International Orthopaedics

, Volume 35, Issue 8, pp 1151–1156 | Cite as

Outcome of opening wedge high tibial osteotomy augmented with a Biosorb® wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up

  • Dominique SaragagliaEmail author
  • Marc Blaysat
  • Dominic Inman
  • Numa Mercier
Original Paper


The objective of this work was firstly to evaluate the long-term results of medial opening wedge high tibial osteotomy (HTO) and secondly to evaluate the tolerance and integration of a Biosorb® wedge (β Tricalcium Phosphate, SBM Company, Lourdes, France). The series consisted of 124 knees in 110 patients, 74 men and 36 women, with mean age of 53.23±10.68 years (range 32–74) and treated between June 1995 and November 2000 for medial compartment knee osteoarthritis by the senior author. The mean preoperative Lysholm and Tegner functional score was 65.44±13.32 (range 27–80) and the preoperative HKA angle was 172.51°±3.8° (range 162–179°). According to the modified Ahlbäck classification there were 27 stage I, 42 stage II, 44 stage III and 11 stage IV knees. All patients were reviewed clinically and radiologically with a mean follow-up of 10.39±1.98 years (range 8–14 years). Immediate postoperative complications consisted of nine undisplaced lateral tibial plateau fractures of no clinical significance, two deep vein thromboses and three pulmonary emboli which resolved with appropriate treatment. At a later stage, there were seven delayed unions without development of pseudarthrosis, and three screw breakages when the AO T-plate was used, leading to a secondary angulation in one case, requiring revision by femoral osteotomy. Postoperative mean weightbearing HKA angle was 182°±1.8° (range 178–186°) and 73.4% of axes were 184°±2°. Fifteen knees (12.1%) underwent total knee arthroplasty (TKA) after a mean delay of 8.87±3.04 years and were excluded from the final analysis. Concerning the long-term results (n = 107 knees), the mean Lysholm-Tegner score was 88±12.7 points (51–100) and the KOOS score was 86±14.6 points (25–100) with 94 patients satisfied or very satisfied (87.85%). In terms of the HTO survivorship curve, with failure consisting of revision to TKA or another operation, survival was 88.8% at five years and 74% at ten years. Concerning Biosorb®, this was completely integrated in 100% of cases and there was complete resorption in 12.1% of cases and greater than 50% resorption in 52.3% of cases.


