Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 1, pp 170–180 | Cite as

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

  • Stephanie FloerkemeierEmail author
  • Alex E. Staubli
  • Steffen Schroeter
  • Sabine Goldhahn
  • Philipp Lobenhoffer



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



Open-wedge osteotomy High tibial osteotomy Medial osteoarthritis Oxford Knee Score Joint-preserving technique Tomofix plate fixator 


  1. 1.
    Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23(8):852–861PubMedCrossRefGoogle Scholar
  2. 2.
    Ahlbäck S (1968) Osteoporosis of the knee. A radiographic investigation. Acta Radiol Diag Suppl 72:7–72Google Scholar
  3. 3.
    Benzakour T, Hefti A, Lemseffer M, El Ahmadi JD, Bouyarmane H, Benzakour A (2010) High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up. Int Orthop 34(2):209–215PubMedCrossRefGoogle Scholar
  4. 4.
    Bonnin MP, Laurent JR, Zadegan F, Badet R, Pooler Archbold HA, Servien E (2011) Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1461-9 Google Scholar
  5. 5.
    Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90(12):1548–1557PubMedCrossRefGoogle Scholar
  6. 6.
    Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ (2010) Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 81(2):193–198PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    Choy WS, Kim KJ, Lee SK, Yang DS, Lee NK (2011) Mid-term results of oxford medial unicompartmental knee arthroplasty. Clin Orthop Surg 3(3):178–183PubMedCrossRefGoogle Scholar
  9. 9.
    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(2):196–201PubMedGoogle Scholar
  10. 10.
    Dawson J, Fitzpatrick R, Murray D, Carr A (2006) A response to issues raised in a recent paper concerning the Oxford Knee Score. Knee 13(1):66–68PubMedCrossRefGoogle Scholar
  11. 11.
    Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63–69PubMedCrossRefGoogle Scholar
  12. 12.
    El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34(10):e622–e628PubMedGoogle Scholar
  13. 13.
    Gaasbeek RD, Sonneveld H, van Heerwaarden RJ, Jacobs WC, Wymenga AB (2004) Distal tuberosity osteotomy in open wedge high tibial osteotomy can prevent patella infera: a new technique. Knee 11(6):457–461PubMedCrossRefGoogle Scholar
  14. 14.
    Gulati A, Pandit H, Jenkins C, Chau R, Dodd CA, Murray DW (2009) The effect of leg alignment on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br 91(4):469–474PubMedCrossRefGoogle Scholar
  15. 15.
    Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15(5):597–603PubMedCrossRefGoogle Scholar
  16. 16.
    Hankemeier S, Mommsen P, Krettek C, Jagodzinski M, Brand J, Meyer C, Meller R (2010) Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 18(10):1328–1333PubMedCrossRefGoogle Scholar
  17. 17.
    Heller MO, Matziolis G, Konig C, Taylor WR, Hinterwimmer S, Graichen H, Hege HC, Bergmann G, Perka C, Duda GN (2007) Musculoskeletal biomechanics of the knee joint. Principles of preoperative planning for osteotomy and joint replacement. Orthopade 36(7):628–634PubMedCrossRefGoogle Scholar
  18. 18.
    Holden DL, James SL, Larson RL, Slocum DB (1988) Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg Am 70(7):977–982PubMedGoogle Scholar
  19. 19.
    Kazakos KJ, Chatzipapas C, Verettas D, Galanis V, Xarchas KC, Psillakis I (2008) Mid-term results of total knee arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg 128(2):167–173PubMedCrossRefGoogle Scholar
  20. 20.
    Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grutzner P (2009) Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 91(11):2581–2588PubMedCrossRefGoogle Scholar
  21. 21.
    Kolb W, Guhlmann H, Windisch C, Koller H, Grutzner P, Kolb K (2010) Opening-wedge high tibial osteotomy with a locked low-profile plate: surgical technique. J Bone Joint Surg Am 92(Suppl 1 Pt 2):197–207PubMedGoogle Scholar
  22. 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
  23. 23.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138PubMedGoogle Scholar
  24. 24.
    Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 91(11):1459–1465PubMedCrossRefGoogle Scholar
