Skip to main content

Hohe tibiale Osteotomie bei Varusgonarthrose

Indikation, Technik, Ergebnisse

High tibial osteotomy for varus arthritis

Indications, technique, and results

Arthroskopie volume 25, pages 184–194 (2012)Cite this article

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.

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

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C et al (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124:575–584

    PubMed  Article  CAS  Google Scholar 

  2. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861

    PubMed  Article  Google Scholar 

  3. Akamatsu Y, Mitsugi N, Mochida Y et al (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593

    PubMed  Article  CAS  Google Scholar 

  4. Akizuki S, Shibakawa A, Takizawa T et al (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596

    PubMed  Article  CAS  Google Scholar 

  5. Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160

    PubMed  Article  Google Scholar 

  6. Brinkman JM, Lobenhoffer P, Agneskirchner JD et al (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557

    PubMed  Article  Google Scholar 

  7. Brouwer RW, Bierma-Zeinstra SM, Koeveringe AJ van, Verhaar JA (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 87:1227–1232

    PubMed  Article  CAS  Google Scholar 

  8. Chae DJ, Shetty GM, Lee DB et al (2008) Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 15:128–133

    PubMed  Article  Google Scholar 

  9. Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13:87–92

    PubMed  Article  CAS  Google Scholar 

  10. El-Azab H, Glabgly P, Paul J et al (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

    PubMed  Article  Google Scholar 

  11. El-Azab H, Halawa A, Anetzberger H et al (2008) The effect of closed- and open-wedge high tibial osteotomy on tibial slope: a retrospective radiological review of 120 cases. J Bone Joint Surg Br 90:1193–1197

    PubMed  Article  CAS  Google Scholar 

  12. Feucht MJ, Mauro CS, Brucker PU et al (2012) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc

  13. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608

    PubMed  CAS  Google Scholar 

  14. Giffin JR, Stabile KJ, Zantop T et al (2007) Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 35:1443–1449

    PubMed  Article  Google Scholar 

  15. Giffin JR, Vogrin TM, Zantop T et al (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382

    PubMed  Article  Google Scholar 

  16. Hankemeier S, Hufner T, Wang G et al (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921

    PubMed  Article  CAS  Google Scholar 

  17. Hernigou P (2002) Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee 9:15–20

    PubMed  Article  Google Scholar 

  18. Hernigou P, 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 69:332–354

    PubMed  CAS  Google Scholar 

  19. Hinterwimmer S, Beitzel K, Paul J et al (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39:851–856

    PubMed  Article  Google Scholar 

  20. Hinterwimmer S, Rauch A, Kohn L, Imhoff AB (2012) High tibial osteotomy for anteromedial or posterolateral knee instability. Arthroskopie 23:14–22

    Article  Google Scholar 

  21. Hohmann E, Bryant A, Imhoff AB (2006) The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc 14:454–459

    PubMed  Article  Google Scholar 

  22. Hui C, Salmon LJ, Kok A et al (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39:64–70

    PubMed  Article  Google Scholar 

  23. Hunt MA, Fowler PJ, Birmingham TB et al (2006) Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 49:401–406

    PubMed  Google Scholar 

  24. Kohn L, Sauerschnig M, Iskansar S et al (2012) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc (accepted)

  25. LaPrade RF, Oro FB, Ziegler CG et al (2010) Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med 38:160–170

    PubMed  Article  Google Scholar 

  26. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    PubMed  Google Scholar 

  27. Luites JW, Brinkman JM, Wymenga AB, Heerwaarden RJ van (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 91:1459–1465

    PubMed  CAS  Google Scholar 

  28. Marti CB, Gautier E, Wachtl SW, Jakob RP (2004) Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy 20:366–372

    PubMed  Article  Google Scholar 

  29. Meidinger G, Imhoff AB, Paul J et al (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19:333–339

    PubMed  Article  Google Scholar 

  30. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res (246):250–259

    Google Scholar 

  31. Muller M, Strecker W (2008) Arthroscopy prior to osteotomy around the knee? Arch Orthop Trauma Surg 128:1217–1221

    PubMed  Article  CAS  Google Scholar 

  32. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ (1999) The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to −22-year followup study. Clin Orthop Relat Res (367):18–27

    Google Scholar 

  33. Naudie DD, Amendola A, Fowler PJ (2004) Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med 32:60–70

    PubMed  Article  Google Scholar 

  34. Niemeyer P, Schmal H, Hauschild O et al (2010) Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy 26:1607–1616

    PubMed  Article  Google Scholar 

  35. Noyes FR, Goebel SX, West J (2005) Opening wedge tibial osteotomy: the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med 33:378–387

    PubMed  Article  Google Scholar 

  36. Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757

    Google Scholar 

  37. Paley D, Pfeil J (2000) Principles of deformity correction around the knee. Orthopade 29:18–38

    PubMed  CAS  Google Scholar 

  38. Pape D, Lorbach O, Schmitz C et al (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211

    PubMed  Article  Google Scholar 

  39. Pape D, Seil R, Adam F et al (2004) Imaging and preoperative planning of osteotomy of tibial head osteotomy. Orthopade 33:122–134

    PubMed  Article  CAS  Google Scholar 

  40. Petrigliano FA, Suero EM, Voos JE et al (2012) The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee. Am J Sports Med 40(6):1322–1328

    PubMed  Article  Google Scholar 

  41. Reichwein F, Nebelung W (2007) High tibial flexion osteotomy for revision of posterior cruciate ligament instability. Unfallchirurg 110:597–602

    PubMed  Article  CAS  Google Scholar 

  42. Rossi R, Bonasia DE, Amendola A (2011) The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 19:590–599

    PubMed  Google Scholar 

  43. Salzmann GM, Ahrens P, Naal FD et al (2009) Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 37:312–318

    PubMed  Article  Google Scholar 

  44. Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb(R) wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35:1151–1156

    PubMed  Article  Google Scholar 

  45. Schaefer TK, Majewski M, Hirschmann MT, Friederich NF (2008) Comparison of sagittal and frontal plane alignment after open- and closed-wedge osteotomy: a matched-pair analysis. J Int Med Res 36:1085–1093

    PubMed  CAS  Google Scholar 

  46. Smith TO, Sexton D, Mitchell P, Hing CB (2011) Opening- or closing-wedged high tibial osteotomy: a meta-analysis of clinical and radiological outcomes. Knee 18:361–368

    PubMed  Article  CAS  Google Scholar 

  47. Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartilage 14:190–195

    PubMed  Article  CAS  Google Scholar 

  48. Sterett WI, Miller BS, Joseph TA et al (2009) Posterior tibial slope after medial opening wedge high tibial osteotomy of the varus degenerative knee. J Knee Surg 22:13–16

    PubMed  Article  Google Scholar 

  49. Tigani D, Ferrari D, Trentani P et al (2001) Patellar height after high tibial osteotomy. Int Orthop 24:331–334

    PubMed  Article  CAS  Google Scholar 

  50. Wright JM, Heavrin B, Begg M et al (2001) Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 14:163–173

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Sportorthopädie, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675, München, Deutschland

    S. Hinterwimmer, M.J. Feucht & A.B. Imhoff

Authors
  1. S. Hinterwimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.J. Feucht
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A.B. Imhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00142-012-0697-9

Schlüsselwörter

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

Keywords

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