Abstract
Closing wedge high tibial osteotomy is a common, effective and well-established procedure to treat unicompartment osteoarthrosis of the knee. It is, however, not without its complications. This article will discuss some of these complications and present an overview of the current literature. It will examine current thoughts on aetiology, techniques to try to avoid, and methods of treatment of these complications.
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References
Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 66:1040–1048
Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72:238–244
Coventry MB, Ilstrup DM, Wallrichs SL (1993) Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 75:196–201
Bettin D, Karbowski A, Schwering L, Matthiass HH (1998) Time-dependent clinical and roentgenographical results of Coventry high tibial valgisation osteotomy. Arch Orthop Trauma Surg 117:53–57
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 18–27
Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 16:21–26
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-A:469–474
Wu LD, Hahne HJ, Hassenpflug T (2004) A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis. Chin J Traumatol 7:348–353
Coventry MB (1965) 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
Turner RS, Griffiths H, Heatley FW (1993) The incidence of deep-vein thrombosis after upper tibial osteotomy. A venographic study. J Bone Joint Surg Br 75:942–944
Motycka T, Eggerth G, Landsiedl F (2000) The incidence of thrombosis in high tibial osteotomies with and without the use of a tourniquet. Arch Orthop Trauma Surg 120:157–159
Gibson MJ, Barnes MR, Allen MJ, Chan RN (1986) Weakness of foot dorsiflexion and changes in compartment pressures after tibial osteotomy. J Bone Joint Surg Br 68:471–475
Bauer T, Hardy P, Lemoine J, Finlayson DF, Tranier S, Lortat-Jacob A (2005) Drop foot after high tibial osteotomy: a prospective study of aetiological factors. Knee Surg Sports Traumatol Arthrosc 13:23–33. doi:10.1007/s00167-003-0481-5
Marti CB, Jakob RP (1999) Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 15:864–866. doi:S074980639900095X [pii]
Miniaci A, Ballmer FT, Ballmer PM, Jakob RP (1989) Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res 250–259
Myrnerts R (1980) Failure of the correction of varus deformity obtained by high tibial osteotomy. Acta Orthop Scand 51:569–573
Kessler OC, Jacob HA, Romero J (2002) Avoidance of medial cortical fracture in high tibial osteotomy: improved technique. Clin Orthop Relat Res 180–185
van Raaij TM, Brouwer RW, de Vlieger R, Reijman M, Verhaar JA (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79:508–514. 902115375 [pii]. doi:10.1080/17453670710015508
Pape D, Adam F, Rupp S, Seil R, Kohn D (2004) Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis. Orthopade 33:208–217. doi:10.1007/s00132-003-0591-2
Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H (1988) Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res 193–200
Parker DA, Viskontas DG (2007) Osteotomy for the early varus arthritic knee. Sports Med Arthrosc 15:3–14. doi:10.1097/JSA.0b013e3180303592, 00132585-200703000-00002 [pii]
Cass JR, Bryan RS (1988) High tibial osteotomy. Clin Orthop Relat Res 196–199
Vainionpaa S, Laike E, Kirves P, Tiusanen P (1981) Tibial osteotomy for osteoarthritis of the knee. A five to ten-year follow-up study. J Bone Joint Surg Am 63:938–946
Cameron HU, Welsh RP, Jung YB, Noftall F (1993) Repair of nonunion of tibial osteotomy. Clin Orthop Relat Res 167–169
Schatzker J, Burgess RC, Glynn MK (1985) The management of nonunions following high tibial osteotomies. Clin Orthop Relat Res 230–233
Tsumaki N, Kakiuchi M, Sasaki J, Ochi T, Yoshikawa H (2004) Low-intensity pulsed ultrasound accelerates maturation of callus in patients treated with opening-wedge high tibial osteotomy by hemicallotasis. J Bone Joint Surg Am 86-A:2399–2405, DOI 86/11/2399 [pii]
