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Hohe tibiale Osteotomie bei Varusgonarthrose

Indikation, Technik, Ergebnisse

High tibial osteotomy for varus arthritis

Indications, technique, and results

Zusammenfassung

Die hohe tibiale Osteotomie (HTO) ist eine erfolgreiche und seit mehreren Jahrzehnten etablierte Behandlungsmethode der Varusgonarthrose. Daneben wird diese Operation auch erfolgreich zur Therapie der schmerzhaften medialen Überlastung, in Kombination mit Knorpelersatztherapien und bei chronischen Bandinstabilitäten eingesetzt. Die valgisierende Open-wedge-Technik hat seit der Einführung winkelstabiler Plattenfixateure die Closed-wedge-Technik als Goldstandard abgelöst. In dieser Arbeit wird ein differenziertes Schema zur Indikationsstellung und Korrekturplanung vorgestellt, welches sich an der zugrunde liegenden Pathologie des Patienten orientiert. Die von uns angewandte Technik der medialen Open-wedge-HTO wird detailliert beschrieben und ein Überblick über die bisherigen Ergebnisse unter besonderer Berücksichtigung von Langzeitüberlebensraten gegeben. Abschließend werden noch einige Besonderheiten dieser Operation, wie z. B. Änderungen von Slope und Patellahöhe, Osteotomien bei Gelenkinstabilität, Pseudarthrosenrate und Einfluss des Alters auf das Operationsergebnis, abgehandelt.

Abstract

High tibial osteotomy (HTO) has been successfully used to treat varus osteoarthritis of the knee joint for several decades. In addition this operation has been proven to be effective in the treatment of medial compartment overloading, in combination with cartilage repair and for chronic knee instability. Since the introduction of locking plates valgus open wedge osteotomy has replaced the closed wedge technique as the current gold standard. In this article we present a sophisticated algorithm regarding indications and correction planning based on the individual underlying pathology. Our preferred operation technique for medial open wedge HTO is described in detail and an overview of the results reported in the literature is provided with special reference to long-term survival rates. Finally, some specialities related to this operation (e.g. changes in tibial slope and patellar height, osteotomy in the case of knee instability, rate of non-union and effect of age on clinical outcomes) are discussed.

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Hinterwimmer, S., Feucht, M. & Imhoff, A. Hohe tibiale Osteotomie bei Varusgonarthrose. Arthroskopie 25, 184–194 (2012). https://doi.org/10.1007/s00142-012-0697-9

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Schlüsselwörter

  • Varusgonarthrose
  • Hohe tibiale Osteotomie
  • Open-wedge-Technik
  • Patellahöhe
  • Kniestabilität

Keywords

  • Varus arthritis
  • High tibial osteotomy
  • Open wedge
  • Patellar height
  • Knee instability