevertheless, a high proportion of patients reported discomfort related to the implant at some point during the follow-up period (40.6%). Open-wedge osteotomy by use of the TomoFix system leads to reliable 3-year results. Results do not depend on the severity of medial cartilage defects, whereas partial-thickness defects of the lateral compartment seem to be well tolerated. The prognostic relevance of patellofemoral cartilage defects remains unclear. Local irritation of the implant was observed in a significant number of patients. Level IV, therapeutic case series.
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    ABSTRACT: Purpose Limb length changes were evaluated after closed- and open-wedge high tibial osteotomies (HTOs) using computer-assisted surgery. Methods A total of 78 closed- and 30 open-wedge HTOs were performed. The changes in limb length were evaluated on a navigation system and radiographs. The correction angle was defined as the difference between the pre and postoperative mechanical axis on the navigation system. The change in limb length with respect to the correction angle was analyzed. Results Following the closed-wedge HTOs, the mean changes in limb length based on the navigation system and radiographs were −1.3 ± 1.9 and −1.3 ± 10.7 mm, respectively, versus 6.2 ± 2.6 and 7.8 ± 2.9 mm after the open-wedge HTOs. The mean correction angle was 11.6 ± 3.2° for closed-wedge HTOs and 11.5 ± 1.9° for open-wedge HTOs. The correction angle did not affect the change in limb length after closed-wedge HTO, while the larger the correction angle required, the greater the increase in limb length after open-wedge HTO. Conclusions The change in limb length was negligible after closed-wedge HTO, while the limb length was increased slightly after open-wedge HTO. The possibility of limb lengthening must be considered carefully when determining whom to perform open-wedge HTO on, especially when a large correction angle is required. Level of evidence III.
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