International Orthopaedics

, Volume 37, Issue 3, pp 427–431 | Cite as

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

  • Ricardo Bastos Filho
  • Robert A. Magnussen
  • Victoria Duthon
  • Guillaume Demey
  • Elvire Servien
  • José Mauro Granjeiro
  • Philippe Neyret
Original Paper



High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening-wedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA.


A total of 141 TKA’s performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment.


The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p <  0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups.


Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.


Total Knee Arthroplasty High Tibial Osteotomy Patellar Height Open Wedge High Tibial Osteotomy Wedge High Tibial Osteotomy 
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.


Conflicts of interest

One of the authors receives royalties from Tornier. Three authors have received research and travel support from Tornier.


  1. 1.
    Backstein D, Meisami B, Gross AE (2003) Patella baja after the modified Coventry-Maquet high tibial osteotomy. J Knee Surg 16:203–208PubMedGoogle Scholar
  2. 2.
    Bae DK, Song SJ, Yoon KH (2010) Total knee arthroplasty following closed wedge high tibial osteotomy. Int Orthop 34:283–287. doi: 10.1007/s00264-009-0749-6 PubMedCrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    Efe T, Heyse TJ, Boese C, Timmesfeld N, Fuchs-Winkelmann S, Schmitt J, Theisen C, Schofer MD (2010) TKA following high tibial osteotomy versus primary TKA—a matched pair analysis. BMC Musculoskelet Disord 11:207. doi: 10.1186/1471-2474-11-207 PubMedCrossRefGoogle Scholar
  5. 5.
    El Amrani MH, Levy B, Scharycki S, Asselineau A (2010) Patellar height relevance in opening-wedge high tibial osteotomy. Orthop Traumatol Surg Res 96:37–43. doi: 10.1016/j.rcot.2009.11.003 PubMedCrossRefGoogle Scholar
  6. 6.
    El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S (2010) Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy: a radiological study on 100 patients. Am J Sports Med 38:323–329. doi: 10.1177/0363546509348050 PubMedCrossRefGoogle Scholar
  7. 7.
    Gaasbeek R, Welsing R, Barink M, Verdonschot N, van Kampen A (2007) The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 15:978–984. doi: 10.1007/s00167-007-0305-0 PubMedCrossRefGoogle Scholar
  8. 8.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMedGoogle Scholar
  9. 9.
    Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983) The total condylar knee prosthesis in gonarthrosis. A five to nine-year follow-up of the first 100 consecutive replacements. J Bone Joint Surg Am 65:619–628PubMedGoogle Scholar
  10. 10.
    Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 66:1040–1048PubMedGoogle Scholar
  11. 11.
    Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72:238–244PubMedGoogle Scholar
  12. 12.
    Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y (2005) Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 13:539–544. doi: 10.1007/s00167-004-0572-y PubMedCrossRefGoogle Scholar
  13. 13.
    Kettelkamp DB, Wenger DR, Chao EY, Thompson C (1976) Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. J Bone Joint Surg Am 58:952–960PubMedGoogle Scholar
  14. 14.
    Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res 229:193–200PubMedGoogle Scholar
  15. 15.
    Ogden S, Mukherjee DP, Keating ME, Ogden AL, Albright JA, McCall RE (2009) Changes in load distribution in the knee after opening-wedge or closing-wedge high tibial osteotomy. J Arthroplasty 24:101–109, 10.1016/j.arth.2008.01.303PubMedCrossRefGoogle Scholar
  16. 16.
    Parvizi J, Hanssen AD, Spangehl MJ (2004) Total knee arthroplasty following proximal tibial osteotomy: risk factors for failure. J Bone Joint Surg Am 86-A:474–479PubMedGoogle Scholar
  17. 17.
    Piedade SR, Pinaroli A, Servien E, Neyret P (2012) TKA outcomes after prior bone and soft tissue knee surgery. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-012-2139-7
  18. 18.
    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 353:185–193PubMedCrossRefGoogle Scholar
  19. 19.
    Schiedel F, Probst A, Buller TC, Rodl R (2009) The postoperative patella height: a comparison of additive and subtractive high tibial osteotomy in correcting the genu varum. Arch Orthop Trauma Surg 129:1271–1277. doi: 10.1007/s00402-009-0824-x PubMedCrossRefGoogle Scholar
  20. 20.
    Treuter S, Schuh A, Honle W, Ismail MS, Chirag TN, Fujak A (2012) Long-term results of total knee arthroplasty following high tibial osteotomy according to Wagner. Int Orthop 36:761–764. doi: 10.1007/s00264-011-1373-9 PubMedCrossRefGoogle Scholar
  21. 21.
    Vainionpaa S, Laike E, Kirves P, Tiusanen P (1981) Tibial osteotomy for osteoarthritis of the knee. A five to ten-year follow-up study. J Bone Joint Surg Am 63:938–946PubMedGoogle Scholar
  22. 22.
    Valenti JR, Calvo R, Lopez R, Canadell J (1990) Long term evaluation of high tibial valgus osteotomy. Int Orthop 14:347–349PubMedCrossRefGoogle Scholar
  23. 23.
    van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79:508–514, 10.1080/17453670710015508PubMedCrossRefGoogle Scholar
  24. 24.
    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 282:186–195PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Ricardo Bastos Filho
    • 1
    • 2
    • 3
  • Robert A. Magnussen
    • 4
  • Victoria Duthon
    • 1
  • Guillaume Demey
    • 1
  • Elvire Servien
    • 1
  • José Mauro Granjeiro
    • 5
    • 6
  • Philippe Neyret
    • 1
  1. 1.Department of Orthopaedic SurgeryHôpital de la Croix-Rousse, Centre Albert TrillatLyonFrance
  2. 2.CAPES FoundationMinistry of EducationBrasíliaBrazil
  3. 3.Post-graduate ProgramFluminense Federal UniversityRio de JaneiroBrazil
  4. 4.Department of Orthopaedics, Sports Health and Performance InstituteThe Ohio State UniversityColumbusUSA
  5. 5.Dental SchoolFluminense Federal UniversityRio de JaneiroBrazil
  6. 6.Bioengeneering DivisionNational Institute of Metrology, Quality, and TechnologyBrasiliaBrazil

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