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Age does not affect the clinical and radiological outcomes after open-wedge high tibial osteotomy

  • Kenichi Goshima
  • Takeshi Sawaguchi
  • Daigo Sakagoshi
  • Kenji Shigemoto
  • Yu Hatsuchi
  • Mika Akahane
Knee

Abstract

Purpose

Open-wedge high tibial osteotomy (OWHTO) is a well-established procedure in the management of medial compartment osteoarthritis and osteonecrosis of the medial femoral condyle. Several studies have evaluated factors that negatively influence outcomes. However, few reports have investigated the effect of age on HTO outcome. We evaluated the influence of the age on the outcome after HTO.

Methods

The TomoFix® plate was used to perform 60 consecutive OWHTOs. Twenty-six knees in 23 patients >65 years old (mean age at surgery 68.7 ± 2.9 years; range 65–75 years, group A) were compared with 34 knees in 27 patients <65 years old (mean age at surgery 56.2 ± 7.5 years; range 38–64 years, group B) with respect to the clinical and radiological outcomes after HTO. The clinical evaluation included the Japanese Orthopedic Association Knee Score (JOA score), Oxford Knee Score (OKS) and complications after surgery.

Results

There were no statistical differences in the background factors between the two groups. Postoperatively, the mean JOA score showed a significant improvement in both groups. The mean OKS after surgery was 41.6 ± 5.9 in group A and 41.4 ± 5.9 in group B. There were no statistical differences in the postoperative knee alignment and clinical outcomes between the two groups.

Conclusion

OWHTO using the rigid long plate was an effective procedure independent of patient’s age. The results showed that age did not influence the clinical and radiological outcomes after OWHTO.

Keywords

Open-wedge osteotomy High tibial osteotomy TomoFix® plate Elderly patients 

Notes

Compliance with ethical standards

Conflict of interest

The authors did not receive and will not receive any benefits or funding from any commercial party related directly or indirectly to the subject of this article.

