Skip to main content

High tibial osteotomy combined with anterior displacement of the tibial tubercle for osteoarthritis of the knee

Summary

Eighty-nine knees with medial tibiofemoral and patellofemoral osteoarthritis were treated by high tibial osteotomy between 1972 and 1978, and 71 were followed up for at least 5 years, the average being 6 years and 9 months. There was no significant loss of motion as recorded before and after operation. In most patients pain decreased or disappeared, and walking ability was regained. Evaluation using the Japanese rating system showed that there were Good and Fair results in 86% of the cases. The average tibio-femoral angle in the Good group was 169±5°. The angles in the Poor group varied over a wide range. There were serious complications such as nonunion, malunion and infection in a few cases. In Group 1 (30 knees) high tibial osteotomy alone was performed. In Group 2 (41 knees) there were associated osteoarthritic changes in the patellofemoral joint and a high tibial osteotomy was combined with anterior displacement of the tibial tubercle (ventralisation). In comparison, Group 2 had better results with regard to both clinical and radiological evaluation.

Résumé

Sur 89 genoux de gonarthrose traités par ostéotomie tibiale haute, de 1972 à 1978, 71 ont été suivis au moins 5 ans, en moyenne 6 ans et 9 mois. Les résultats ont été bons ou passables dans 86% des cas. Il n'y a pas eu de perte notable de la mobilité du genou par rapport à l'état pré-opératoire. Dans la plupart des cas la douleur a disparu ou diminué et les possibilités de marche ont été récupérées. Il n'y a eu qu'un petit nombre de complications, telles que pseudarthrose, cal vicieux ou infection. Les meilleurs résultats ont été obtenus quand l'angle fémoro-tibial post-opératoire était de 169° ±5, les plus mauvais avec une grande disparité de cet angle. Un premier groupe (30 genoux) a été traité par ostéotomie tibiale haute isolée. L'autre groupe (41 genoux), présentant une ostéoarthrite fémoro-patellaire importante, a été traité par ostéotomie tibiale haute, associée à une transposition vers l'avant de la tubérosité tibiale antérieure. Les résultats obtenus dans le second groupe ont été plus satisfaisants sur le plan clinique et radiologique.

This is a preview of subscription content, access via your institution.

References

  1. 1

    Aglietti P, Rinonapoli E, Stringa G, and Taviani A (1983) Tibial Osteotomy for the Varus Osteoarthritic Knee. Clin Orthop 176: 239–251

    Google Scholar 

  2. 2

    Ahlbäck S (1968) Osteoarthrosis of the Knee. A Radiographic Investigation. Acta Radiol [Suppl] 277: 1–72

    Google Scholar 

  3. 3

    Bandi W (1972) Chondromalacia Patellae und Femoropatellare Arthrose. Atiologie, Klinik und Therapie. Helv Chir Acta [Suppl] 11: 1–70

    Google Scholar 

  4. 4

    Bauer GCH, Insall J, Koshino T (1969) Tibial Osteotomy in Gonarthrosis (Osteo-Arthritis of the Knee). J Bone Joint Surg 51-A: 1545–1563

    Google Scholar 

  5. 5

    Bourguignon RL (1981) Combined Coventry-Maquet Tibial Osteotomy, Preliminary Report of Two Cases. Clin Orthop 160: 144–148

    Google Scholar 

  6. 6

    Coventry MB (1965) Osteotomy of the Upper Portion of the Tibial for Degenerative Arthritis of the Knee. A Preliminary Report. J Bone Joint Surg 47-A: 984–990

    Google Scholar 

  7. 7

    Coventry MB (1973) Osteotomy about the Knee for Degenerative and Rheumatoid Arthritis. J Bone Joint Surg 55-A: 23–48

    Google Scholar 

  8. 8

    Ferguson AB, Brown TD, Fu FH, Butkowski RR (1979) Relief of Patellofemoral Contact Stress by Anterior Displacement of the Tibial Tubercle. J Bone Joint Surg 61-A: 159–166

    Google Scholar 

  9. 9

    Hirsh DM, Reddy DK (1980) Experience with Maquet Anterior Tibial Tubercle Advancement for Patellofemoral Arthrolgia. Clin Orthop 148: 136–139

    Google Scholar 

  10. 10

    Hofmann AA, Wyatt RBW, Jones RE (1984) Combined Coventry-Maquet Procedure for Two-compartment Degenerative Arthritis. Clin Orthop 190: 186–191

    Google Scholar 

  11. 11

    Insall JN, Shoji H, Mayer V (1974) High Tibial Osteotomy. A Five-Year Evaluation. J Bone Joint Surg 56-A: 1397–1405

    Google Scholar 

  12. 12

    Insall JN (1981) Patellar Pain Syndromes and Chondromalacia Patellae. AAOS Instructional Course Lectures, Vol 30. CV Mosby, St Louis

    Google Scholar 

  13. 13

    Insall JN, Douglas MJ, Msika C (1984) High Tibial Osteotomy for Varus Gonarthrosis. A Long-Term Follow-up Study. J Bone Joint Surg 66-A: 1040–1048

    Google Scholar 

  14. 14

    Jackson JP (1958) Osteotomy for Osteoarthritis of the Knee. J Bone Joint Surg 40-B: 826

    Google Scholar 

  15. 15

    Kettelkamp DB, Leach RE, Nasca R (1975) Pitfalls of Proximal Tibial Osteotomy. Clin Orthop 106: 232–241

    Google Scholar 

  16. 16

    Kettelkamp DB, Wenger 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 Joint Surg 58-A: 952–960

    Google Scholar 

  17. 17

    Levy M, Pauker M, Lotem M, Seelenfreund M, Fried M (1973) High Tibial Osteotomy: A Follow-up Study and Description of a Modified Technique. Clin Orthop 93: 274–277

    Google Scholar 

  18. 18

    Maquet PGS (1963) Un traitement biomécanique de l'arthrose fémoro-patellaire. L'avancement du tendon rotulien. Rev Rhumat 30: 779–783

    Google Scholar 

  19. 19

    Maquet PGS (1976) Biomechanics of the Knee. With Application to the Pathogenesis and the Surgical Treatment of Osteoarthritis. Springer, Berlin Heidelberg, New York

    Google Scholar 

  20. 20

    Miller R, Kettelkamp DB, Laubenthal KN, Karagiorgos A, Smidt GL (1973) Quantitative correlations in Degenerative Arthritis of the Knee. J Bone Joint Surg 55-A: 956–962

    Google Scholar 

  21. 21

    Myrnerts R (1980) High Tibial Osteotomy with Overcorrection of Varus Malaligament in Medial Gonarthrosis. Acta Orthop Scand 51: 557–560

    Google Scholar 

  22. 22

    Onozawa T, Kato T, Sasaki T (1977) Clinical Results of High Tibial Osteotomy for the Osteoarthritic Knee. J Clin Orthop (Jpn) 12: 669–679

    Google Scholar 

  23. 23

    Sasaki T, Kato T, Susuda K (1980) High Tibial Osteotomy for Osteoarthritis of the Knee; Effect of Ventralization. J Orthop Surg (Jpn) 31: 867–876

    Google Scholar 

  24. 24

    Sasaki T, Yagi T, Mongi J (1984) Clinical and Roentgenological Findings of the Patello-Femoral Joint in Medial Tibio-Femoral Osteoarthritis. The Knee (Jpn) 9: 136–143

    Google Scholar 

  25. 25

    Shoji H, Insall J (1973) High Tibial Osteotomy for Osteoarthritis of the Knee with Valgus Deformity. J Bone and Joint Surg 55-A: 963–973

    Google Scholar 

  26. 26

    Tjörnstrand BAE, Egund N, Hagstedt BV (1981) High Tibial Osteotomy. A Seven-Year Clinical and Radiographic Follow-up. Clin Orthop 160: 124–136

    Google Scholar 

  27. 27

    Tsutsumi M, Sasaki T, Susuda K (1982) Experience of Ventralization using Ceramic Spacer. Orthop Ceramic Implant 2: 195–199

    Google Scholar 

  28. 28

    Vainionpää S, Laike E, Kirves O, Tiusanen P (1981) Tibial Osteotomy for Osteoarthritis of the Knee. J Bone Joint Surg 63-A: 938–946

    Google Scholar 

Download references

Author information

Affiliations

Authors

Additional information

Read at the 16th Congress of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie, London, England, 5th October, 1984

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sasaki, T., Yagi, T., Monji, J. et al. High tibial osteotomy combined with anterior displacement of the tibial tubercle for osteoarthritis of the knee. International Orthopaedics 10, 31–40 (1986). https://doi.org/10.1007/BF00266270

Download citation

Key words

  • Osteoarthritis
  • Knee
  • High tibial osteotomy
  • Anterior displacement of tibial tubercle