Combined Lateral Closing and Medial Opening-Wedge High Tibial Osteotomy

Nagi, O. N.; Kumar, Senthil; Aggarwal, Sameer
March 2007
Journal of Bone & Joint Surgery, American Volume;Mar2007, Vol. 89-A Issue 3, p542
Academic Journal
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.


Related Articles

  • Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty. Sossai, D.; Dagnino, G.; Sanguineti, F.; Franchin, F. // Journal of Orthopaedics & Traumatology;Dec2011, Vol. 12 Issue 4, p207 

    Background: Surgical site infections are important complications in orthopedic surgery. A mobile laminar air flow (LAF) screen could represent a useful addition to an operating room (OR) with conventional turbulent air ventilation (12.5 air changes/h), as it could decrease the bacterial count...

  • The Midvastus Approach to the Knee. Engh, Gerard A.; Ammeen, Deborah J. // Journal of Knee Surgery (SLACK Incorporated);Jan2003, Vol. 16 Issue 1, p48 

    Deals with the use of the midvastus muscle splitting surgical approach to total knee arthroplasty (TKA). Other surgical approaches to TKA; Description of the midvastus approach; Overview of studies comparing the results of a midvastus arthrotomy with standard medial parapatellar approach for...

  • The Medial Parapatellar Approach to the Knee. Harwin, Steven F. // Journal of Knee Surgery (SLACK Incorporated);Jan2003, Vol. 16 Issue 1, p43 

    Describes the medial parapatellar surgical approach to total knee arthroplasty (TKA). Effect of the approach on the vastus medialis muscle fibers; Modifications made to the approach; Application of the approach in arthrotomy; Details of the actual use of the approach during TKA.

  • The Lateral Approach for Total Knee Arthroplasty. Keblish, Peter A. // Journal of Knee Surgery (SLACK Incorporated);Jan2003, Vol. 16 Issue 1, p62 

    Describes the use of the lateral approach for total knee arthroplasty. Link between fixed valgus deformity and femorotibial malrotation, resorption of the lateral femoral condyle and distal medial condyle; Components of the extra- and intra-articular layers; Discussion on the medial...

  • The Quadriceps Snip for Exposing the Stiff Knee. Arsht, Steven J.; Scuderi, Giles R. // Journal of Knee Surgery (SLACK Incorporated);Jan2003, Vol. 16 Issue 1, p55 

    Describes the use of quadriceps snip as a means of exposing the tight knee in primary and revision total knee arthroplasty (TKA). Patients selected to undergo TKA using the surgical technique; Details of the surgical technique involved in exposing the knee; Effect of quadriceps snip on the...

  • Modified subvastus TKA approach offers smaller incisions, quicker recovery. Bonutti, Peter M. // Orthopedics Today;Feb2008, Vol. 28 Issue 2, p35 

    The article discusses the orthopedic surgical technique called minimally invasive surgery (MIS) in total knee arthroplasty (TKA). The approaches ranked by difficulty are the mini-midvastus, the mini-subvastus, and the quadriceps-sparing. Key steps for MIS TKA are listed. Reduced incision length,...

  • Minimal Incision Total Knee Arthroplasty Using the Suspended Leg Technique. Bonutti, Peter M.; Neal, David J.; Kester, Mark A. // Orthopedics;Sep2003, Vol. 26 Issue 9, p899 

    The article explains the suspended leg technique, used in total knee arthroplasty. This technique uses flexion and weight of the limb to stretch the incision. The surgeon, then, is provided with greater access to the knee. Using minimal incision, it results in several advantages including...

  • Gait analysis following TKA: comparison of conventional technique, computer-assisted navigation and minimally invasive technique combined with computer-assisted navigation. Bejek, Zoltán; Paróczai, Róbert; Szendrői, Miklós; Kiss, Rita M. // Knee Surgery, Sports Traumatology, Arthroscopy;Feb2011, Vol. 19 Issue 2, p285 

    Purpose: There are questions concerning the influence of computer-assisted surgery and the minimal invasive surgical technique on the outcome of total knee arthroplasty. The authors followed up the rehabilitation of patients during the first postoperative year. Methods: The ZEBRIS gait analysis...

  • Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Kosashvili, Yona; Safir, Oleg; Gross, Allan; Morag, Guy; Lakstein, Dror; Backstein, David // International Orthopaedics;Feb2010, Vol. 34 Issue 2, p249 

    Distal femoral varus osteotomy (DFVO) may be indicated for symptomatic lateral compartment gonarthrosis associated with valgus deformity in younger, active patients. Thirty-three consecutive DFVOs (31 patients) with a minimum follow-up of ten years (mean 15.1, range 10-25) were reviewed. Fifteen...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics