Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate: Surgical Technique

• Published in: Journal of bone and joint surgery. American volume 2010-09, Vol.92 (Supplement_1_Part_2), p.197-207
• Main Authors: Kolb, Werner, Guhlmann, Hanno, Windisch, Christoph, Koller, Heiko, Grützner, Paul, Kolb, Klaus
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Bone Plates; Bone Wires; Diseases of the osteoarticular system; Epiphyses - surgery; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; Osteotomy - instrumentation; Osteotomy - methods; Pain Measurement; Pain, Postoperative - physiopathology; Prospective Studies; Radiography; Range of Motion, Articular - physiology; Recovery of Function; Risk Assessment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tibia - diagnostic imaging; Tibia - surgery; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.J.00188

High tibial osteotomy has been recognized as a beneficial treatment for osteoarthritis of the medial compartment of the knee. The purpose of this prospective study was to assess the short-term results of opening-wedge high tibial osteotomies with locked plate fixation. From September 2002 to November 2005, fifty-one consecutive medial opening-wedge high tibial osteotomies were performed. The mean age of the patients at the time of the index operation was forty-nine years. The preoperative and postoperative factors analyzed included the grade of arthritis of the tibiofemoral compartment (the Ahlbäck radiographic grade), the anatomic tibiofemoral angle, patellar height, the Hospital for Special Surgery rating system score, and the Lysholm and Gillquist knee score. Postoperatively, one superficial wound infection occurred. Fifty of the fifty-one osteotomies healed after an average period of 12.9 weeks (range, eight to sixteen weeks) without bone grafts. A nonunion developed in a sixty-two-year-old patient who was a cigarette smoker. The average postoperative tibiofemoral angle was 9° of valgus. Forty-nine patients were followed for a mean of fifty-two months. The average score on the Hospital for Special Surgery rating system was 86 points at the time of the most recent follow-up. The rating was excellent in twenty-eight patients (57%), good in twelve (24%), fair in four (8%), and poor in five (10%). The average score on the Lysholm and Gillquist knee-scoring scale was 83 points. According to these scores, the outcome was excellent in nine patients (18%), good in thirty-one (63%), fair in three (6%), and poor in six (12%). Four knees failed after an average of thirty-six months. Our results suggest that an opening-wedge high tibial osteotomy with locked plate fixation allows a correct valgus angle to be achieved with good short-term results.