Skip to main content
SpringerLink
Log in

High tibial osteotomy using two threaded pins and figure-of-eight wiring fixation for medial knee osteoarthritis: 14 to 24 years follow-up results

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

High tibial osteotomy (HTO) is an established surgical treatment for medial knee osteoarthritis (OA). Several studies have reported the deterioration of clinical results with time, especially after more than 10 years. The purpose of this study was to evaluate the long-term results after HTO using our originally developed fixation method and to clarify the factors affecting the long-term clinical outcome.

Methods

Sixty-eight HTO treatments in 55 patients were evaluated. Eighteen patients were unable to be analyzed, thus reducing the study to 48 knees in 37 patients. The follow-up rate of the knee joint was 70.6% and the mean follow-up period was 17.1 years. The first evaluation was performed at a mean of 6.5 years postoperatively, and the most recent evaluation was done at more than 10 years postoperative follow-up. A closing-wedge osteotomy was performed, and the osteotomy site was fixed with two threaded pins and a figure-of-eight wiring technique. The Japanese Orthopaedic Association knee rating score (JOA score) was used for the clinical assessment. The change of the femorotibial angle (FTA) and progression of knee OA were radiographically analyzed. The whole knees were subsequently divided into two groups, satisfactory group and unsatisfactory group, according to the JOA score at the most recent follow-up.

Results

The mean JOA score was 59.1 before HTO and 83.1 at the most recent evaluation. In comparing the satisfactory and unsatisfactory groups, the JOA score before HTO was the same, but the JOA score of the unsatisfactory group was significantly lower at the first evaluation. The FTA in the unsatisfactory group was the same as in the satisfactory group preoperatively, but it was significantly larger after HTO. The radiographic OA was significantly progressed at the most recent evaluation, but no difference was observed in the distribution of the preoperative OA grade between the two groups.

Conclusions

HTO with two threaded pins and figure-of-eight wiring fixation showed an acceptable clinical outcome, but careful attention was needed for correction loss in early postoperative periods. In addition, the proper correction angle is necessary in order to achieve satisfactory long-term results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 1998;41:1343–1355.

    Article  CAS  PubMed  Google Scholar 

  2. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 1961;43:746–751.

    PubMed  Google Scholar 

  3. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 1965;47:984–990.

    CAS  PubMed  Google Scholar 

  4. Coventry MB. Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long-term results. Orthop Clin North Am 1979;10:191–210.

    CAS  PubMed  Google Scholar 

  5. Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop 1990;255:251–256.

    PubMed  Google Scholar 

  6. Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 1984;66:1040–1048.

    CAS  PubMed  Google Scholar 

  7. Berman AT, Bosacco SJ, Kirshner S, Avolio A. Factors influencing long-term results in high tibial osteotomy. Clin Orthop 1991;272:192–198.

    PubMed  Google Scholar 

  8. Yasuda K, Majima T, Tsuchida T, Kaneda K. A ten-to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop 1992;282:186–195.

    PubMed  Google Scholar 

  9. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. J Bone Joint Surg Am 1993;75:196–201.

    CAS  PubMed  Google Scholar 

  10. Rinonapoli E, Mancini GB, Corvaglia A, Musiello S. Tibial osteotomy for varus gonarthrosis. Clin Orthop 1998;353:185–193.

    Article  PubMed  Google Scholar 

  11. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. Survivorship of the high tibial valgus osteotomy. Clin Orthop 1999;367:18–27.

    PubMed  Google Scholar 

  12. Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A. High tibial valgus osteotomy for medial gonarthrosis. J Knee Surg 2003;16:21–26.

    PubMed  Google Scholar 

  13. Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis. J Bone Joint Surg Am 2003;85:469–474.

    Article  PubMed  Google Scholar 

  14. Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 2004;11:439–444.

    Article  PubMed  Google Scholar 

  15. Koshino T, Morii T, Wada J, Saito H, Ozawa N, Noyori K. High tibial osteotomy with fixation by a blade plate for medial compartment osteoarthritis of the knee. Orthop Clin North Am 1989;20:227–243.

    CAS  PubMed  Google Scholar 

  16. Hofmann AA, Wyatt RW, Beck SW. High tibial osteotomy. Use of an osteotomy jig, rigid fixation, and early motion versus conventional surgical technique and cast immobilization. Clin Orthop 1991;271:212–217.

    PubMed  Google Scholar 

  17. Weber BG, Wörsdörfer O. Zuggurtungsosteosynthese bei tibiakopfosteotomie. Z Orthop 1980;118:637–643.

    Google Scholar 

  18. Flamme CH, Ruhmann O, Schmolke S, Wichmann R. Long-term outcome following high tibial osteotomy with tension bend principle. Arch Orthop Trauma Surg 2003;123:12–16.