References

  1. 1.
    Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P (2006) Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:291–300CrossRefPubMedGoogle Scholar
  2. 2.
    Aoki Y, Yasuda K, Mikami S et al (2006) Inverted V-shaped high tibial osteotomy compared with closing-wedge high tibial osteotomy for osteoarthritis of the knee. Ten-year follow-up result. J Bone Joint Surg Br 88:1336–1340CrossRefPubMedGoogle Scholar
  3. 3.
    Bonnin MP, Laurent JR, Zadegan F, Badet R, Pooler Archbold HA, Servien E (2013) Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc 21:64–73CrossRefPubMedGoogle Scholar
  4. 4.
    Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557CrossRefPubMedGoogle Scholar
  5. 5.
    Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ (2010) Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 81:193–198CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dorsey WO, Miller BS, Tadje JP, Bryant CR (2006) The stability of three commercially available implants used in medial opening wedge high tibial osteotomy. J Knee Surg 19:95–98PubMedGoogle Scholar
  7. 7.
    Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B, Lakemeier S, Schofer MD (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    El-Azab HM, Morgenstern M, Ahrens P, Schuster T, Imhoff AB, Lorenz SG (2011) Limb alignment after open-wedge high tibial osteotomy and its effect on the clinical outcome. Orthopedics 34:e622–e628PubMedGoogle Scholar
  9. 9.
    Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year follow up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96CrossRefPubMedGoogle Scholar
  10. 10.
    Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180CrossRefPubMedGoogle Scholar
  11. 11.
    Hankemeier S, Mommsen P, Krettek C, Jagodzinski M, Brand J, Meyer C, Meller R (2010) Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 18:1328–1333CrossRefPubMedGoogle Scholar
  12. 12.
    Holden DL, James SL, Larson RL, Slocum DB (1988) Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg Am 70:977–982CrossRefPubMedGoogle Scholar
  13. 13.
    Jung WH, Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH (2013) Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 29:1063–1071CrossRefPubMedGoogle Scholar
  14. 14.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kohn L, Sauerschnig M, Iskansar S, Lorenz S, Meidinger G, Imhoff AB, Hinterwimmer S (2013) Age does not influence the clinical outcome after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:146–151CrossRefPubMedGoogle Scholar
  16. 16.
    Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grutzner P (2009) Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 91:2581–2588CrossRefPubMedGoogle Scholar
  17. 17.
    Kolb W, Guhlmann H, Windisch C, Koller H, Grutzner P, Kolb K (2010) Opening-wedge high tibial osteotomy with a locked low-profile plate: surgical technique. J Bone Joint Surg Am 92:197–207CrossRefPubMedGoogle Scholar
  18. 18.
    Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138CrossRefPubMedGoogle Scholar
  19. 19.
    Luscombe KL, Lim J, Jones PW, White SH (2007) Minimally invasive Oxford medial unicompartmental knee arthroplasty. A note of caution! Int Orthop 31:321–324CrossRefPubMedGoogle Scholar
  20. 20.
    Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ (2009) Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br 91:1459–1465CrossRefPubMedGoogle Scholar
  21. 21.
    Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S (2011) May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 19:333–339CrossRefPubMedGoogle Scholar
  22. 22.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89:1010–1014CrossRefPubMedGoogle Scholar
  23. 23.
    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 367:18–27CrossRefGoogle Scholar
  24. 24.
    Odenbring S, Tjornstrand B, Egund N, Hagstedt B, Hovelius L, Lindstrand A, Luxhoj T, Svanstrom A (1989) Function after tibial osteotomy for medial gonarthrosis below aged 50 years. Acta Orthop Scand 60:527–531CrossRefPubMedGoogle Scholar
  25. 25.
    Pandit H, Jenkins C, Beard DJ, Gallagher J, Price AJ, Dodd CA, Goodfellow JW, Murray DW (2009) Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year. J Bone Joint Surg Br 91:185–189CrossRefPubMedGoogle Scholar
  26. 26.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW (2011) Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br 93:198–204CrossRefPubMedGoogle Scholar
  27. 27.
    Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, Kohn DM (2010) Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc 18:204–211CrossRefPubMedGoogle Scholar
  28. 28.
    Rudan JF, Simurda MA (1990) High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 255:251–256Google Scholar
  29. 29.
    Staubli AE, De SC, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 34:B55–B62CrossRefPubMedGoogle Scholar
  30. 30.
    Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 19:944–950CrossRefGoogle Scholar
  31. 31.
    Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM (2013) The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:96–112CrossRefPubMedGoogle Scholar
  32. 32.
    Spahn G, Wittig R (2002) Primary stability of various implants in tibial opening wedge osteotomy: a biomechanical study. J Orthop Sci 7:683–687CrossRefPubMedGoogle Scholar
  33. 33.
    Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85:469–474CrossRefPubMedGoogle Scholar
  34. 34.
    Takeuchi R, Aratake M, Bito H, Saito I, Kumagai K, Hayashi R, Sasaki Y, Akamatsu Y, Ishikawa H, Amakado E, Aota Y, Saito T (2009) Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 17:361–368CrossRefPubMedGoogle Scholar
  35. 35.
    Takeuchi R, Bito H, Akamatsu Y, Shiraishi T, Morishita S, Koshino T, Saito T (2010) In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee 17:217–220CrossRefPubMedGoogle Scholar
  36. 36.
    Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25:46–53CrossRefPubMedGoogle Scholar
  37. 37.
    Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A (2006) Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 14:149–152CrossRefPubMedGoogle Scholar
  38. 38.
    Yasuda K, Majima T, Tsuchida T, Kaneda K (1992) A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 282:186–195Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Kenichi Goshima
    • 1
  • Takeshi Sawaguchi
    • 1
  • Daigo Sakagoshi
    • 1
  • Kenji Shigemoto
    • 1
  • Yu Hatsuchi
    • 1
  • Mika Akahane
    • 1
  1. 1.Department of Orthopedic Surgery and Joint Reconstructive SurgeryToyama Municipal HospitalToyamaJapan

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