  25. 25.
    Luscombe KL, Lim J, Jones PW, White SH (2007) Minimally invasive Oxford medial unicompartmental knee arthroplasty. A note of caution! Int Orthop 31(3):321–324PubMedCrossRefGoogle Scholar
  26. 26.
    Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19(3):333–339PubMedCrossRefGoogle Scholar
  27. 27.
    Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646PubMedCrossRefGoogle Scholar
  28. 28.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014PubMedCrossRefGoogle Scholar
  29. 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
  30. 30.
    Nelissen EM, van Langelaan EJ, Nelissen RG (2010) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 34(2):217–223PubMedCrossRefGoogle Scholar
  31. 31.
    Odenbring S, Tjornstrand B, Egund N, Hagstedt B, Hovelius L, Lindstrand A, Luxhoj T, Svanstrom A (1989) Function after tibial osteotomy for medial gonarthrosis below aged 50 years. Acta Orthop Scand 60(5):527–531PubMedCrossRefGoogle Scholar
  32. 32.
    Outerbridge RE (2001) The etiology of chondromalacia patellae. 1961. Clin Orthop Relat Res 389:5–8PubMedCrossRefGoogle Scholar
  33. 33.
    Pandit H, Jenkins C, Beard DJ, Gallagher J, Price AJ, Dodd CA, Goodfellow JW, Murray DW (2009) Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year. J Bone Joint Surg Br 91(2):185–189PubMedCrossRefGoogle Scholar
  34. 34.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93(2):198–204PubMedCrossRefGoogle Scholar
  35. 35.
    Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Traumatol Arthrosc 19(1):122–127PubMedCrossRefGoogle Scholar
  36. 36.
    Schroter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D (2011) High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy 27(5):644–652PubMedCrossRefGoogle Scholar
  37. 37.
    Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195PubMedCrossRefGoogle Scholar
  38. 38.
    Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653PubMedCrossRefGoogle Scholar
  39. 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
  40. 40.
    Staubli AE, De SC, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia-early results in 92 cases. Injury 34(Suppl 2):B55–B62PubMedCrossRefGoogle Scholar
  41. 41.
    Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15(9):1094–1100PubMedCrossRefGoogle Scholar
  42. 42.
    Takeuchi R, Aratake M, Bito H, Saito I, Kumagai K, Hayashi R (2009) Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 17(4):361–368PubMedCrossRefGoogle Scholar
  43. 43.
    Takeuchi R, Bito H, Akamatsu Y, Shiraishi T, Morishita S, Koshino T, Saito T (2010) In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee 17(3):217–220PubMedCrossRefGoogle Scholar
  44. 44.
    Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53PubMedCrossRefGoogle Scholar
  45. 45.
    Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2011) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28(1):85–94PubMedGoogle Scholar
  46. 46.
    Takeuchi R, Sawaguchi T, Nakamura N, Ishikawa H, Saito T, Goldhahn S (2011) Cross-cultural adaptation and validation of the Oxford 12-item knee score in Japanese. Arch Orthop Trauma Surg 131(2):247–254PubMedCrossRefGoogle Scholar
  47. 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
  48. 48.
    van Raaij TM, Bakker W, Reijman M, Verhaar JA (2007) The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 8:74PubMedCrossRefGoogle Scholar
  49. 49.
    Wilkens KJ, Duong LV, McGarry MH, Kim WC, Lee TQ (2007) Biomechanical effects of kneeling after total knee arthroplasty. J Bone Joint Surg Am 89(12):2745–2751PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Stephanie Floerkemeier
    • 1
    Email author
  • Alex E. Staubli
    • 2
  • Steffen Schroeter
    • 3
  • Sabine Goldhahn
    • 4
  • Philipp Lobenhoffer
    • 5
  1. 1.Department of Orthopaedic SurgeryHannover Medical SchoolHannoverGermany
  2. 2.Private Clinic Sonnmatt LuzernLuzern 15Switzerland
  3. 3.BG Unfallklinik TübingenTübingenGermany
  4. 4.AO Clinical Investigation and DocumentationDübendorfSwitzerland
  5. 5.Sports Clinic GermanyHannoverGermany

Personalised recommendations