International Orthopaedics

, Volume 34, Issue 2, pp 217–223 | Cite as

Stability of medial opening wedge high tibial osteotomy: a failure analysis

  • E. M. Nelissen
  • E. J. van Langelaan
  • R. G. H. H. Nelissen
Original Paper


Medial opening wedge high tibial osteotmy (HTO) is often used to treat varus gonarthrosis in young, active, highly demanding patients, although it has many pitfalls, which were evaluated in a consecutive cohort of patients. A retrospective analysis of a consecutive series of 45 patients with 49 medial opening HTO for varus gonarthrosis using a spacer plate (Puddu I, Arthrex, USA) were included. A Chi square test was used to study the effect between the wedge size and complications. Complications occurred in 22 knees (45%). There was no significant difference between groups for individual complications; however, when combined, there were significantly more complications in the >10 mm wedge group (Chi square p = 0.05). The overall complication rate in this series was 45%. The majority were related to intrinsic instability at the osteotomy site (24%) and surgical technique (20%). The evaluated spacer provided inadequate stability.


Total Knee Arthroplasty Mechanical Axis Unicompartmental Knee Arthroplasty Wedge Osteotomy Partial Weight Bearing 
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.


Analyse des échecs après ostéotomie tibiale d’ouverture interne. L’ostéotomie tibiale d’ouverture interne HTO est très souvent utilisée dans le traitement des gonarthroses en varus chez le sujet jeuneet actif, cependant, il existe beaucoup de pièges. Ceux-ci ont été évalués sur une cohorte de patients consécutifs. Analyse rétrospective d’une série consécutive de 45 patients ayant bénéficié de 49 ostéotomies internes d’ouverture du tibia pour gonarthrose en varus utilisant une plaque spéciale de type Puddu (Arthrex USA). Le Chi test a été utilisé de façon à évaluer les effets secondaires dûs à l’importance de la taille du spacer et ses complications. 45% de complications (22 genoux) sont apparues. Il n’y a pas de différence significative entre les groupes concernant les complications habituelles, cependant il existe un taux significativement plus important de complications si l’ouverture osseuse est supérieure à 10 m (Chi Square p = 0,05). Globalement, le taux de complications de cette série est de 45% dont la majorité est secondaire à des problèmes d’instabilité au niveau de l’ostéotomie (24%) ou de la technique chirurgicale (20%). Cette plaque spéciale ne permet pas d’avoir une bonne stabilité de l’ostéotomie.


  1. 1.
    Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) Suppl 277:7–72Google Scholar
  2. 2.
    Brouwer RW, Jakma TSC, Bierma-Zeinstra SMA, Verhagen AP, Verhaar JAN (2005) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 1:CD004019Google Scholar
  3. 3.
    Brouwer RW (2006) Unicompartmental osteoarthritis of the knee: diagnosis and treatment of malalignment. Doctoral Thesis, Erasmus University, Rotterdam, 17 May 2006Google Scholar
  4. 4.
    Catani F, Marcacci M, Benedetti MG, Leardini A, Battistini A, Iacono F, Giannini S (1998) The influence of clinical and biomechanical factors on the results of valgus high tibial osteotomy. Chir Organi Mov 83(3):249–262PubMedGoogle Scholar
  5. 5.
    Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 47:984–990PubMedGoogle Scholar
  6. 6.
    Dorsey WO, Miller BS, Tadje JP, Bryant CR (2006) The stability of three commercially available implants used in medial opening wedge high tibial osteotomy. J Knee Surg 19(2):95–98PubMedGoogle Scholar
  7. 7.
    Gao TJ, Lindholm TS, Kommonen B, Ragni P, Paronzini A, Lindholm TC (1997) Stabilization of an inserted tricalcium phosphate spacer enhances the healing of a segmental tibial defect in sheep. Arch Orthop Trauma Surg 116(5):290–294CrossRefPubMedGoogle Scholar
  8. 8.
    Harrington IJ (1983) Static and dynamic loading patterns in knee joints with deformities. J Bone Joint Surg Am 65(2):247–259PubMedGoogle Scholar
  9. 9.
    Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (1974) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30(5):403–408CrossRefGoogle Scholar
  10. 10.
    Johnson F, Leitl S, Waugh W (1980) The distribution of load across the knee. A comparison of static and dynamic measurements. J Bone Joint Surg Br 62(3):346–349PubMedGoogle Scholar
  11. 11.
    Koshino T, Murase T, Takagi T, Saito T (2001) New bone formation around porous hydroxyapatite wedge implanted in opening wedge high tibial osteotomy in patients with osteoarthritis. Biomaterials 22(12):1579–1582CrossRefPubMedGoogle Scholar
  12. 12.
    Valenti JR, Calvo R, Lopez R, Cañadell J (1990) Long term evaluation of high tibial valgus osteotomy. Int Orthop 14(4):347–349CrossRefPubMedGoogle Scholar
  13. 13.
    Maquet P (1980) The biomechanics of the knee and surgical possibilities of healing osteoarthritic knee joints. Clin Orthop Relat Res 146:102–110PubMedGoogle Scholar
  14. 14.
    Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557CrossRefPubMedGoogle Scholar
  15. 15.
    Leutloff D, Tobian F, Perka C (2001) High tibial osteotomy for valgus and varus deformities of the knee. Int Orthop 25(2):93–96CrossRefPubMedGoogle Scholar
  16. 16.
    Papachristou G (2004) Photoelastic study of the internal and contact stresses on the knee joint before and after osteotomy. Arch Orthop Trauma Surg 124(5):288–297CrossRefPubMedGoogle Scholar
  17. 17.
    Puddu G, Fowler PJ, Amendola A (1998) Opening wedge osteotomy system by Arthrex surgical technique. Arthrex, Naples, FLGoogle Scholar
  18. 18.
    Puddu G, Cipolla M, Franco V (1999) A plate for open wedge tibial and femoral osteotomies. In: Congress the of International Society of Arthroscopy. Knee Surgery and Orthopaedic Sports Medicine, Washington, DCGoogle Scholar
  19. 19.
    Shaw JA, Moulton MJ (1996) High tibial osteotomy: an operation based on a spurious mechanical concept. A theoretic treatise. Am J Orthop 25(6):429–436Google Scholar
  20. 20.
    Spahn G, Wittig R (2002) Primary stability of various implants in tibial opening wedge osteotomy: a biomechanical study. J Orthop Sci 7(6):683–687CrossRefPubMedGoogle Scholar
  21. 21.
    Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653CrossRefPubMedGoogle Scholar
  22. 22.
    Bhan S, Dave PK (1992) High valgus tibial osteotomy for osteoarthritis of the knee. Int Orthop 16(1):13–17CrossRefPubMedGoogle Scholar
  23. 23.
    Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon) 19(9):944–950CrossRefGoogle Scholar
  24. 24.
    Brown GA, Amendola A (2000) Radiographic evaluation and preoperative planning for high tibial osteotomies. Oper Tech Sports Med 8(1):2–14CrossRefGoogle Scholar
  25. 25.
    Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 16(2):137–162CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • E. M. Nelissen
    • 1
  • E. J. van Langelaan
    • 2
  • R. G. H. H. Nelissen
    • 1
  1. 1.Department of Orthopaedic SurgeryLeiden University Hospital (LUMC)LeidenThe Netherlands
  2. 2.Department of Orthopaedic SurgeryRijnland HospitalLeiderdorpThe Netherlands

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