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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 4/2014

01-12-2014 | Modern Techniques in Lower Limb Realignment (DE Bonasia and P Phisitkul, Section Editors)

High tibial osteotomy

Authors: Davide Edoardo Bonasia, Giorgio Governale, Simone Spolaore, Roberto Rossi, Annunziato Amendola

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2014

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Abstract

High tibial osteotomy (HTO) is a widely accepted and performed procedure to treat medial knee arthrosis. The aim of this review is to evaluate the different surgical options in medial knee arthrosis, focusing on indications, patient’s selection, long-term follow-up and survival analysis of HTO. Comparison and pooling of results are challenging because of different evaluation systems, small cohort number, and different surgical techniques. No differences have been described between opening and closing wedged HTO in terms of outcomes. Excellent early survivorship and good clinical outcomes were reported also with concomitant procedures. Correct indications, preoperative workup/planning, and technique selection are essential in achieving good results. The choice between opening and closing wedge osteotomy, graft selection in opening wedge HTO, comparison between HTO and unicompartmental knee arthroplasty, and the results of revised HTO to total knee replacement are currently under debate and will be discussed in the present review.
Literature
1.•
Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg. 2011;19:590–9. Note the preoperative planning calculations.PubMed
2.
3.•
Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S. Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years' follow-up. Knee. 2014;21:445–50. [Epub Nov 27, 2013]. doi:10.​1016/​j.​knee.​2013.​11.​013. Combination of HTO and cartilage resurfacing is described.
4.
Aglietti P, Rinonapoli E, Stringa G, Taviani A. Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res. 1983;176:239–51.PubMed
5.
Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10 to 22-year follow-up study. Clin Orthop Relat Res. 1999;367:18–27.PubMedCrossRef
6.
Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res. 1990;255:251–6.PubMed
7.
8.
Schallberger A, Jacobi M, Wahl P, Maestretti G, Jakob RP. High tibial valgus osteotomy in unicompartmental medial osteoarthritis of the knee: a retrospective follow-up study over 13-21 years. Knee Surg Sports Traumatol Arthrosc. 2011;19:122–7. doi:10.​1007/​s00167-010-1256-4 [Epub Sep 7, 2010].PubMedCrossRef
9.•
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. doi:10.​1016/​j.​arthro.​2010.​05.​006. This paper helps understanding arthroscopic prognostic factors before HTO.PubMedCrossRef
10.
Bode G, von Heyden J, Pestka J, Schmal H, Salzmann G, Südkamp N, et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2013. [Epub ahead of print].
11.
Schröter S, Gonser CE, Konstantinidis L, Helwig P, Albrecht D. High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute. Arthroscopy. 2011;27:644–52. doi:10.​1016/​j.​arthro.​2011.​01.​008.PubMedCrossRef
12.
13.
14.
Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy. 2012;28:354–64. doi:10.​1016/​j.​arthro.​2011.​08.​310 [Epub Dec 14, 2011].PubMedCrossRef
15.•
Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42:690–8. [Epub Jan 21, 2014]. doi:10.​1177/​0363546513516577​. This paper describes pre- and postoperative prognostic factors of opening wedge HTO.
16.•
Niinimäki TT, Eskelinen A, Mann BS, Junnila M, Ohtonen P, Leppilahti J. Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee: finnish registry-based study of 3195 knees. J Bone Joint Surg (Br). 2012;94:1517–21. doi:10.​1302/​0301-620X.​94B11.​29601. This paper describes the results of HTO from a national registry.CrossRef
17.
Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12–28-year follow-up study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91–6.PubMedCrossRef
18.
19.
