Valgisierende Tibiakopfosteotomie in öffnender Technik

Medial opening wedge high tibial osteotomy

Zusammenfassung

Operationsziel

Druckreduktion des medialen Kompartiments bei Patienten mit medialer Varusgonarthrose und Entlastung v. a. der posterolateralen Bandstrukturen bei Varusdeformität und komplexen Bandinstabilitäten.

Indikationen

Mediale Varusgonarthrose bei noch gut erhaltenem lateralen und patellofemoralen Gelenkabschnitt. Komplexe Bandinstabilitäten bei gleichzeitig vorliegender Varusdeformität.

Kontraindikationen

Erhebliche Bewegungseinschränkungen

Operationstechnik

Mediale Hautinzision am proximalen Unterschenkel. Darstellung des Pes anserinus. Markierung der Osteotomie vom tiefsten Punkt der medialen Metaphyse ansteigend nach lateral. Biplanare Stufenosteotomie unter Schutz der posterioren neurovaskulären Strukturen mit ventraler Ausleitung der Osteotomie nach proximal der Tuberositas tibiae oder nach distal in Abhängigkeit von Begleitpathologien. Fixation mit winkelstabilem Plattenfixateur.

Weiterbehandlung

Im Grundsatz ist eine frühe Belastung bei Verwendung eines winkelstabilen Plattenfixateurs möglich. Oft erfordern jedoch Begleitpathologien wie z. B. eine begleitende knorpelregenerative Therapie eine längere Entlastungsphase. Die Beweglichkeit kann bei alleiniger Osteotomie ebenfalls früh freigegeben werden. Eine orthetische Versorgung ist für viele Fälle empfohlen.

Ergebnisse

Bei korrekter Indikationsstellung lassen sich unter der Voraussetzung einer standardisierten Operationstechnik mit der Open-Wedge-Osteotomie (OW-HTO) – trotz statistisch vergleichsweise hoher Komplikationsrate – gute Ergebnisse mit hoher Patientenzufriedenheit erzielen. Ein tendenziell schlechteres Outcome zeigen Patienten mit Body-Mass-Index über 30 und höheren Arthrosegraden.

Abstract

Objective

Reduction of the load to the medial compartment in patients with medial knee osteoarthritis and varus malalignment. Unloading of the posterolateral complex in varus deformity with complex ligamentous laxity.

Indications

Medial knee osteoarthritis and varus malalignment with largely intact lateral and patellofemoral joint aspect. Complex ligament insufficiency combined with varus deformity.

Contraindications

Substantially impaired range of motion.

Surgical technique

Medial skin incision on the proximal lower leg. Preparation of the pes anserinus. Marking of the osteotomy from the deepest point of the medial metaphysis laterally ascending. Biplane osteotomy, carefully protecting the posterior neurovascular structures, with ventral completion proximal or distal to the tibial tuberosity, depending on concomitant pathologies. Angular-stable plate fixation.

Postoperative management

In general, early weight bearing is possible when angular-stable plate fixation is used. Often concomitant pathologies such as accompanying cartilage regenerative therapy necessitate longer unloading. Range of motion does not need to be restricted following stand-alone osteotomy. Orthoses are recommended regularly.

Results

Under the correct indication, the medial opening wedge high tibial osteotomy (OW-HTO) technique can achieve good results with high patient satisfaction, despite a relatively high statistical complication rate, provided that a standardized surgical technique is used. There is a tendency for a poorer outcome in patients with a body mass index above 30 and higher stages of osteoarthritis.

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Correspondence to Prof. Dr. P. Niemeyer.

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Interessenkonflikt

P. Niemeyer, A. Stöhr, M. Köhne und A. Hochrein geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Editor

A.B. Imhoff, München

Zeichner

J. Kühn, Mannheim

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Niemeyer, P., Stöhr, A., Köhne, M. et al. Valgisierende Tibiakopfosteotomie in öffnender Technik. Oper Orthop Traumatol 29, 294–305 (2017). https://doi.org/10.1007/s00064-017-0509-5

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Schlüsselwörter

  • Gonarthrose
  • Kniegelenk
  • Genu varum
  • Gelenkinstabilität
  • Osteotomie

Keywords

  • Osteoarthritis, knee
  • Knee joint
  • Genu varum
  • Joint instability
  • Osteotomy