Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment

Abstract

Purpose

Studies comparing mid- or long-term outcomes of open- and closed-wedge high tibial osteotomy are limited. Here, the midterm survival rate and clinical and radiographic outcomes were compared for these two techniques. The study hypothesis, based on short-term follow-up, was that after midterm follow-up, the two techniques would not differ.

Methods

A prospective follow-up study was conducted for a previously reported randomized controlled trial of an original 50 patients (25 open-wedge osteotomy and 25 closed-wedge osteotomy) with medial knee osteoarthritis and a varus leg alignment. We analyzed patients without knee arthroplasty (mean age 48.7 years, SD 8.0) for clinical and radiographic follow-up.

Results

Five patients in each group had undergone conversion to a total knee arthroplasty or unicompartmental knee arthroplasty, leaving 19 patients for analysis in each group. At 7.9 years of follow-up (range 7–9 years), survival did not differ significantly between groups (open-wedge group 81.3 % [95 % confidence interval (CI) 75.2–100], closed-wedge group 82.0 % [95 % CI 66.7–100]). At final follow-up, total Dutch Western Ontario and McMaster Universities Arthritis (WOMAC), Knee Society Score, and visual analog scale (VAS) pain did not differ between groups. However, the results were significantly better in the closed-wedge group for VAS satisfaction and WOMAC pain and stiffness compared to the open-wedge group. Radiographic evaluation did not differ between groups for any outcome at final follow-up.

Conclusion

After a mean follow-up of 7.9 years, patients undergoing a closed-wedge osteotomy had favorable clinical results compared to those who underwent an open-wedge osteotomy.

Level of evidence

II.

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References

  1. 1.

    Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (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  CAS  Article  Google Scholar 

  2. 2.

    Aryee S, Imhoff AB, Rose T, Tischer T (2008) Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials 29:3497–3502

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Stüdkamp N, Niemeyer P (2013) Prospective 5-year survival data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2762-y

    Google Scholar 

  4. 4.

    Caton J (1989) Method of measuring the height of the patella. Acta Orthop Belg 55:385–386

    PubMed  CAS  Google Scholar 

  5. 5.

    Devgan A, Marya KM, Kundu ZS, Sangwan SS, Siwach RC (2003) Medial opening wedge high tibial osteotomy for osteoarthritis of knee: long-term results in 50 knees. Med J Malays 58:62–68

    CAS  Google Scholar 

  6. 6.

    Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264

    PubMed  Google Scholar 

  7. 7.

    El-Azab H, Glabgly P, Paul J, Imhoff AB (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 

  8. 8.

    Esenkaya I, Unay K, Akan K (2012) Proximal tibial osteotomies for the medial compartment arthrosis of the knee: a historical journey. Strateg Trauma Limb Reconstr 7:13–21

    CAS  Article  Google Scholar 

  9. 9.

    Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96

    PubMed  Article  Google Scholar 

  10. 10.

    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

    PubMed  Article  Google Scholar 

  11. 11.

    Gaasbeek RD, Nicolaas L, Rijnberg WJ, Van Loon CJM, Van Kampen A (2010) Correction accuracy and collateral laxity in open versus closed wedge high tibial osteotomy. A one-year randomised controlled study. Int Orthop 34:201–207

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Haviv B, Bronak S, Thein R, Thein R (2013) The results of corrective osteotomy for valgus arthritic knees. Knee Surg Sports Trauma Arthrosc 21:49–56

    Article  Google Scholar 

  13. 13.

    Hernigou P, Roussignol X, Flouzat-Lachaniette CH et al (2010) Opening wedge tibial osteotomy for large varus deformity with Ceraver resorbable beta tricalcium phosphate wedges. Int Orthop 34:191–199

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  15. 15.

    Kellgren JH, Lawrence JS (1956) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–503

    Article  Google Scholar 

  16. 16.

    Koshino T (2010) Osteotomy around young deformed knees: 38-year super-long-term follow-up to detect osteoarthritis. Int Orthop 34:263–269

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Kujala UM, Jaakkola LH, Koskinsen SK, Taimela S, Humr M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Lachman D, Bonnin MP (1994) Tibial translation after anterior cruciate ligament rupture. J Bone Joint Surg Br 76-B:745–749

    Google Scholar 

  19. 19.

    Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24:61–69

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Lustig S, Scholes CJ, Costa AJ, Coolican MJ, Parker DA (2013) Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:32–38

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    McNamara I, Birmingham TB, Fowler PJ, Giffin JR (2013) High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surg Sports Traumatol Arthrosc 21:23–31

    PubMed  CAS  Article  Google Scholar 

  22. 22.

    Odenbring S, Egund N, Lindstrand A, Lohmander SL, Willen H (1990) Cartilage regeneration after proximal tibial osteotomy for medial gonarthrosis. Clin Biomech 277:210–216

    Google Scholar 

  23. 23.

    Poignard A, Lachaniette CHF, Amzallag J, Hernigou P (2010) Revisiting high tibial osteotomy: fifty years of experience with the opening-wedge technique. J Bone Joint Surg Am 92(Suppl 2):187–195

    PubMed  Article  Google Scholar 

  24. 24.

    Roorda LD (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63:36–42

    PubMed  CAS  PubMed Central  Article  Google Scholar 

  25. 25.

    Rudan JF, Simurda MA (1990) High tibial osteotomy. Clin Orthop Relat Res 255:251–256

    PubMed  Google Scholar 

  26. 26.

    Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34:185–190

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP (2011) High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13–21 years. Knee Surg Sports Trauma Arthrosc 19:122–127

    Article  Google Scholar 

  28. 28.

    Schröter S, Lobenhoffer P, Mueller J, Ihle C, Stöckle U, Albrecht D (2012) Changes of patella position after closed and open wedge high tibial osteotomy: review of the literature. Orthopäde 41:186, 188–194

  29. 29.

    Song IH, Song EK, Seo HY, Lee KB, Yim JH, Seon JK (2012) Patellofemoral alignment and anterior knee pain after closing- and opening-wedge valgus high tibial osteotomy. Arthroscopy 28:1087–1093

    PubMed  Article  Google Scholar 

  30. 30.

    Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis: survival and failure analysis of twenty-two years. J Bone Joint Surg Am 85-A:469–474

    PubMed  Google Scholar 

  31. 31.

    Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK (2010) Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 38(7):1420–1424

    PubMed  Article  Google Scholar 

  32. 32.

    Tang WC, Henderson IJP (2005) High tibial osteotomy: long term survival analysis and patients’ perspective. Knee 12:410–413

    PubMed  Article  Google Scholar 

  33. 33.

    Van Raaij TM, Brouwer RW, De Vlieger R, Reijman M, Verhaar JAN (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79:508–514

    PubMed  Article  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to N. van Egmond.

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van Egmond, N., van Grinsven, S., van Loon, C.J.M. et al. Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthrosc 24, 34–41 (2016). https://doi.org/10.1007/s00167-014-3303-z

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Keywords

  • Open-wedge high tibial osteotomy
  • Closed-wedge high tibial osteotomy
  • Osteoarthritis
  • Knee
  • RCT