Summary
High tibial osteotomies were performed on 136 osteoarthritic knees for correction of varus deformity. Before osteotomy all patients experienced moderate or severe pain, and the knees showed lateral thrust on weight-bearing. The patients were followed up for one to five years. Marked relief of pain was obtained in 112 knees, and the patients were satisfied with the result of operation in 122. These painless knees showed no lateral thrust, and in the majority the deformity had been adequately corrected, with post-operative femoro-tibial angles (standing) ranging from 165° to 174°. Four of 28 knees with femoro-tibial angles of 175° to 179°, when measured one year after operation, showed recurrence of varus deformity three years after osteotomy. Preoperative ranges of knee motion were well maintained after osteotomy even when arthrotomy had also been undertaken. Intra-articular assessment in two patients, several years after operation, showed that the most degenerated portions of the articular surface were completely covered by a fibrocartilagenous layer, with no bare bone.
High tibial osteotomy is most effective in osteoarthritic knees with varus deformity, when correction is made to a femoro-tibial angle (standing) of 170° (10° valgus).
Résumé
Une ostéotomie de l'extrémité supérieure du tibia a été réalisée chez 125 malades (136 genoux) porteurs d'une arthrose sur genu varum. Avant l'intervention, tous les sujets se plaignaient de douleurs plus ou moins importantes et présentaient une augmentation de la déformation lors de l'appui.
Le recul est de 1 à 5 ans. Une diminution notable des douleurs a été obtenue sur 112 genoux et 122 malades sont satisfaits de l'intervention. Les genoux stables et indolores ne présentent plus de bâillement externe et ont été en majorité corrigés de façon satisfaisante, avec un angle fémoro-tibial compris entre 165° et 174°. Sur les 28 genoux comportant un angle de 175° à 179° un an après l'opération, 4 ont donné lieu à une récidive du varus trois ans après l'ostéotomie. La mobilité pré-opératoire a été conservée, même dans les cas où une arthrotomie a été associée à l'ostéotomie. Un bilan intraarticulaire, effectué chez 2 malades, plusieurs années après l'ostéotomie, a montré que les parties les plus détruites de la surface articulaire étaient complétement recouvertes d'un tissu fibro-cartilagineux.
L'ostéotomie tibiale est efficace dans l'arthrose sur genu varum, surtout si la correction réalise un angle fémoro-tibial de 170°, soit 10° de valgus.
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References
Ahlbäck, S.: Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol. [Suppl.] (Stockh) 277, 7–72 (1968)
Ahlbäck, S., Bauer, G.C.H., Bohne, W. H.: Spontaneous osteonecrosis of the knee. Arthritis Rheum. 11, 705–733 (1968)
Bauer, G. C. H., Smith, E. M.: Sr-85 scintimetry in osteoarthritis of the knee. J. Nucl. Med. Allied Sci. 10, 109–116 (1969)
Bauer, G. C. H., Insall, J., Koshino, T.: Tibial osteotomy in gonarthrosis (osteoarthritis of the knee). J. Bone Joint Surg. [Am.] 51, 1545–1563 (1969)
Byers, P. D.: The effect of high femoral osteotomy on osteoarthritis of the hip. An anatomical study of six hip joints. J. Bone Joint Surg. [Br.] 56, 279–290 (1974)
Coventry, M. B.: Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J. Bone Joint Surg. [Am.] 47, 984–990 (1965)
Conventry, M. B.: Osteotomy about the knee for degenerative and rheumatoid arthritis. Indications, operative technique and results. J. Bone Joint Surg. [Am.] 55, 23–48 (1973)
Devas, M. B.: High tibial osteotomy for arthritis of the knee. A method specially suitable for the elderly. J. Bone Joint Surg. [Br.] 51, 95–99 (1969)
Harris, W. R., Kostuik, J. P.: High tibial osteotomy for osteoarthritis of the knee. J. Bone Joint Surg. [Am.] 52, 330–336 (1970)
Helal, B.: The pain in primary osteoarthritis of the knee. Its causes and treatment by osteotomy. Postgrad. Med. J. 41, 172–181 (1965)
Jackson, J. P., Waugh, W.: Tibial osteotomy for osteoarthritis of the knee. J. Bone Joint Surg. [Br.] 43, 746–751 (1961)
Jackson, J. P., Waugh, W., Green, J. P.: High tibial osteotomy for osteoarthritis of the knee. J. Bone Joint Surg. [Br.] 51, 88–94 (1969)
Kettelkamp, D. B., Chao, E. Y.: A method for quantitative analysis of medial and lateral compression forces at the knee during standing. Clin. Orthop. 83, 202–213 (1972)
Koshino, T.: Effect of weight-bearing forces on healing process of tibial osteotomy in man observed through strontium-85 scintimetry. Clin. Orthop. 78, 286–295 (1971)
Koshino, T., Ranawat, N. S.: Effect of mechanical factors on bone metabolism in man strontium-85 scintimetry following osteotomy of the tibiae in gonarthrosis. Calcif. Tissue Res. 4 (Suppl.), 159–160 (1970)
Koshino, T., Ranawat, N. S.: Healing process of osteoarthritis in the knee after high tibial osteotomy through observation of strontium-85 scintimetry. Clin. Orthop. 82, 149–156 (1972)
Maquet, P.: Biomechanics and osteoarthritis of the knee. SICOT, XIe Congress, pp. 317–356. Mexico: October 1969
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Koshino, T., Tsuchiya, K. The effect of high tibial osteotomy on osteoarthritis of the knee. International Orthopaedics 3, 37–45 (1979). https://doi.org/10.1007/BF00266324
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DOI: https://doi.org/10.1007/BF00266324