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Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Open-wedge valgus high tibial osteotomy is a well-established procedure in the management of medial osteoarthritis of the knee. In recent years, improved osteotomy and fixation methods have led to an increased use of this technique. The aim of this study was to identify predictive parameters for the clinical outcome after valgus high tibial osteotomy.

Methods

A multicentre case series involving retrospective capture of baseline data and prospective outcome assessment of patients with knee OA who underwent an osteotomy using Tomofix® plate was conducted. Functional outcome was assessed using Oxford 12-item Knee Score.

Results

Before surgery, the majority of patients had grade III (52 %) and grade IV (33 %) lesions according to Outerbridge classification. Three hundred and eighty-six of 533 eligible patients were interviewed for follow-up after an average of 3.6 years. The mean Oxford Knee Score was 43 points. Six per cent experienced at least one local postoperative complication. There was a tendency towards lower score results in patients with a higher preoperative degree of the medial cartilage lesion. No correlation between patient age and the Oxford Knee Score was observed.

Conclusion

Being male, being operated by an experienced surgeon, having no intake of pain medication at follow-up and having no postoperative complication are positive predictors of the Oxford Knee Score up to 5 years after surgery. This study reveals favourable midterm results after valgus high tibial osteotomy in varus osteoarthritis, even in older patients with high degree of cartilage damage.

Level of evidence

II.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Stephanie Floerkemeier

  2. Private Clinic Sonnmatt Luzern, Hemschlennstrasse, Postfach, 6000, Luzern 15, Switzerland

    Alex E. Staubli

  3. BG Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany

    Steffen Schroeter

  4. AO Clinical Investigation and Documentation, AO Center, Stettbachstr. 10, 8600, Dübendorf, Switzerland

    Sabine Goldhahn

  5. Sports Clinic Germany, Uhlemeyerstr. 16, 30175, Hannover, Germany

    Philipp Lobenhoffer

Authors
  1. Stephanie Floerkemeier
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  2. Alex E. Staubli
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  3. Steffen Schroeter
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  4. Sabine Goldhahn
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  5. Philipp Lobenhoffer
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Corresponding author

Correspondence to Stephanie Floerkemeier.

Appendix: The German-language version of the Oxford Knee Score

Appendix: The German-language version of the Oxford Knee Score

Bitte beantworten Sie die folgenden 12 Fragen, indem Sie bei jeder Frage die zutreffende Zahl ankreuzen.

Wählen Sie nur eine Antwort pro Frage. Während der letzten 4 Wochen…

  1. 1.

    Wie würden Sie die Schmerzen beschreiben, die Sie üblicherweise in Ihrem Knie hatten?

    1. (1)

      Keine

    2. (2)

      Sehr Gering

    3. (3)

      Gering

    4. (4)

      Mässig

    5. (5)

      Stark

  2. 2.

    Hatten Sie wegen Ihrem Knie Schwierigkeiten, sich selbst zu waschen und abzutrocknen (am ganzen Körper)?

    1. (1)

      Überhaupt keine Schwierigkeiten

    2. (2)

      Sehr geringe Schwierigkeiten

    3. (3)

      Mässige Schwierigkeiten

    4. (4)

      Extreme Schwierigkeit

    5. (5)

      Unmöglich zu tun

  3. 3.

    Hatten Sie wegen Ihrem Knie Schwierigkeiten, in ein, bzw. aus einem Auto zu steigen oder öffentliche Verkehrsmittel zu benutzen? (welches Sie eher benutzen)

    1. (1)

      Überhaupt keine Schwierigkeiten

    2. (2)

      Sehr geringe Schwierigkeiten

    3. (3)

      Mässige Schwierigkeiten

    4. (4)

      Extreme Schwierigkeit

    5. (5)

      Unmöglich zu tun

  4. 4.

    Wie lange konnten Sie gehen, bevor Sie starke Schmerzen in Ihrem Knie bekamen (mit oder ohne Stock)?

    1. (1)

      Keine Schmerzen > 30 Minuten

    2. (2)

      16 bis 30 Minuten

    3. (3)

      5 bis 15 Minuten

    4. (4)

      Nur zu Hause

    5. (5)

      Gar nicht

  5. 5.

    Wie schmerzhaft war es für Sie wegen Ihrem Knie, nach einer Mahlzeit wieder vom Tisch aufzustehen?

    1. (1)

      Gar nicht schmerzhaft

    2. (2)

      Ein wenig schmerzhaft

    3. (3)

      Mässig schmerzhaft

    4. (4)

      Sehr schmerzhaft

    5. (5)

      Unerträglich

  6. 6.

    Haben Sie wegen Ihrem Knie beim Gehen gehinkt?

    1. (1)

      Selten/nie

    2. (2)

      Manchmal oder nur am Anfang

    3. (3)

      Oft, nicht nur am Anfang

    4. (4)

      Die meiste Zeit

    5. (5)

      Die ganze Zeit

  7. 7.

    Konnten Sie sich hinknien und danach wieder aufstehen?

    1. (1)

      Ja, leicht

    2. (2)

      Mit geringen Schwierigkeiten

    3. (3)

      Mit mässigen Schwierigkeiten

    4. (4)

      Mit extremen Schwierigkeiten

    5. (5)

      Nein, unmöglich

  8. 8.

    Wurden Sie nachts im Bett durch Schmerzen in Ihrem Knie gestört?

    1. (1)

      Nie

    2. (2)

      Nur 1 oder 2 Nächte

    3. (3)

      Einige Nächte

    4. (4)

      Die meisten Nächte

    5. (5)

      Jede Nacht

  9. 9.

    Wie sehr haben Schmerzen in Ihrem Knie Ihre normale Arbeit (einschliesslich Hausarbeit) beeinträchtigt?

    1. (1)

      Gar nicht

    2. (2)

      Ein wenig

    3. (3)

      Mässig

    4. (4)

      Erheblich

    5. (5)

      Vollständig

  10. 10.

    Hatten Sie das Gefühl, dass Ihr Knie plötzlich ‘‘nachgeben’’oder Sie nicht mehr tragen könnte?

    1. (1)

      Selten/nie

    2. (2)

      Manchmal oder nur am Anfang

    3. (3)

      Oft, nicht nur am Anfang

    4. (4)

      Die meiste Zeit

    5. (5)

      Die ganze Zeit

  11. 11.

    Konnten Sie die Haushaltseinkäufe selbst erledigen?

    1. (1)

      Ja, leicht

    2. (2)

      Mit geringen Schwierigkeiten

    3. (3)

      Mit mässigen Schwierigkeiten

    4. (4)

      Mit extremen Schwierigkeiten

    5. (5)

      Nein, unmöglich

  12. 12.

    Konnten Sie eine Treppe hinunter gehen?

    1. (1)

      Ja, leicht

    2. (2)

      Mit geringen Schwierigkeiten

    3. (3)

      Mit mässigen Schwierigkeiten

    4. (4)

      Mit extremen Schwierigkeiten

    5. (5)

      Nein, unmöglich

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Floerkemeier, S., Staubli, A.E., Schroeter, S. et al. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21, 170–180 (2013). https://doi.org/10.1007/s00167-012-2087-2

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  • DOI: https://doi.org/10.1007/s00167-012-2087-2

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