Gstöttner M, Pedross F, Liebensteiner M, Bach C. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008;128:111–5.PubMedCrossRef
20.
Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, et al. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med. 2011;39:64–70. Epub Sep 10, 2010]. doi:10.​1177/​0363546510377445​.
21.
22.
Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br). 1961;43-B:746–51.
23.
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-A:984–90.
24.
Atrey A, Morison Z, Tosounidis T, Tunggal J, Waddell JP. Complications of closing wedge high tibial osteotomies for unicompartmental osteoarthritis of the knee. Bone Joint Res. 2011;1:205–9.CrossRef
25.
Huang Y, Gu J, Zhou Y, Li Y. Osteotomy at the distal third of tibial tuberosity with LCP L-buttress plate for correction of tibia vara. J Orthopaed Surg Res. 2014;9:9.CrossRef
26.
Spahn G. Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg. 2004;124:649–53.PubMedCrossRef
27.
28.
Brouwer RW, Bierma-Zeinstra SMA, Raaij TM, et al. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu Plate. J Bone Joint Surg (Br). 2006;88-B:1454–9.
29.
Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11:132–8.PubMed
30.
31.
32.
Aryee S, Imhoff AB, Rose T, Tischer T. Do we need synthetic osteotomy augmentation materials for opening wedge high tibial osteotomy. Biomaterials. 2008;29:3497–502.PubMedCrossRef
33.
Hernigou P, Ma W. Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee. 2001;8:103–10.PubMedCrossRef
34.
Dallari D, Savarino L, Stagni C, Cenni E, Cenacchi A, Fornasari PM, et al. Enhanced tibial osteotomy healing with use of bone grafts supplemented with platelet gel or platelet gel and bone marrow stromal cells. J Bone Joint Surg Am. 2007;89:2413–20.PubMedCrossRef
35.
Kawaguchi H, Jingushi S, Izumi T, Fukunaga M, Matsushita T, Nakamura T, et al. Local application of recombinant human fibroblast growth factor-2 on bone repair: a dose-escalation prospective trial on patients with osteotomy. J Orthop Res. 2007;25:480–7.PubMedCrossRef
36.
Peerbooms JC, Colaris JW, Hakkert AA, Van Appeldorn M, Bruijn DJ, Den Oudsten BL, et al. No positive bone healing after using platelet rich plasma in a skeletal defect. An observational prospective cohort study. Int Orthop. 2012;36:2113–9. doi:10.​1007/​s00264-012-1603-9 [Epub Jun 26, 2012].PubMedCrossRefPubMedCentral
37.
Griffin XL, Wallace D, Parsons N, Costa ML. Platelet rich therapies for long bone healing in adult. Cochrane Database System Rev. 2012;7:CD009496.
38.
Pape D, Lorbach O, Schmitz C, Busch LC, Van Giffen N, Seil R, et al. Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. Knee Surg Sports Traumatol Arthrosc. 2010;18:204–11.PubMedCrossRef
39.
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.PubMedCrossRef
40.
Dorsey WO, Miller BS, Tadje JP, Bryant CR. The stability of three commercially available implants used in medial opening wedge high tibial osteotomy. J Knee Surg. 2006;19:95–8.PubMed
41.
Spahn G, Mückley T, Kahl E, Hofmann GO. Biomechanical investigation of different internal fixations in medial opening wedge high tibial osteotomy. Clin Biomech (Bristol, Avon). 2006;21:272–8.CrossRef
42.
Pape D, Kohn D, van Giffen N, Hoffmann A, Seil R, Lorbach O. Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2013;21:82–9. doi:10.​1007/​s00167-011-1693-8 [Epub Oct 9, 2011].PubMedCrossRef
43.
44.
Cotic M, Vogt S, Hinterwimmer S, Feucht MJ, Slotta-Huspenina J, Schuster T, et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate vs titanium plate. Knee Surg Sports Traumatol Arthrosc. 2014. [Epub ahead of print].
45.
McNamara I, Birmingham TB, Fowler PJ, Griffin JR. High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surg Sports Traumatol Arthrosc. 2013;21:23–31.PubMedCrossRef
46.
Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med. 2004;32:60–70.PubMedCrossRef
47.
Genin P, Weill G, Julliard R. The tibial slope: proposal for a measurement method [French]. J Radiol. 1993;74:27–33.PubMed
48.
Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X, et al. Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res. 2012;98:68–74.PubMedCrossRef
