Abstract
Purpose
The purpose of this study was to analyze the long-term clinical and radiological outcomes of patients who underwent closing-wedge High Tibial Osteotomy (HTO) for the treatment of medial compartment osteoarthritis and to evaluate the conversion rate to knee arthroplasty.
Methods
A retrospective, non-randomized, monocentric study was performed in our Institution considering 166 patients between 1989 and 2012. The final population was composed by 82 patients (94 knees), median age at time of operation was 53 (range 45–73) years. All patients were evaluated clinically (HSS Score, Tegner Scale, VAS and Crosby–Insall Grading) and radiographically (osteoarthritis staging, hip–knee–ankle (HKA) angle, tibial slope and metaphyseal varus).
Results
Mean follow-up was 11.9 ± 7.2 years. HSS Score increased significantly from 70.8 ± 10 to 93.2 ± 9.1 (p < 0.05) instead Tegner Scale increased from 1.3 ± 0 (range 1–4) to 2.8 ± 0.7 (range 2–6) at the last control (n.s.); VAS score significantly decreased from 7.9 ± 1.4 to 1.6 ± 1.1 (p < 0.05) at last follow-up. According to the Crosby–Insall Grading System, 80 patients (97.4%) reported excellent–good results. HKA angle decreased from 6.9° ± 3.5 to 2.6° ± 2.6 (p < 0.01), tibial slope decreased from 10.1° ± 1.4 to 6.8° ± 2.1 (p < 0.05) and finally the metaphyseal varus decreased from 4.2° ± 0 to 2.1° ± 1.2 (n.s.) at the last follow-up. Adverse events were reported in 4.8%. Osteotomy survivorship rate resulted 92% at 10 years, 82% at 15 years and 80% at 20 years. Sixteen revisions (9.6%) were reported at a mean period of 12.8 years.
Conclusions
CW-HTO is a valid option for medial osteoarthritis treatment, with successful results in both clinical and radiological outcomes.
Level of evidence
IV.
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References
Ahlback S, Rydberg J (1980) X-ray classification and examination technics in gonarthrosis. Lakartidningen 77:2091–2093
Bonnin M, Chambat P (2004) Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis. Orthopade 33:135–142
Chabok HA (2019) Midterm follow-up of closing wedge high tibial osteotomy with upper tibiofibular joint capsulotomy. Eur J Orthop Surg Traumatol 29(5):1153–1159
Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58:9–13
DeMeo PJ, Johnson EM, Chiang PP, Flamm AM, Miller MC (2010) Midterm follow-up of opening-wedge high tibial osteotomy. Am J Sports Med 38:2077–2084
Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R (2010) High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 30:131–140
Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X, Zayni R, Bonnin M, Jalil R, Amzallag J, Rosset P, Servien E, Gaudot F, Judet T, Catonne Y (2012) Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res 98:68–74
Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy: the effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264
Duivenvoorden T, van Diggele P, Reijman M, Bos PK, van Egmond J, Bierma-Zeinstra SMA, Verhaar JAN (2017) Adverse events and survival after closing-and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc 25:895–901
Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B, Lakemeier S, Schofer MD (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46
Ehlinger M, D’Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, Lustig S, Parratte S, Colmar M, Argenson JN, French Society of Othopedic Surgery, Traumatology (SoFCOT) (2017) Total knee arthroplasty after opening- versus closing-wedge high tibial osteotomy.A 135-case series with minimum 5-year follow-up. Orthop Traumatol Surg Res 103(7):1035–1039
Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96
Han JH, Yang JH, Bhandare NN, Suh DW, Lee JS, Chang YS, Yeom JW, Nha KW (2016) Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc 24(8):2567–2577
Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39:64–70
