International Orthopaedics

, Volume 34, Issue 2, pp 191–199

Opening wedge tibial osteotomy for large varus deformity with CeraverTM resorbable beta tricalcium phosphate wedges

  • Philippe Hernigou
  • Xavier Roussignol
  • Charles Henri Flouzat-Lachaniette
  • Paolo Filippini
  • Isaac Guissou
  • Alexandre Poignard
Original Paper


The results in 53 knees that had been treated by proximal tibial opening-wedge osteotomy for large varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of ten years (range, 8–12 years). We used a porous beta-tricalcium phosphate (β-TCP) wedge because it is resorbable and osteoinductive. All osteotomies were completely consolidated and complete osseointegration of the remnant of the β-TCP wedge took place. However, after a mean maximum follow-up of ten years none of the cases showed complete resorption. After ten years, 40 (81%) of the 53 knees had an excellent or good result, and in 13 knees there was recurrent pain for which six had an arthroplasty. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the knees that had a hip-knee-ankle angle of 183–186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the three knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow. Therefore, proximal tibial osteotomy is a very suitable operation even for patients who have gonarthrosis of the medial compartment and a large varus deformity. Although, a rigidly standardised and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy, and this exact alignment is difficult to obtain for patients with large varus deformity.


  1. 1.
    Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13:87–92CrossRefPubMedGoogle Scholar
  2. 2.
    Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 210:585–588Google Scholar
  3. 3.
    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 11:457–461CrossRefPubMedGoogle Scholar
  4. 4.
    Grelsamer RP (1995) Unicompartmental osteoarthritis of the knee. J Bone Jt Surg [Am] 77:278–281Google Scholar
  5. 5.
    Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. J Bone Jt Surg [Am] 69:332–354Google Scholar
  6. 6.
    Goulet JA, Senunas LE, DeSilva GL, Greenfield ML (1997) Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop Relat Res 339:76–81CrossRefPubMedGoogle Scholar
  7. 7.
    Hernigou P, Ovadia H, Goutallier D (1992) Modélisation mathématique de l'ostéotomie tibiale d'ouverture et table de correction. Revue de Chirurgie Orthopédique 78:258–263Google Scholar
  8. 8.
    Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8:103–110CrossRefPubMedGoogle Scholar
  9. 9.
    Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9:15–20CrossRefPubMedGoogle Scholar
  10. 10.
    Bignon A, Chouteau J, Chevalier J, Fantozzi G, Carret JP, Chavassieux P et al (2003) Effect of micro- and macroporosity of bone substitutes on their mechanical properties and cellular response. J Mater Sci Mater Med 14:1089–1097CrossRefPubMedGoogle Scholar
  11. 11.
    Hirata M, Murata H, Takeshita H, Sakabe T, Tsuji Y, Kubo T (2006) Use of purified beta-tricalcium phosphate for filling defects after curettage of benign bone tumours. Int Orthop 30:510–513CrossRefPubMedGoogle Scholar
  12. 12.
    Sarkar MR, Wachter N, Patka P, Kinzl L (2001) First histological observations on the incorporation of a novel calcium phosphate bone substitute material in human cancellous bone. J Biomed Mater Res 58:329–334CrossRefPubMedGoogle Scholar
  13. 13.
    Schilling AF, LinhartW FS, Gebauer M, Schinke T, Rueger JM et al (2004) Resorbability of bone substitute biomaterials by human osteoclasts. Biomaterials 25:3963–3972CrossRefPubMedGoogle Scholar
  14. 14.
    Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) (Suppl 72):1–21Google Scholar
  15. 15.
    van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB (2004) Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. Knee 11:451–456CrossRefPubMedGoogle Scholar
  16. 16.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138PubMedGoogle Scholar
  17. 17.
    Murphy SB (1994) Tibial osteotomy for genu varum. Indications, preoperative planning, and technique. Orthop Clin North Am 25:477–482PubMedGoogle Scholar
  18. 18.
    Dehoux E, Madi K, Fourati E, Mensa C, Segal P (2005) High tibial open-wedge osteotomy using a tricalcium phosphate substitute: 70 cases with 18 months mean follow-up. Rev Chir Orthop Repar Appar Mot 91:143–148Google Scholar
  19. 19.
    Bonnevialle P, Abid A, Mansat P, Verhaeghe L, Clement D, Mansat M (2002) Tibial valgus osteotomy using a tricalcium phosphate medial wedge: a minimally invasive technique. Rev Chir Orthop Repar Appar Mot 88:486–492Google Scholar
  20. 20.
    Tunggal JAW, Higgins GA, Waddell JP (2009) Complications of closing wedge high tibial osteotomy. Int Orthop. doi:10.1007/s00264-009-0819-9 PubMedGoogle Scholar
  21. 21.
    Nelissen EM, van Langelaan EJ, Nelissen RG (2009) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop. doi:10.1007/s00264-009-0723-3 Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Philippe Hernigou
    • 1
  • Xavier Roussignol
    • 1
  • Charles Henri Flouzat-Lachaniette
    • 1
  • Paolo Filippini
    • 1
  • Isaac Guissou
    • 1
  • Alexandre Poignard
    • 1
  1. 1.Hôpital Henri MondorUniversity Paris XIICreteilFrance

Personalised recommendations