International Orthopaedics

, Volume 30, Issue 5, pp 403–408 | Cite as

Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age

  • G. Papachristou
  • S. Plessas
  • J. Sourlas
  • C. Levidiotis
  • E. Chronopoulos
  • C. Papachristou
Original Paper


We have investigated, in a prospective study, the outcome of a valgus osteotomy of the tibia in patients less than 60 years of age with arthrosis of the medial compartment and a varus angle of no more than 177.7°. Included in the study were 44 high tibial osteotomies (HTO) performed in 42 patients from 1981 until 1996. There were 35 females (2 bilateral) and 7 males, with an average age of 51 years (range: 30–60 years). Only patients in the first three grades, according to Ahlback’s classification, were included. During a mean follow-up period of 10 years (range: 5–17 years), all but 2 patients experienced pain relief. The average loss of postoperative correction at 10 years was 2.4°. The average postoperative Hospital for Special Surgery Knee Rating System score (HSSK) for patients with excellent or good results was 83.5 points. Survivorship analysis showed a success rate of 80% and 66% at 10 and 15 years respectively, and over 52.8% at 17 years of follow-up. HTO results in redistribution of the main stresses towards normal levels, although normal values are never attained. This is probably the reason why patients experienced good results only in the medium term.


High Tibial Osteotomy Tibial Tubercle Medial Compartment Average Loss Varus Angle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Nous avons réalisé une étude prospective sur le devenir des ostéotomies tibiales de valgisation chez les patients de moins de 60 ans, présentant une arthrose du compartiment médial du genou et un varus qui était toujours inférieur à 177,7°. Nous avons inclus dans cette étude 44 ostéotomies tibiales proximales, réalisées chez 42 patients de 1981 à 1996 (35 sujets féminins don’t 2 ostéotomies bilatérales et 7 sujets masculins). L’âge moyen était de 51 ans (entre 30 et 60). Seuls les patients présentant une lésion classée dans les trois premiers grades de la classification d’Ahlback ont été inclus. Après un suivi moyen de 10 ans (entre 5 et 17 ans), tous les patients ont été revus sauf deux. La perte de correction à 10 ans était de 2,4°. Le score HSSK était de 83,5 points (excellents et bons résultats), la courbe de survie a été de 80% à 10 ans et 66% à 15 ans, 52,8% à 17 ans. L’évolution de l’ostéotomie tibiale proximale montre qu’avec le temps se produit une récidive de la déformation ce qui explique de bons résultats uniquement à moyen terme.


