Background
Medial opening wedge high tibial osteotomy (MOWHTO) has proven to be an effective treatment for varus osteoarthritic knees. Various methods of fixation with different implant types and using either bone grafts or bone substitutes have been reported. We performed non-locking T-buttress plate fixation with autologous iliac bone graft augmentation, which is defined here as the traditional method, and locking compression plate fixation without any bone graft or bone substitute. We aimed to compare bone union and complications of these two MOWHTO techniques.
Materials and Methods
Between June 2005 and December 2007, 50 patients who underwent MOWHTO (a total of 60 knees) were retrospectively reviewed and classified into two groups: group A, which consisted of 26 patients (30 knees) was treated using T-buttress plate fixation with autologous iliac bone graft augmentation and group B, which consisted of 24 patients (30 knees) was operated upon using a medial high tibial locking compression plate without any augmentation. Demographic characteristics and radiographic outcomes, including union rate, time to union, medial osteotomy defects, and complications, were collected and compared between the two groups. The progress of all patients was followed for at least 2 years.
Results
All osteotomies united within 12 weeks after surgery. Group B had slightly longer time to union than group A (10.3 weeks and 9.5 weeks, respectively; P = 0.125). A significantly higher incidence of medial defects after osteotomy was reported in the locking compression plate group (P = 0.001). A total of 5 (8.3%) knees had complications. In group A, one knee had a superficial wound infection and another knee had a lateral tibial plateau fracture without significant loss of correction. In group B, one knee had screw penetration into the knee joint and two knees had local irritation that required the removal of the hardware.
Conclusion
Locking compression plate fixation without the use of bone grafts or bone substitutes provides a satisfactory union rate and an acceptable complication rate when compared to the traditional MOWHTO technique. Thus, we recommend using this technique for treating unicompartmental medial knee osteoarthritis.
Similar content being viewed by others
References
Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 1961;43:746–51.
Coventry MB. Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am. 1985;67:1136–40.
Dong JC, Gautam MS, Kook HW, Antonio Santa CM Jr, Jong IK, Kyung WN. Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation. Knee 2011;18:278–84.
Valkering KP, van den Bekerom MP, Kappelhoff FM, Albers GH. Complications after tomofix medial opening wedge high tibial osteotomy. J Knee Surg 2009;22:218–25.
Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H. Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop 1988;229:193–200.
Miller BS, Downie B, McDonough EB, Wojtys EM. Complications after medial opening wedge high tibial osteotomy. Arthroscopy 2009;25:639–46.
Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. 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 2010;26:1607–16.
Warden SJ, Morris HG, Crossley KM, Brukner PD, Bennell KL. Delayed- and nonunion following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases. Knee Surg Sports Traumatol Arthrosc 2005;13:34–7.
Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P. Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2006;14:291–300.
Amendola A, Fowler PJ, Litchfield R, Kirkley S, Clatworthy M. Opening wedge high tibial osteotomy using a novel technique: early results and complications. J Knee Surg 2004;17:164–9.
Asik M, Sen C, Kilic B, Goksan SB, Ciftci F, Taser OF. High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc. 2006;14:948–54.
Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 2008;90-B:1548–57.
Chae DJ, Shetty GM, Lee DB, Choi HW, Han SB, Nha KW. Tibial slope and patellar height after opening wedge high tibia osteotomy using autologous tricortical iliac bone graft. Knee 2008;15:128–33.
De Simoni C, Staubli A. Neue Fixationstechniken fur mediale open-wedge Osteotomien der proximalen Tibia. Schweiz Med Wochenschr 2000;119:130.
Koshino T, Murase T, Saito T. Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Joint Surg Am 2003;85:78–85.
Noyes FR, Mayfield W, Barber-Westin SD, Albright JC, Heckmann TP. Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med 2006;34:1262–73.
Harnroongroj T, Vanadurongwan V. The stable upper tibial osteotomy for the treatment of osteoarthritic knee: Medial opening step wedge technique (Part II). Siriraj Hosp Gaz 1994;46:28–33.
Harnroongroj T, Vanadurongwan V. The stable upper tibial osteotomy for the treatment of osteoarthritic knee: The simplified medial opening step wedge technique (Part III). Siriraj Hosp Gaz 1994;46:120–5.
Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989;3:192–5.
Kellgren JH, Jeffrey M, Ball J. Atlas of standard radiographs. Vol 2. Oxford: Blackwell Scientific, 1963.
Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. Orthop Clin North Am. 1970;10:585–608.
Krettek C, Miclau T, Grun O. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 1998;29:29–39.
Apley AG, Solomon L. Apleys system of orthopaedics and fractures. 7th edn. United Kingdom: Butterworth and Heinemann; 1994
Koshino T, Wada S, Ara Y, Saito T. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee. 2003;10: 229–36.
Smith TO, Sexton D, Mitchell P, Hing CB. Opening- or closingwedged high tibial osteotomy: A meta-analysis of clinical and radiological outcomes. Knee. 2010;18:361–8.
van den Bekerom MP, Patt TW, Kleinhout MY, van der Vis HM, Albers GH. Early complications after high tibial osteotomy: a comparison of two techniques. J Knee Surg 2008;21:68–74.
Trieb K, Grohs J, Hanslik-Schnabel B, Stulnig T, Panotopoulos J, Wanivenhaus A. Age predicts outcome of high-tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2006;14:149–52.
Esenkaya I, Elmali N. Proximal tibia medial open-wedge osteotomy using plates with wedges: early results in 58 cases. Knee Surg Sports Traumatol Arthrosc 2006;14:955–61.
Brouwer RW, Bierma-Zeinstra SM, van Raaij TM, Verhaar JA. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. J Bone Joint Surg Br 2006;88:1454–9.
Kolb W, Guhlmann H, Windisch C, Kolb K, Koller H, Grützner P. Opening-wedge high tibial osteotomy with a locked low-profile plate. J Bone Joint Surg Am 2009;91:2581–8.
Santic V, Tudor A, Sestan B, Legovic D, Sirola L, Rakovac I. Bone allograft provides bone healing in the medial opening high tibial osteotomy. Int Orthop 2010;34:225–9.
Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical longterm study of eighty-seven cases. J Bone Joint Surg Am 1993;75:196–201.
Rose T, Imhoff AB. Complications after transgenicular osteotomies. Oper Tech Orthop 2007;17:80–6.
Esenkayaa I, Misirlioglua M, Kelestemurb MH, Elmalia N, Fadillioglu E. Biomechanical evaluation of different fixation plates in medial opening upper tibial osteotomy. Knee 2007;14:46–50.
Lobenhoffer P, De Simoni C, Staubli AE. Open-wedge high-tibial osteotomy with rigid plate fixation. Tech Knee Surg 2002;1: 93–105.
Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 2004;19:944–50.
El-Assal MA, Khalifa YE, Abdel-Hamid MM, Said HG, Bakr Hatem MA. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc 2010;18:961–6.
Staubli AE, Jacob HA. Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop 2010;34:167–72.
Franco V, Cerullo G, Cipolla M, Gianni E, Puddu G. Open wedge high tibial osteotomy. Tech Knee Surg 2002;1:43–53.
Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity: a ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987;69:332–54.
Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 2004;124:649–53.
van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB. Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: A radiological study with a new evaluation system. Knee 2004;11:451–6.
Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a balance between stability and biology. J Bone Joint Surg Br 2002;84:1093–110.
Hammer R, Hammerby S, Lindholm B. Accuracy of radiological assessment of tibial shaft fractures in humans. Clin Orthop 1985;199:233–8.
Meidinger G, Imhoff AB, Paul J, Kirchhoff C, Sauerschnig M, Hinterwimmer S. May smokers and overweight patients be treated with a medial open-wedge HTO? Risk factors for nonunion. Knee Surg Sports Traumatol Arthrosc 2011;19: 333–9.
Completo A, Fonseca F, Relvas C, Ramos A, Simões JA. Improved stability with intramedullary stem after anterior femoral notching in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;20:487–94.
Bottlang M, Doornink J, Lujan TJ, Fitzpatrick DC, Marsh JL, Augat P, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg Am 2010;92 Suppl 2:12–22.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pornrattanamaneewong, C., Numkanisorn, S., Chareancholvanich, K. et al. A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee. IJOO 46, 455–461 (2012). https://doi.org/10.4103/0019-5413.98833
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.98833