The Journal of Bone and Joint Surgery 82:70-9 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
High Tibial Osteotomy with a Calibrated Osteotomy Guide, Rigid Internal Fixation, and Early Motion. Long-Term Follow-up*
ANNETTE BILLINGS, M.D. ,
DAVID F. SCOTT, M.D. ,
MARCELO P. CAMARGO, M.D. and
AARON A. HOFMANN, M.D., SALT LAKE CITY, UTAH
Investigation performed at the Department of Orthopedics, University of Utah School of Medicine, Salt Lake City
Background: We studied the results of sixty-four valgus-producing high tibial osteotomies performed with the use of a calibrated osteotomy cutting guide and rigid internal fixation, and followed by early motion, in fifty-six patients who had medial unicompartmental osteoarthritis and varus malalignment. Long-term studies have demonstrated that a high tibial osteotomy performed with staple fixation and followed by immobilization in a cast has an expected survival rate of approximately 85 percent at five years and 60 percent at ten years (in studies of ninety-five knees and 213 knees, respectively). To the best of our knowledge, there are no long-term reports on high tibial osteotomies performed with a calibrated osteotomy cutting guide and rigid internal fixation and followed by early motion.
Methods: The indications for high tibial osteotomy were medial unicompartmental osteoarthritis and varus malalignment. A lateral closing-wedge osteotomy was performed. The patients were reexamined to obtain a knee score, to make lateral radiographs of both knees, and to make a full-length anteroposterior radiograph (showing the entire lower extremity, including the hip and ankle) of the involved knee with the patient standing.
Results: Twenty-one knees were treated with a subsequent total knee arthroplasty at an average of sixty-five months after the high tibial osteotomy. The remaining forty-three knees had a good or excellent clinical result, with an average knee score of 94 points at an average of 8.5 years after the osteotomy. Survivorship analysis showed an expected rate of survival, with conversion to a total knee arthroplasty as the end point, of 85 percent at five years and 53 percent at ten years. No patient had patella baja postoperatively. There were six complications: four superficial wound infections, one superficial-vein thrombosis, and one delayed union (union occurred at five months).
Conclusions: High tibial osteotomy has been criticized because of a high rate of complications, a loss of effectiveness with time, and the difficulty of conversion to a total knee arthroplasty secondary to patella baja. In our series, in which an osteotomy was performed with a calibrated osteotomy cutting guide and rigid internal fixation and was followed by early motion, the rate of complications was low and approximately two-thirds of the knees had a good or excellent clinical result at an average of 8.5 years. Conversion to a total knee arthroplasty was accomplished without difficulty in the patients who had this procedure. We highly recommend high tibial osteotomy with a calibrated osteotomy cutting guide, rigid internal fixation, and early motion for patients who wish to continue an active lifestyle.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
R. W. Brouwer, S. M. A. Bierma-Zeinstra, A. J. van Koeveringe, and J. A. N. Verhaar
Patellar height and the inclination of the tibial plateau after high tibial osteotomy: THE OPEN VERSUS THE CLOSED-WEDGE TECHNIQUE
J Bone Joint Surg Br,
September 1, 2005;
87-B(9):
1227 - 1232.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Wright, H. C. Crockett, D. P. Slawski, M. W. Madsen, and R. E. Windsor
High Tibial Osteotomy
J. Am. Acad. Ortho. Surg.,
July 1, 2005;
13(4):
279 - 289.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. R. Noyes, S. X. Goebel, and J. West
Opening Wedge Tibial Osteotomy: The 3-Triangle Method to Correct Axial Alignment and Tibial Slope
Am. J. Sports Med.,
March 1, 2005;
33(3):
378 - 387.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Dr. S. Aggarwal, S.S. Sangwan, V. Yadav, Z. Singh, T. R. Sprenger, and J. F. Doerzbacher
Angulatory Stresses After High Tibial Osteotomy: Are They Relevant Enough to Warrant Additional Fixation? * T.R. Sprenger and J.F. Doerzbacher reply:
J. Bone Joint Surg. Am.,
April 1, 2004;
86(4):
872 - 874.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Iorio and W. L. Healy
Unicompartmental Arthritis of the Knee
J. Bone Joint Surg. Am.,
July 3, 2003;
85(7):
1351 - 1364.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Archibeck and R. E. White
What's New in Adult Reconstructive Knee Surgery
J. Bone Joint Surg. Am.,
September 1, 2001;
83(9):
1444 - 1450.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. K. Marti, R. A.W. Verhagen, G. M.M.J. Kerkhoffs, and T. M. Moojen
Proximal Tibial Varus Osteotomy : Indications, Technique, and Five to Twenty-one-Year Results
J. Bone Joint Surg. Am.,
February 1, 2001;
83(2):
164 - 164.
[Abstract]
[Full Text]
|
|
|
|
