The Journal of Bone and Joint Surgery 83:164 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Proximal Tibial Varus Osteotomy
Indications, Technique, and Five to Twenty-one-Year Results
René K. Marti, MD, PhD,
Ronald A.W. Verhagen, MD,
Gino M.M.J. Kerkhoffs, MD and
Thybout M. Moojen, MD
Investigation performed at Academic Medical Center, Amsterdam,
The Netherlands
René K. Marti, MD, PhD
Ronald A.W. Verhagen, MD
Gino M.M.J. Kerkhoffs, MD
Thybout M. Moojen, MD
Academic Medical Center, Department of Orthopaedic Surgery, G4-222,
P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. Please address requests
for reprints to R.K. Marti. E-mail address for R.K. Marti: orthopaedie{at}amc.uva.nl
No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background: Although high tibial osteotomy has
been proved effective for the treatment of painful osteoarthritis of
the medial compartment of the knee, the role of proximal tibial
varus osteotomy for the treatment of painful osteoarthritis of the
lateral compartment still remains controversial.
Methods: From 1974 to 1993, we performed proximal
tibial varus osteotomy for the treatment of osteoarthritis of the
lateral compartment of the knee in thirty-six consecutive patients.
The procedure consisted of a proximal lateral opening-wedge varus
osteotomy of the tibia with use of corticocancellous bone grafts from
the iliac crest. The valgus deformity was posttraumatic in twenty-three
patients, followed a lateral meniscectomy in five, was due to overcorrection
of a varus deformity in four, and was idiopathic in four. The preoperative
valgus deformity averaged 11.6° (range, 4° to 22°).
Results: At a mean of eleven years (range, five
to twenty-one years) after the operation, the clinical results for
thirty-four of the thirty-six patients were analyzed. None of the
patients had severe progression of the osteoarthritis after the
osteotomy, and none had a meaningful loss in the range of motion
of the knee joint. A superficial wound infection developed in one
patient, and another patient had thrombophlebitis. Three patients
(9%) had a transient palsy of the peroneal nerve. According to the
system of Insall et al., the mean knee score was 84 points (range,
54 to 99 points). According to the knee score described by Lysholm
and Gillquist, the subjective result was excellent in nine patients (26%),
good in twenty-one (62%), fair in three (9%), and poor in one (3%).
Conclusions: We concluded that when the indications
outlined in this study are followed and our opening-wedge technique
is used, a proximal lateral opening-wedge varus osteotomy of the
tibia is a good alternative for the treatment of isolated osteoarthritis
of the lateral compartment of the knee. High accuracy in preoperative
planning, based on a slight overcorrection, is important to prevent
failure.
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