Rozbruch SR, Herzenberg JE, Tetsworth K, Tuten HR, Paley D (2002) Distraction osteogenesis for nonunion after high tibial osteotomy. Clin Orthop Relat Res 227–235
Yoshino N, Takai S, Watanabe Y, Nakamura S, Kubo T (2004) Total knee arthroplasty with long stem for treatment of nonunion after high tibial osteotomy. J Arthroplasty 19:528–531, doi:S0883540304000737 [pii]
Wootton JR, Ashworth MJ, MacLaren CA (1995) Neurological complications of high tibial osteotomy—the fibular osteotomy as a causative factor: a clinical and anatomical study. Ann R Coll Surg Engl 77:31–34
Georgoulis AD, Makris CA, Papageorgiou CD, Moebius UG, Xenakis T, Soucacos PN (1999) Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study. Knee Surg Sports Traumatol Arthrosc 7:15–19
Aydogdu S, Yercan H, Saylam C, Sur H (1996) Peroneal nerve dysfunction after high tibial osteotomy. An anatomical cadaver study. Acta Orthop Belg 62:156–160
Kirgis A, Albrecht S (1992) Palsy of the deep peroneal nerve after proximal tibial osteotomy. An anatomical study. J Bone Joint Surg Am 74:1180–1185
Curley P, Eyres K, Brezinova V, Allen M, Chan R, Barnes M (1990) Common peroneal nerve dysfunction after high tibial osteotomy. J Bone Joint Surg Br 72:405–408
Zaidi SH, Cobb AG, Bentley G (1995) Danger to the popliteal artery in high tibial osteotomy. J Bone Joint Surg Br 77:384–386
Sawant MR, Ireland J (2001) Pseudo-aneurysm of the anterior tibial artery complicating high tibial osteotomy—a case report. Knee 8:247–248. doi:S0968-0160(01)00066-7 [pii]
Tindall AJ, Shetty AA, James KD, Middleton A, Fernando KW (2006) Prevalence and surgical significance of a high-origin anterior tibial artery. J Orthop Surg (Hong Kong) 14:13–16
Smith PN, Gelinas J, Kennedy K, Thain L, Rorabeck CH, Bourne RB (1999) Popliteal vessels in knee surgery. A magnetic resonance imaging study. Clin Orthop Relat Res 158–164
Kettelkamp DB, Wenger DR, Chao EY, Thompson C (1976) Results of proximal tibial osteotomy. The effects of tibiofemoral angle, stance-phase flexion-extension, and medial-plateau force. J Bone Joint Surg Am 58:952–960
Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608
Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354
Jakob RP, Murphy SB (1992) Tibial osteotomy for varus gonarthrosis: indication, planning, and operative technique. Instr Course Lect 41:87–93
Koshino T, Tsuchiya K (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. Clinical and histological observations. Int Orthop 3:37–45
Myrnerts R (1980) Optimal correction in high tibial osteotomy for varus deformity. Acta Orthop Scand 51:689–694
Pfahler M, Lutz C, Anetzberger H, Maier M, Hausdorf J, Pellengahr C, Refior HJ (2003) Long-term results of high tibial osteotomy for medial osteoarthritis of the knee. Acta Chir Belg 103:603–606
Myrnerts R (1980) High tibial osteotomy with overcorrection of varus malalignment in medial gonarthrosis. Acta Orthop Scand 51:557–560
Prodromos CC, Andriacchi TP, Galante JO (1985) A relationship between gait and clinical changes following high tibial osteotomy. J Bone Joint Surg Am 67:1188–1194
Shaw JA, Dungy DS, Arsht SS (2004) Recurrent varus angulation after high tibial osteotomy: an anatomic analysis. Clin Orthop Relat Res 205–212
Pape D, Seil R, Adam F, Rupp S, Kohn D, Lobenhoffer P (2004) Imaging and preoperative planning of osteotomy of tibial head osteotomy. Orthopade 33:122–134. doi:10.1007/s00132-003-0585-0
Gaasbeek RD, Welsing RT, Verdonschot N, Rijnberg WJ, van Loon CJ, van Kampen A (2005) Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study. Knee Surg Sports Traumatol Arthrosc 13:689–694. doi:10.1007/s00167-004-0599-0
Keppler P, Gebhard F, Grutzner PA, Wang G, Zheng G, Hufner T, Hankemeier S, Nolte LP (2004) Computer aided high tibial open wedge osteotomy. Injury 35(Suppl 1):S-A68–S-A78, S0020138304001573 [pii], doi:10.1016/j.injury.2004.05.013
Wang G, Zheng G, Keppler P, Gebhard F, Staubli A, Mueller U, Schmucki D, Fluetsch S, Nolte LP (2005) Implementation, accuracy evaluation, and preliminary clinical trial of a CT-free navigation system for high tibial opening wedge osteotomy. Comput Aided Surg 10:73–85. P3P21MM53244P551 [pii]. doi:10.1080/10929080500228837