  1. 1.
    Adili A, Bhandari M, Giffin R, Whately C, Kwok DC (2002) Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 10(3):169–176PubMedCrossRefGoogle Scholar
  2. 2.
    Agoropoulos Z, Papachristou G, Efstathopoulos N, Karras K, Giannakopoulos P (1989) High tibial osteotomy. Common meeting of the Hellenic Association of Orthopaedic Surgery and Traumatology with the British Orthopaedic Association. 2–6 May, RhodesGoogle Scholar
  3. 3.
    Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Radiol Diagn (Stockh) Suppl 277:7–72Google Scholar
  4. 4.
    Antonescu DN (2000) Is knee osteotomy still indicated in knee osteoarthritis. Acta Orthop Belg 66(5):421–432PubMedGoogle Scholar
  5. 5.
    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(5):305–308PubMedCrossRefGoogle Scholar
  6. 6.
    Bauer G, Insall J, Koshino T (1969) Tibial osteotomy in gonarthrosis (osteoarthritis of the knee). J Bone Surg 51-A:1545–1563Google Scholar
  7. 7.
    Bouharras M, Hoet F, Watillon M, Dspontin J, Geullete R, Thomas P, Parmentier D (1994) Results of tibial valgus osteotomy for internal femoro-tibial arthritis with an average 8-year follow-up. Acta Orthop Belg 60:163–168PubMedGoogle Scholar
  8. 8.
    Choi HR, Hasegawa Y, Kondo S, Shimizu T, Ida K, Iwata H (2001) High tibial osteotomy for varus gonarthrosis: a 10- to 24-year follow-up study. J Orthop Sci 6(6):493–497PubMedCrossRefGoogle Scholar
  9. 9.
    Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Surg 47-A:984–990Google Scholar
  10. 10.
    Flamme CH, Kohn D, Kirsch L (1999) High tibial osteotomy—primary stability of several implants. Z Orthop Ihre Grenzgeb 137(1):48–53PubMedCrossRefGoogle Scholar
  11. 11.
    Gariepy R (1964) Genu varum treated by high tibial osteotomy. J Bone Surg 46-B:783–788Google Scholar
  12. 12.
    Gautier E, Thomann BW, Brantchen R, Jacob RP (1999) Fixation of high tibial osteotomy with the AO cannulated knee plate. Acta Orthop Scand 70(4):397–399PubMedCrossRefGoogle Scholar
  13. 13.
    Giagounidis EM, Sell S (1999) High tibial osteotomy: factors influencing the duration of satisfactory function. Arch Orthop Trauma Surg 119(7–8):445–449PubMedCrossRefGoogle Scholar
  14. 14.
    Harrison MHM, Schajowicz F, Trueta J (1953) Osteoarthritis of the hip: a study of the nature and evolution of the disease. J Bone Joint Surg 35-A:598–604Google Scholar
  15. 15.
    Insall J, Ranawat CS, Anglietti P, Shine J (1976) A comparison of four models of total knee replacement prostheses. J Bone and Joint Surg 58-A:754–765Google Scholar
  16. 16.
    Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Surg 43-B:746–751Google Scholar
  17. 17.
    Kettelcamp DB, Wender DR, Chao EYS, Thompson C (1976) Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase, flexion-extension, and medial plateau force. J Bone Jt Surg 58A:952–960Google Scholar
  18. 18.
    Khan MT, Matthews JG (2000) High tibial osteotomy without internal fixation for medial uni-compartmental osteoarthrosis. Orthopedics 23(10):1045–1048PubMedGoogle Scholar
  19. 19.
    Kurosaka M, Tsumura N, Yoshiya S, Matsui N, Mizuno K (2000) A new fibular osteotomy in association with high tibial osteotomy (a comparative study with conventional mid-third fibular osteotomy). Int Orthop 24(4):227–230PubMedCrossRefGoogle Scholar
  20. 20.
    MacIntosh DL, Welsh RP (1997) Joint debridement. A compliment to high tibial osteotomy in the treatment of denerative arthritis of the knee. J Bone Jt Surg 59A:1094–1097Google Scholar
  21. 21.
    Papachristou G (2004) Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg 124:288–297PubMedCrossRefGoogle Scholar
  22. 22.
    Rinonapoli E, Mancini GB, Corvaglia A, Musiello S (1998) Tibial osteotomy for varus gonarthrosis. A 10- to 21-year followup study. Clin Orthop 353:185–193PubMedCrossRefGoogle Scholar
  23. 23.
    Scuderi GR, Winsdsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Jt Surg 71A:245–248Google Scholar
  24. 24.
    Vainiopää S, Laike E, Kirves P, Tiusanen P (1981) Tibial osteotomy for osteoarthitis of the knee. A five to ten year follow-up study. J Bone Jt Surg 63A:938–946Google Scholar
  25. 25.
    Valenti JR, Calvo R, Lopez R, Canadell J (1990) Long term evaluation of high tibial osteotomy. Int Orthop 14:347–349PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • G. Papachristou
    • 1
  • S. Plessas
    • 1
  • J. Sourlas
    • 1
  • C. Levidiotis
    • 1
  • E. Chronopoulos
    • 1
  • C. Papachristou
    • 1
  1. 1.2nd University Department of OrthopaedicsNational and Kapodistrian University, Constantopoulion HospitalAthensGreece

Personalised recommendations