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Delayed- and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases

  • Stuart J. WardenEmail author
  • Hayden G. Morris
  • Kay M. Crossley
  • Peter D. Brukner
  • Kim L. Bennell
Knee

Abstract

Opening wedge high tibial osteotomy (OWHTO) is a recently described procedure for medial compartment arthritis of the knee in the active, younger population. Despite having a number of advantages over the traditional closing wedge high tibial osteotomy (CWHTO) a potential complication of OWHTO is a high rate of delayed- and non-union. This study reports the occurrence of delayed- and non-union following OWHTO for medial compartment arthritis of the knee. Questionnaires were sent to all current members of the Australian Knee Society (n=45), a special interest group of the Australian Orthopaedic Group. Surgeons were asked primarily to indicate how many OWHTOs they had performed, and how many of these had progressed to union, delayed-union and non-union. All 45 questionnaires were returned, with 21 surgeons (47%) performing OWHTOs. A total of 188 OWHTO cases were reported, of which 182 were complete. Of these complete cases 167 (91.8%) were classed as united, 12 (6.6%) delay-united and 3 (1.6%) non-united. The results of this study demonstrate that the rate of delayed- and non-union following OWHTO for medial compartment arthritis of the knee is relatively low and comparable to that reported for traditional CWHTO.

Keywords

Fracture fixation Knee Orthopedics Osteoarthritis Osteotomy 

Notes

Acknowledgements

The authors thank all members of the Australian Knee Society, a special interest group of the Australian Orthopaedic Association, for their completion of the questionnaire. This work was presented at the Combined New Zealand and Australian Knee and Sports Surgery Society Meeting in Queenstown, New Zealand, October 2001. S.J.W. holds a National Health and Medical Research Council (Australia) CJ Martin Fellowship (Regkey no. 209169). K.M.C. holds a National Health and Medical Research Council (Australia) Health Professional Training Fellowship (Regkey no. 209168).

References

  1. 1.
    Aydogdu S, Cullu E, Arac N, Varolgunes N, Sur H (2000) Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study. Knee Surg Sports Traumatol Arthrosc 8:305–308CrossRefPubMedGoogle Scholar
  2. 2.
    Cameron HU, Welsh RP, Jung Y-B, Noftall F (1993) Repair of nonunion of tibial osteotomy. Clin Orthop 287:167–169PubMedGoogle Scholar
  3. 3.
    Dowdy PA, Cole BJ, Harner CD (1998) Knee arthritis in active individuals: matching treatment to the diagnosis. Physician Sportsmed 26:43–54Google Scholar
  4. 4.
    Fowler PJ (2001) The role of osteotomy in the post-meniscectomy knee: an open or closed case. Presented at the American Academy of Orthopaedic Surgeons 68th Annual Meeting, San Francisco, CAGoogle Scholar
  5. 5.
    Fowler PJ, Tan JL, Brown GA (2000) Medial opening wedge high tibial osteotomy: how do I do it? Oper Tech Sports Med 8:32–38Google Scholar
  6. 6.
    Hart JAL, Sekel R (2002) Osteotomy of the knee: is there a seat at the table? J Arthroplasty 4 [Suppl 1]:45–49Google Scholar
  7. 7.
    Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8:103–110CrossRefPubMedGoogle Scholar
  8. 8.
    Karabatsos B, Mahomed NN, Maistrelli GL (2002) Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg 45:116–119PubMedGoogle Scholar
  9. 9.
    Kharrazi D, Chandler RW, Spitzer AI (2000) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Curr Opin Orthop 11:26–34CrossRefGoogle Scholar
  10. 10.
    Kitson J, Weale AE, Lee AS, Maceachern AG (2001) Patellar tendon length following opening wedge high tibial osteotomy using an external fixator with particular reference to later total knee replacement. Injury 32:S-D-140–143CrossRefGoogle Scholar
  11. 11.
    Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg [Am] 85:78–85Google Scholar
  12. 12.
    Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) Survivorship of the high tibial valgus osteotomy: a 10- to 22-year followup study. Clin Orthop 367:18–27PubMedGoogle Scholar
  13. 13.
    Nizard RS, Cardinne L, Bizot P, Witvoet J (1998) Total knee replacement after failed tibial osteotomy: results of a matched-pair study. J Arthroplasty 13:847–853PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Stuart J. Warden
    • 1
    • 2
    Email author
  • Hayden G. Morris
    • 1
  • Kay M. Crossley
    • 1
  • Peter D. Brukner
    • 1
  • Kim L. Bennell
    • 1
  1. 1.Centre for Health, Exercise and Sports Medicine, School of PhysiotherapyUniversity of MelbourneParkvilleAustralia
  2. 2.Department of Orthopaedic Surgery, School of MedicineIndiana UniversityIndianapolisUSA

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