Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 10, pp 1328–1333 | Cite as

Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique

  • S. Hankemeier
  • P. Mommsen
  • C. Krettek
  • M. Jagodzinski
  • J. Brand
  • C. Meyer
  • R. Meller


High tibial osteotomy is an established technique for the treatment of varus malaligned knees. This study analyses the difference between the amount of correction in the preoperative planning and the postoperative result. Furthermore, it compares the difference of the accuracy between open-wedge osteotomy and closed-wedge osteotomy. About 61 patients were either treated with open-wedge or closed-wedge high tibial osteotomy. Preoperative planning and postoperative analysis were performed with a special planning software. The influence of operative technique, aetiology, age, number of previous surgeries, amount of correction and accuracy of the correction compared to the preoperative planning were analysed. The overall postoperative mechanical axis differed form preoperative planning by 2.1° ± 1.7°. The accuracy in the open-wedge group (1.7° ± 1.6°) was significantly higher than in the closed-wedge group (2.6° ± 1.8°; P = 0.038). In patients with congenital varus deformity, the accuracy of the correction was significantly higher than in patients with post-traumatic deformity. The authors recommend open-wedge technique in combination with fixed-angle plates for high tibial osteotomy.


High tibial osteotomy Osteoarthritis Open-wedge osteotomy Closed-wedge osteotomy Accuracy 


Conflict of interest statement

The authors declare that they have no conflict of interest. All authors disclose any financial or personal relationship with other people or organizations. The presentation of the issue is independent.


  1. 1.
    Agneskircher JD, Freiling D, Hurschler C et al (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:291–300CrossRefGoogle Scholar
  2. 2.
    Baums MH, Esenwein SA, Klinger HM (2005) An open wedge head osteotomy using continuous callus distraction. An alternative method for the treatment of varus arthrosis. Unfallchirurg 108:43–48CrossRefPubMedGoogle Scholar
  3. 3.
    Bonnin M, Chambat P (2004) Der Stellenwert der valgisierenden, zuklappenden Tibiakopfosteotomie bei der medialen Gonarthrose. Orthopäde 33:135–142CrossRefPubMedGoogle Scholar
  4. 4.
    Brouwer RW, Bierma-Zeinstra SM, van Raaij TM et al (2006) Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 88:1454–1459CrossRefPubMedGoogle Scholar
  5. 5.
    Coventry MB (1979) Upper tibial Osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin North Am 10:191–210PubMedGoogle Scholar
  6. 6.
    Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial Osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201PubMedGoogle Scholar
  7. 7.
    Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial Osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608PubMedGoogle Scholar
  8. 8.
    Gaasbeek R, Welsing R, Verdonshot N et al (2005) Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study. Knee Surg Sports Traumatol Arthrosc 13:689–694CrossRefPubMedGoogle Scholar
  9. 9.
    Galla M, Lobenhoffer P (2004) High tibial open wedge valgus osteotomy stabilized with the TomoFix® plate fixator. Operat Orthop und Traumatol 16:397–417CrossRefGoogle Scholar
  10. 10.
    Hankemeier S, Gösling T, Richter M et al (2006) Computer-assisted analysis of lower limb geometry: higher intraobserver reliability compared to conventional method. Comput Aided Surg 11:81–86CrossRefPubMedGoogle Scholar
  11. 11.
    Hankemeier S, Hüfner T, Wang G et al (2006) Navigated open wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921CrossRefPubMedGoogle Scholar
  12. 12.
    Hernigou P, Medevielle D, Debeyre J et al (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow up study. J Bone Joint Surg Am 69:332–354PubMedGoogle Scholar
  13. 13.
    Hoell S, Suttmoeller J, Stoll V et al (2005) The high tibial osteotomy, open versus closed wedge a comparison of methods in 108 patients. Arch Orthop Trauma Surg 125:638–643CrossRefPubMedGoogle Scholar
  14. 14.
    Hsu RW, Himeno S, Coventry MB et al (1990) Normal axial alignment of the lower extremity and loadbearing distribution at the knee. Clin Orthop 255:215–227PubMedGoogle Scholar
  15. 15.
    Kendoff D, Board TN, Citak M et al (2008) Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res 26:553–561CrossRefPubMedGoogle Scholar
  16. 16.
    Kettelkamp DB, Wenger DR, Chao EY et al (1976) Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. J Bone Joint Surg Am 58:952–960PubMedGoogle Scholar
  17. 17.
    Koschino T, Morii T, Wada J et al (1989) High tibial osteotomy with fixation by a blade plate for medial compartment osteoarthritis of the knee. Orthop Clin North Am 20:227–243Google Scholar
  18. 18.
    Krettek C, Miclau T, Grün O et al (1998) Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 29:29–39CrossRefGoogle Scholar
  19. 19.
    Leutloff D, Tobian F, Perka C (2001) High tibial osteotomy for valgus and varus deformities of the knee. Int Orthop 25:93–96CrossRefPubMedGoogle Scholar
  20. 20.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138PubMedGoogle Scholar
  21. 21.
    Lobenhoffer P, Simoni CD, Staubli AE (2002) Open-wedge high tibial osteotomy with rigid plate fixation. Tech Knee Surg 2:1–11Google Scholar
  22. 22.
    Magyar G, Toksvig-Larsen S, Lindstrand A (1998) Open wedge osteotomy by callus distraction in gonarthrosis: operative technique and early results in 36 patients. Acta Orthop Scand 69:147–151CrossRefPubMedGoogle Scholar
  23. 23.
    Müller W, Kentsch A, Schafer N (2000) The elastic high tibia valgus Osteotomy in the varus deformity. Oper Tech Sports Med 8:19–26CrossRefGoogle Scholar
  24. 24.
    Nakamura E, Mizuta H, Kudo S et al (2001) Open-wedge osteotomy of the proximal tibia hemicallotasis. J Bone Joint Surg Br 83:1111–1115CrossRefPubMedGoogle Scholar
  25. 25.
    Paley D (2001) Realignment for mono-compartment osteoarthritis of the Knee. In: Principles of deformity correction. Springer, Berlin/Heidelberg/New York, pp 479–485Google Scholar
  26. 26.
    Paley D, Herzenberg JE, Tetsworth K et al (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465PubMedGoogle Scholar
  27. 27.
    Pape D, Adam F, Rupp S et al (2004) Stabilität, Knochenheilung und Korrekturverlust nach valgisierender Tibiakopfumstellung. Orthopäde 33:208–217CrossRefPubMedGoogle Scholar
  28. 28.
    Pascher A, Materna W, Windhager R (2003) Analysis of two different techniques of osteosynthesis in high tibial osteotomy. Z Orthop Ihre Grenzgeb 141:37–41CrossRefPubMedGoogle Scholar
  29. 29.
    Sharma L, Song J, Felson DT et al (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195CrossRefPubMedGoogle Scholar
  30. 30.
    Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85A:469–474Google Scholar
  31. 31.
    Staubli AE, De Simoni C, Babst R et al (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 34(Suppl 2):55–62CrossRefGoogle Scholar
  32. 32.
    Trieb K, Grohs J, Hanslik-Schnabel B et al (2006) Age predicts outcome of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:149–152CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • S. Hankemeier
    • 1
  • P. Mommsen
    • 1
  • C. Krettek
    • 1
  • M. Jagodzinski
    • 1
  • J. Brand
    • 2
  • C. Meyer
    • 1
  • R. Meller
    • 1
  1. 1.Trauma DepartmentHanover Medical School (MHH)HanoverGermany
  2. 2.Praxisklinik UelzenUelzenGermany

Personalised recommendations