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The Journal of Bone and Joint Surgery, Vol 75, Issue 2 196-201, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Proximal tibial osteotomy. A critical long-term study of eighty-seven cases
MB Coventry, DM Ilstrup and SL Wallrichs
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905.
Eighty-seven valgus osteotomies of the tibia were performed in
seventy-three patients for osteoarthrosis of the medial compartment of the
knee; the median follow-up was ten years (range, three to fourteen years).
The data were subjected to univariate and multivariate statistical analysis
and to survivorship analysis. For these calculations, the end-point of
failure was defined as an arthroplasty of the knee, and additional
calculations were performed with the end-point defined as the performance
of an arthroplasty or moderate or severe pain in patients who had declined
an arthroplasty. None of the many risk factors that were evaluated could be
found to be associated with the duration of survival, except for relative
weight and angular correction. The median loss of correction after the
osteotomy was 1 degree. If, at one year after the operation, the valgus
angulation was 8 degrees or more, or if the patient's weight was 1.32 times
the ideal weight or less, the probability of survival five years thereafter
was at least 90 per cent and the probability ten years thereafter was at
least 65 per cent. However, when valgus angulation at one year was less
than 8 degrees in a patient whose weight was more than 1.32 times the ideal
weight, the rate of survival decreased to 38 per cent five years thereafter
and to 19 per cent ten years thereafter. There is a considerable risk of
failure of a proximal tibial osteotomy if the alignment is not
overcorrected to at least 8 degrees of valgus angulation and if the patient
is substantially overweight.
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