TITLE

Combined Lateral Closing and Medial Opening-Wedge High Tibial Osteotomy

AUTHOR(S)
Nagi, O. N.; Kumar, Senthil; Aggarwal, Sameer
PUB. DATE
March 2007
SOURCE
Journal of Bone & Joint Surgery, American Volume;Mar2007, Vol. 89-A Issue 3, p542
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Long-term studies have indicated that the clinical success of high tibial osteotomy deteriorates with time. The purpose of this study was to evaluate the long-term results of a combined lateral closing and medial opening-wedge technique for high tibial osteotomy with a minimum follow-up of fifteen years. Methods: From January 1981 to June 1990, ninety-two patients (ninety-four knees) had a high tibial valgus osteotomy. The average preoperative varus deformity was 13.5°. The surgical technique consisted of a proximal lateral closing-wedge osteotomy and use of the lateral wedge as a graft on the medial side of the osteotomy. No internal fixation was used. A knee brace was used to maintain the 8° to 100 of valgus overcorrection. Seventy-two knees in seventy patients with at least fifteen years of follow-up were evaluated. Clinical evaluation was done with The Hospital for Special Surgery knee-rating scale. The femorotibial alignment, posterior tibial slope, and the Insall-Salvati ratio were measured on radiographs. Results: The mean initial postoperative correction (and standard deviation) for all knees was to 8.3° ± 2.7° of valgus alignment. Survivorship analysis showed that the probability of survival (and 95% confidence interval), with conversion to total knee arthroplasty as the end point, was 100% at one year, 92% ± 5.8% at ten years, 80% ±7.7% at fifteen years, and 58% ± 4.3% at twenty years. The survivorship, with a Hospital for Special Surgery knee score of <70 points as the end point, was 80% ± 4.5% at ten years, 72% ± 5.6% at fifteen years, and 42% ± 4.2% at twenty years. Twenty-six knees underwent an arthroplasty at an average of 15.6 years after the index procedure. For the forty-six knees that had not undergone an arthroplasty, the knee score improved from an average of 67 points preoperatively to 82 points at the time of the most recent follow-up. There were two superficial wound infections and one delayed union. Conclusions: We believe that our technique of a combined lateral closing and medial opening-wedge high tibial osteotomy can provide good long-term outcomes because of the off-loading of the diseased medial compartment with minimal complications.
ACCESSION #
24344855

 

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