Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients
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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.
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.
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.
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
KeywordsOpen-wedge osteotomy High tibial osteotomy Medial osteoarthritis Oxford Knee Score Joint-preserving technique Tomofix plate fixator
- 2.Ahlbäck S (1968) Osteoporosis of the knee. A radiographic investigation. Acta Radiol Diag Suppl 72:7–72Google Scholar
- 7.Brosset T, Pasquier G, Migaud H, Gougeon F (2011) Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix) and early weight-bearing: Prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 97(7):705–711PubMedCrossRefGoogle Scholar
- 22.Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41(5):778–799PubMedCrossRefGoogle Scholar
- 29.Naal FD, Impellizzeri FM, Sieverding M, Loibl M, von KF, Mannion AF, Leunig M, Munzinger U (2009) The 12-item Oxford Knee Score: cross-cultural adaptation into German and assessment of its psychometric properties in patients with osteoarthritis of the knee. Osteoarthr Cartil 17(1):49–52Google Scholar
- 39.Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2011) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1751-2
- 47.van den Bekerom MP, Patt TW, Kleinhout MY, van der Vis HM, Albers GH (2008) Early complications after high tibial osteotomy: a comparison of two techniques. J Knee Surg 21(1):68–74Google Scholar