Huizinga MR, Brouwer RW, van Raaij TM (2014) High tibial osteotomy: closed 257 wedge versus combined wedge osteotomy. BMC Musculoskelet Disord 15:124
Khoshbin A, Sheth U, Ogilvie-Harris D, Mahomed N, Jenkinson R, Gandhi R, Wasserstein D (2017) The effect of patient, provider and surgical factors on survivorship of high tibial osteotomy to total knee arthroplasty: a population-based study. Knee Surg Sports Traumatol Arthrosc 25:887–894
Kim JH, Kim HJ, Lee DH (2017) Survival of opening versus closing wedge high tibial osteotomy: a meta analysis. Sci Rep 7:7296
Kuwashima U, Tashiro Y, Okazaki K, Mizu-Uchi H, Hamai S, Murakami K, Iwamoto Y (2017) Comparison of the impact of closing wedge versus opening wedge high tibial osteotomy on proximal tibial deformity and subsequent revision to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(3):869–875
Levigne C, Dejour D, Neyret P (1991) Intérêt de l’axe épiphysaire dans l’arthrose. In: Dejour H, Neyret P Les Gonarthroses 7èmes Journées Lyonnaises, Lyon
Liu X, Chen Z, Gao Y, Zhang J, Jin Z (2019) High tibial osteotomy: review of techniques and biomechanics. J Healthc Eng 2(2019):8363128
Loia MC, Vanni S, Rosso F, Bonasia DE, Bruzzone M, Dettoni F, Rossi R (2016) High tibial osteotomy in varus knees: indications and limits. Joints 4:98–110
Lutzner J, Kasten P, Gunther KP, Kirschner S (2009) Surgical options for patients with osteoarthritis of the knee. Nat Rev Rheumatol 5:309–316
Majima T, Yasuda K, Katsuragi R, Kaneda K (2000) Progression of joint arthrosis 10 to 15 years after high tibial osteotomy. Clin Orthop Relat Res 381:177–184
Marcheggiani Muccioli GM, Fratini S, Cammisa E, Vaccari V, Grassi A, Bragonzoni L, Zaffagnini S (2019) Lateral closing wedge high tibial osteotomy for medial compartment arthrosis or overload. Clin Sports Med 38(3):375–386
Nerhus TK, Ekeland A, Solberg G, Sivertsen EA, Madsen JE, Heir S (2017) Radiological outcomes in a randomized trial comparing opening wedge and closing wedge techniques of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:910–917
Nwachukwu BU, McCormick FM, Schairer WW, Frank RM, Provencher MT, Roche MW (2014) Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplasty 29:1586–1589
Pfitzner T, Perka C, von Roth P (2017) Unicompartmental vs. Total Knee Arthroplasty for Medial osteoarthritis. Z Orthop Unfall 155:527–533
Polat G, Balci HI, Cakmak MF, Demirel M, Sen C, Asik M (2017) Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. J Orthop Surg Res 12:44
Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study. Clin Orthop Relat Res 353:185–193
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 19:122–127
Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta analysis of clinical and radiological outcomes. Knee 18:361–368
Stuart MJ, Grace JN, Ilstrup DM, Kelly CM, Adams RA, Morrey BF (1990) Late recurrence of varus deformity after proximal tibial osteotomy. Clin Orthop Relat Res 260:61–65
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Wang Z, Zeng Y, She W, Luo X, Cai L (2018) Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials. Int J Surg. 60:153–163
Dahl AW, Robertsson O, Lohmander LS (2012) High tibial osteotomy in Sweden, 1998-2007: a population-based study of the use and rate of revision to knee arthroplasty. Acta Orthop 83:244–248
Wu L, Lin J, Jin Z, Cai X, Gao W (2017) Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: a comprehensive meta-analysis. PLoS ONE 12:e0171700
Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195
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The current study was approved by the local Ethics Committee (Comitato Etico Milano AREA 2 - protocol number IOGPMB02).
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Berruto, M., Maione, A., Tradati, D. et al. Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc 28, 3955–3961 (2020). https://doi.org/10.1007/s00167-020-05890-0
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DOI: https://doi.org/10.1007/s00167-020-05890-0