Hankemeier S, Hufner T, Wang G, Kendoff D, Zeichen J, Zheng G, Krettek C (2006) Navigated open-wedge high tibial osteotomy: advantages and disadvantages compared to the conventional technique in a cadaver study. Knee Surg Sports Traumatol Arthrosc 14:917–921. doi:10.1007/s00167-006-0035-8
Pearle AD, Goleski P, Musahl V, Kendoff D (2009) Reliability of image-free navigation to monitor lower-limb alignment. J Bone Joint Surg Am 91(Suppl 1):90–94, 91/Supplement_1/90 [pii]. doi:10.2106/JBJS.H.01439
Kazakos KJ, Chatzipapas C, Verettas D, Galanis V, Xarchas KC, Psillakis I (2008) Mid-term results of total knee arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg 128:167–173. doi:10.1007/s00402-007-0488-3
van Raaij TM, Bakker W, Reijman M, Verhaar JA (2007) The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 8:74. 1471-2474-8-74 [pii]. doi:10.1186/1471-2474-8-74
Meding JB, Keating EM, Ritter MA, Faris PM (2000) Total knee arthroplasty after high tibial osteotomy. A comparison study in patients who had bilateral total knee replacement. J Bone Joint Surg Am 82:1252–1259
Haddad FS, Bentley G (2000) Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty 15:597–603. doi:S0883540300787894 [pii]
Amendola A, Rorabeck CH, Bourne RB, Apyan PM (1989) Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty 4(Suppl):S11–S17
Haslam P, Armstrong M, Geutjens G, Wilton TJ (2007) Total knee arthroplasty after failed high tibial osteotomy long-term follow-up of matched groups. J Arthroplasty 22:245–250. S0883-5403(06) 00367-6 [pii]. doi:10.1016/j.arth.2006.01.031
Madan S, Ranjith RK, Fiddian NJ (2002) Total knee replacement following high tibial osteotomy. Bull Hosp Jt Dis 61:5–10
Karabatsos B, Mahomed NN, Maistrelli GL (2002) Functional outcome of total knee arthroplasty after high tibial osteotomy. Can J Surg 45:116–119
Noda T, Yasuda S, Nagano K, Takahara Y, Namba Y, Inoue H (2000) Clinico-radiological study of total knee arthroplasty after high tibial osteotomy. J Orthop Sci 5:25–36, doi:00050025.776 [pii]
Nizard RS, Cardinne L, Bizot P, Witvoet J (1998) Total knee replacement after failed tibial osteotomy: results of a matched-pair study. J Arthroplasty 13:847–853, doi:S0883-5403(98)90188-7 [pii]
Mont MA, Antonaides S, Krackow KA, Hungerford DS (1994) Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group. Clin Orthop Relat Res 125–130
Windsor RE, Insall JN, Vince KG (1988) Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg Am 70:547–555
Wright JM, Heavrin B, Begg M, Sakyrd G, Sterett W (2001) Observations on patellar height following opening wedge proximal tibial osteotomy. Am J Knee Surg 14:163–173
Scuderi GR, Windsor RE, Insall JN (1989) Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 71:245–248
Westrich GH, Peters LE, Haas SB, Buly RL, Windsor RE (1998) Patella height after high tibial osteotomy with internal fixation and early motion. Clin Orthop Relat Res 169–174
Closkey RF, Windsor RE (2001) Alterations in the patella after a high tibial or distal femoral osteotomy. Clin Orthop Relat Res 51–56
Billings A, Scott DF, Camargo MP, Hofmann AA (2000) High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg Am 82:70–79
Bathis H, Perlick L, Tingart M, Luring C, Perlick C, Grifka J (2004) Flexion gap configuration in total knee arthroplasty following high tibial osteotomy. Int Orthop 28:366–369. doi:10.1007/s00264-004-0595-5
Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE (2005) High tibial osteotomy. J Am Acad Orthop Surg 13:279–289, 13/4/279 [pii]
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Tunggal, J.A.W., Higgins, G.A. & Waddell, J.P. Complications of closing wedge high tibial osteotomy. International Orthopaedics (SICOT) 34, 255–261 (2010). https://doi.org/10.1007/s00264-009-0819-9
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DOI: https://doi.org/10.1007/s00264-009-0819-9