49.
Lerat JL, Moyen B, Garin C, Mandrino A, Besse JL, Brunet-Guedj E. Anterior laxity and internal arthritis of the knee. Results of the reconstruction of the anterior cruciate ligament associated with tibial osteotomy. Rev Chir Orthop Reparatrice Appar Mot. 1993;79:365–74.PubMed
50.
Hohmann E, Bryant A, Imhoff AB. The effect of closed wedge high tibial osteotomy on tibial slope: a radiographic study. Knee Surg Sports Traumatol Arthrosc. 2006;14:454–9.PubMedCrossRef
51.
Dejour H, Neyret P, Boileau P, Donell ST. Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res. 1994;299:220–8.PubMed
52.
Williams III RJ, Kelly BT, Wickiewicz TL, Altchek DW, Warren RF. The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency. J Knee Surg. 2003;16:9–16.PubMed
53.
Bonin N, Ait Si Selmi T, Donell ST, Dejour H, Neyret P. Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. Knee. 2004;11:431–7.PubMedCrossRef
54.
Boss A, Stutz G, Oursin C, Gächter A. Anterior cruciate ligament reconstruction combined with valgus tibial osteotomy (combined procedure). Knee Surg Sports Traumatol Arthrosc. 1995;3:187–91.PubMedCrossRef
55.
Trojani C, Elhor H, Carles M, Boileau P. Anterior cruciate ligament reconstruction combined with valgus high tibial osteotomy allows return to sports. Ortop Traumatol Surg Res. 2014;100:209–12.CrossRef
56.
Bonasia DE, Amendola A. Combined medial meniscal transplantation and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2010;18:870–3.PubMedCrossRef
57.
Amendola A. Knee osteotomy and meniscal transplantation: indications, technical considerations, and results. Sports Med Arthrosc. 2007;15:32–8.PubMedCrossRef
58.
Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH. Injectable cultured bone marrow-derived mesenchymal stem cells in varus knee with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years' follow-up. Arthroscopy. 2013;29:2020–8.PubMedCrossRef
59.
60.
Broughton NS, Newman JH, Baily RA. Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. A comparative study after 5–10 years' follow-up. J Bone Joint Surg (Br). 1986;68:447–52.
61.
Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A. High tibial osteotomy vs unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7–10-year follow-up prospective randomised study. Knee. 2001;8:187–94.PubMedCrossRef
62.
Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM. The impact of high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21:96–112.PubMedCrossRef
63.
Brouwer RW, Raaij TM, Bierma-Zeinstra SM, Verhagen AP, Jakma TS, Verhaar JA. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev. 2007;18:CD004019.
64.
Dettoni F, Maistrelli GL, Rossi P, Castoldi F, Stojimirovich D, Rossi R. UKA vs HTO: clinical results at short term follow-up. 75th AAOS Annual Meeting. San Francisco, CA; 2008.
65.
Yim JH, Song EK, Seo HY, Kim MS, Seon JK. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum follow-up of 3 years. J Arthroplasty. 2013;28:243–7.PubMedCrossRef
66.
Fu D, Li G, Chen K, Zhao Y, Hua Y, Cai Z. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty in the treatment of unicompartmental osteoarthritis: a meta-analysis. J Arthroplasty. 2013;28:759–65.PubMedCrossRef
67.
Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy vs unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131–40.PubMedPubMedCentral
68.
Gill T, Schemitsch EH, Brick GW, Thornhill TS. Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop Relat Res. 1995;321:10–8.PubMed
69.•
Robertsson O, W-Dahl A. The risk of revision after TKA is affected by previous HTO or UKA. Clin Orthop Relat Res. 2014. [Epub ahead of print] Important paper describing the risks of revision HTO and UKA to TKR.
Metadata
Title
High tibial osteotomy
Authors
Davide Edoardo Bonasia
Giorgio Governale
Simone Spolaore
Roberto Rossi
Annunziato Amendola
Publication date
01-12-2014
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 4/2014
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-014-9234-y

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