    PubMed  Google Scholar 

  19. Koshino T, Tsuchiya K. The effect of high tibial osteotomy on osteoarthritis of the knee. Clinical and histological observations. Int Orthop 1979;3:37–45.

    Article  CAS  PubMed  Google Scholar 

  20. Schatzker J, Burgess RC, Glynn MK. The management of nonunions following high tibial osteotomies. Clin Orthop 1985;193:230–233.

    PubMed  Google Scholar 

  21. Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and X-ray changes. Ann Rheum Dis 1966;25:1–24.

    CAS  PubMed  Google Scholar 

  22. Ogata K. Interlocking wedge osteotomy of the proximal tibia for gonarthrosis. Clin Orthop 1984;186:129–134.

    PubMed  Google Scholar 

  23. Ogata K, Yoshii I, Kawamura H, Miura H, Arizono T, Sugioka Y. Standing radiographs cannot determine the correction in high tibial osteotomy. J Bone Joint Surg Br 1991;73:927–931.

    CAS  PubMed  Google Scholar 

  24. Kanamiya T, Naito M, Hara M, Yoshimura I. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy 2002;18:725–729.

    Article  PubMed  Google Scholar 

  25. Billings A, Scott DF, Camargo MP, Hofmann AA. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. J Bone Joint Surg Am 2000;82:70–79.

    CAS  PubMed  Google Scholar 

  26. Zhang Y, Shall LM, Kiritsis PG, Wolfinbarger L, Fairclots JR. Varus tension testing of fixation devices used in proximal tibial osteotomy. Contemp Orthop 1995;30:471–476.

    CAS  PubMed  Google Scholar 

  27. Flamme CH, Kohn D, Kirsch L, Hurschler C. Primary stability of different implants used in conjunction with high tibial osteotomy. Arch Orthop Trauma Surg 1999;119:450–455.

    Article  CAS  PubMed  Google Scholar 

  28. Gautier E, Thomann BW, Brantschen R, Jakob RP. Fixation of high tibial osteotomy with AO cannulated knee plate. Acta Orthop Scand 1999;70:397–399.

    Article  CAS  PubMed  Google Scholar 

  29. Yasumoto H, Omori G, Tanabe Y, Koga Y. Mechanical stability of different fixation procedures after high tibial osteotomy (in Japanese). J Jpn Soc Clin Biomech 2001;22:319–323.

    Google Scholar 

  30. Holden DL, James SL, Larson RL, Slocum DB. Proximal tibial osteotomy in patients who are fifty years old or less. J Bone Joint Surg Am 1988;70:977–982.

    CAS  PubMed  Google Scholar 

  31. Sasazaki Y, Fujikawa K, Kobayashi T, Miwa M. Clinical results of the overcorrected high tibial osteotomy for advanced osteoarthritis of the knee (in Japanese). Bessatsu Seikeigeka 2002;42:153–158.

    Google Scholar 

  32. Choi HR, Hasegawa Y, Kondo S, Shimizu T, Ida K, Iwata H. High tibial osteotomy for varus gonarthrosis: a 10-to 24-year follow-up study. J Orthop Sci 2001;6:493–497.

    Article  CAS  PubMed  Google Scholar 

  33. Takemae T, Omori G, Nishino K, Terajima K, Koga Y, Endo N. Three-dimensional knee motion before and after high tibial osteotomy for medial knee osteoarthritis. J Orthop Sci 2006;11:601–606.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Transdisciplinary Research, Niigata University, 2-8050 Igarashi, Niigata, 950-2181, Niigata, Japan

    Go Omori

  2. Department of Orthopedic Surgery, Niigata Kobari Hospital, Niigata, Japan

    Yoshio Koga & Takashi Sato

  3. Department of Orthopedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan

    Masunao Miyao

  4. Rehabilitaton Center Midori Hospital, Niigata, Japan

    Takashi Takemae

  5. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan

    Hiroshi Yamagiwa

Authors
  1. Go Omori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshio Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masunao Miyao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Takemae
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Yamagiwa
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Omori, G., Koga, Y., Miyao, M. et al. High tibial osteotomy using two threaded pins and figure-of-eight wiring fixation for medial knee osteoarthritis: 14 to 24 years follow-up results. J Orthop Sci 13, 39–45 (2008). https://doi.org/10.1007/s00776-007-1189-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-007-1189-z

Keywords

Search

Navigation