Total Knee Arthroplasty High Tibial Osteotomy Unicompartmental Knee Arthroplasty Opening Wedge High Tibial Osteotomy Tegner Score 
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  1. 1.
    Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10 to 21-year study. J Knee Surg 16:21–26PubMedGoogle Scholar
  2. 2.
    Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy. A ten to 20-year follow up. J Bone Joint Surg Br 90:592–596PubMedCrossRefGoogle Scholar
  3. 3.
    Bonnevialle P, Abid A, Mansat P, Verhaeghe L, Clément D, Mansat M (2002) Ostéotomie tibiale de valgisation par addition médiale d’un coin de phosphate tricalcique. Rev Chir Orthop 88:486–492PubMedGoogle Scholar
  4. 4.
    Bove JC (2002) Utilisation d’une cale en céramique d’alumine poreuse dans l’ostéotomie tibiale de valgisation par ouverture interne. Rev Chir Orthop 88:480–485PubMedGoogle 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.
    Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy: a critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201PubMedGoogle Scholar
  7. 7.
    Debeyre J, Artigou JM (1972) Résultats à distance de 260 ostétomies tibiales pour déviation frontale en varus du genou. Rev Chir Orthop 58:335–337PubMedGoogle Scholar
  8. 8.
    Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year follow-up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96PubMedCrossRefGoogle Scholar
  9. 9.
    Franco V, Cerullo G, Cipolla M, Gianni E, Puddu GC (2002) Open wedge high tibial osteotomy. Tech Knee Surg 11:43–53CrossRefGoogle Scholar
  10. 10.
    Goutallier D, Juliéron A, Hernigou Ph (1992) La cale de ciment remplaçant les greffons iliaques dans les ostéotomies tibiales d’addition interne. Rev Chir Orthop 78:138–144PubMedGoogle Scholar
  11. 11.
    Hernigou Ph, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity: a ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354PubMedGoogle Scholar
  12. 12.
    Hernigou Ph, Roussignol X, Flouzat-Lachaniette CH, Filippini P, Guissou I, Poignard A (2010) Opening wedge tibial osteotomy for large varus deformity with Ceraver™ resorbable beta tricalcium phosphate wedges. Int Orthop 34:191–199PubMedCrossRefGoogle Scholar
  13. 13.
    Holden DL, James SL, Larson RL, Slocum DB (1988) Proximal tibial osteotomy in patients who are fifty years old or less. J Bone Joint Surg Am 70:977–982PubMedGoogle Scholar
  14. 14.
    Insall JN, Douglas MJ, Msika C (1984) High tibial osteotomy for varus gonarthrosis. J Bone Joint Surg Am 66:1040–1048PubMedGoogle Scholar
  15. 15.
    Jackson JP, Waugh W (1961) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 43:746–751PubMedGoogle Scholar
  16. 16.
    Jenny JY, Tavan A, Jenny G, Kehr P (1998) Taux de survie à long terme des ostéotomies tibiales de valgisation pour gonarthrose. Rev Chir Orthop 84:350–357PubMedGoogle Scholar
  17. 17.
    Judet R, Dupuis JF, Honnard F et al (1964) Désaxations et arthroses du genou. Le genu varum de l’adulte. Indications thérapeutiques, résultats. Rev Chir Orthop 13:1–28Google Scholar
  18. 18.
    Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porus hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 85:78–85PubMedCrossRefGoogle Scholar
  19. 19.
    Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444PubMedCrossRefGoogle Scholar
  20. 20.
    Kraal T, Mullender M, de Bruine JH, Reinhard R, de Gast A, Kuik DJ, van Royen BJ (2008) Resorbability of rigid beta tricalcium phosphate wedges in open-wedge high tibial osteotomy: a retrospective radiological study. Knee 15:201–205PubMedCrossRefGoogle Scholar
  21. 21.
    Lascard T, Favard L, Burdin P, Traoré O (1998) Utilisation du phosphate tricalcique dans les ostéotomies tibiales de valgisation par addition interne. Ann Orthop Ouest 30:137–141Google Scholar
  22. 22.
    Lootvoet L, Massinon A, Rossillon R, Himmer O, Lambert K, Ghosez JP (1993) Ostéotomie tibiale haute de valgisation pour gonarthrose sur genu varum: à propos d’une série de 193 cas revus après 6 à 10 ans de recul. Rev Chir Orthop 79:375–384PubMedGoogle Scholar
  23. 23.
    Nelissen EM, Van Langelaan EJ, Nelissen RGHH (2010) Stability of medial opening wedge high tibial osteotomy: a failure analysis. Int Orthop 34:217–223PubMedCrossRefGoogle Scholar
  24. 24.
    Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:406–408Google Scholar
  25. 25.
    Ramadier JO, Buard JE, Lortat-Jacob A et al (1982) Mesure radiologique des déformations frontales du genou. Procédé du profil vrai radiologique. Rev Chir Orthop 68:75–78PubMedGoogle Scholar
  26. 26.
    Rinonapoli E, Mancini GB, Corvaglia A et al (1998) Tibial osteotomy for varus gonarthrosis. A 0 to 21-year follow-up study. Clin Orthop 353:185–193PubMedCrossRefGoogle Scholar
  27. 27.
    Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS): validation of a Swedish version. Scand J Med Sci Sports 8:439–448PubMedCrossRefGoogle Scholar
  28. 28.
    Saragaglia D, Pradel Ph, Picard F (2004) L’ostéotomie de valgisation assistée par ordinateur dans le genu varum arthrosique: résultats radiologiques d’une étude cas-témoin de 56 cas. E-mémoires de l’Académie Nationale de Chirurgie 3:21–25. Available at
  29. 29.
    Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopaedics 28(suppl 10):1269–1274Google Scholar
  30. 30.
    Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34:185–190PubMedCrossRefGoogle Scholar
  31. 31.
    Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty two years. J Bone Joint Surg Am 469–474Google Scholar
  32. 32.
    Staubli AE, De Simoni C, 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
  33. 33.
    Staubli AE, Jacob HAC (2010) Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop 34:167–172PubMedCrossRefGoogle Scholar
  34. 34.
    Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14:156–159PubMedCrossRefGoogle Scholar
  35. 35.
    Tunggal JAW, Higgins GA, Waddell JP (2010) Complications of closing wedge high tibial osteotomy. Int Orthop 34:255–261PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Dominique Saragaglia
    • 1
    Email author
  • Marc Blaysat
    • 1
  • Dominic Inman
    • 2
  • Numa Mercier
    • 1
  1. 1.Department of Orthopaedic Surgery and Sport TraumatologyGrenoble South Teaching HospitalÉchirollesFrance
  2. 2.Newcastle-upon-TyneUK

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