Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2011

Open Access 01-12-2011 | Research article

Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up

Authors: Turgay Efe, Gafar Ahmed, Thomas J Heyse, Ulrich Boudriot, Nina Timmesfeld, Susanne Fuchs-Winkelmann, Bernd Ishaque, Stefan Lakemeier, Markus D Schofer

Published in: BMC Musculoskeletal Disorders | Issue 1/2011

Login to get access

Abstract

Background

Closing-wedge high tibial osteotomy (HTO) is successful for the treatment of medial osteoarthritis with varus malalignment. Preoperative risk factors for HTO failure are still controversial. The aim of this study was to elucidate the outcome and assess the influence of risk factors on long term HTO survival.

Methods

199 patients were retrospectively studied with a mean follow-up period of 9.6 years after HTO. HTO failure was defined as the need for conversion to TKA. Survival was analyzed with the Kaplan-Meier method. Knee function was evaluated by the Hospital for Special Surgery (HSS) score. HTO-associated complications were also assessed. Univariate, multivariate, and logistic regression analysis were performed to evaluate the influence of age, gender, BMI, preoperative Kellgren-Lawrence osteoarthritis grade, and varus angle on HTO failure.

Results

39 complications were recorded. Thus far, 36 HTOs were converted to TKA. The survival of HTO was 84% after 9.6 years. Knee function was considered excellent or good in 64% of patients. A significant preoperative risk factor for HTO failure was osteoarthritis, Kellgren-Lawrence grade >2.

Conclusion

HTO provides good clinical results in long-term follow-up. Preoperative osteoarthritis Kellgren-Lawrence grade >2 is a significant predictive risk factor for HTO failure. Results of HTO may be improved by careful patient selection. Complications associated with HTO should not be underestimated.
Appendix
Available only for authorised users
Literature
1.
Jackson JP, Waugh W: Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961, 43-B: 746-751.PubMed
2.
Debeyre J, Artigou JM: [Long term results of 260 tibial osteotomies for frontal deviations of the knee]. Rev Chir Orthop Reparatrice Appar Mot. 1972, 58 (4): 335-339.PubMed
3.
Coventry MB: Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am. 1973, 55 (1): 23-48.PubMed
4.
Wagner H, Zeiler G, Baur W: [Indication, technic and results of supra- and infracondylar osteotomy in osteoarthrosis of the knee joint]. Orthopade. 1985, 14 (3): 172-192.PubMed
5.
Devas MB: High tibial osteotomy for arthritis of the knee. A method specially suitable for the elderly. J Bone Joint Surg Br. 1969, 51 (1): 95-99.PubMed
6.
Dietz FR, Weinstein SL: Spike osteotomy for angular deformities of the long bones in children. J Bone Joint Surg Am. 1988, 70 (6): 848-852.PubMed
7.
Insall J, Shoji H, Mayer V: High tibial osteotomy. A five-year evaluation. J Bone Joint Surg Am. 1974, 56 (7): 1397-1405.PubMed
8.
Gstottner M, Pedross F, Liebensteiner M, Bach C: Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008, 128 (1): 111-115.PubMed
9.
Koshino T, Yoshida T, Ara Y, Saito I, Saito T: Fifteen to twenty-eight years' follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee. 2004, 11 (6): 439-444. 10.1016/j.knee.2004.03.005.CrossRefPubMed
10.
Virolainen P, Aro HT: High tibial osteotomy for the treatment of osteoarthritis of the knee: a review of the literature and a meta-analysis of follow-up studies. Arch Orthop Trauma Surg. 2004, 124 (4): 258-261. 10.1007/s00402-003-0545-5.CrossRefPubMed
11.
Ivarsson I, Myrnerts R, Gillquist J: High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br. 1990, 72 (2): 238-244.PubMed
12.
Robertsson O, Knutson K, Lewold S, Lidgren L: The Swedish Knee Arthroplasty Register 1975-1997: an update with special emphasis on 41,223 knees operated on in 1988-1997. Acta Orthop Scand. 2001, 72 (5): 503-513. 10.1080/000164701753532853.CrossRefPubMed
13.
Coventry MB, Ilstrup DM, Wallrichs SL: Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am. 1993, 75 (2): 196-201.PubMed
14.
Flecher X, Parratte S, Aubaniac JM, Argenson JN: A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006, 452: 91-96. 10.1097/01.blo.0000229362.12244.f6.CrossRefPubMed
15.
Naudie D, Bourne RB, Rorabeck CH, Bourne TJ: The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999, 18-27. 367
16.
Wolcott M: Osteotomies around the knee for the young athlete with osteoarthritis. Clin Sports Med. 2005, 24 (1): 153-161. 10.1016/j.csm.2004.08.002.CrossRefPubMed
17.
Matthews LS, Goldstein SA, Malvitz TA, Katz BP, Kaufer H: Proximal tibial osteotomy. Factors that influence the duration of satisfactory function. Clin Orthop Relat Res. 1988, 193-200. 229
18.
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 (2): 149-152. 10.1007/s00167-005-0638-5.CrossRefPubMed
19.
20.
Aydogdu S, Yercan H, Saylam C, Sur H: Peroneal nerve dysfunction after high tibial osteotomy. An anatomical cadaver study. Acta Orthop Belg. 1996, 62 (3): 156-160.PubMed
21.
Clemente Jiménez M, Pérez Trullén A, Rubio Aranda E, Marrón Tundidor R, Rodríguez Ibáñez M, Herrero Labarga I: A version of DSM-IV criteria adapted for adolescents and applied to young smokers. Arch Bronconeumol. 2003, 39 (7): 303-309.CrossRefPubMed
22.
Insall JN, Ranawat CS, Aglietti P, Shine J: A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am. 1976, 58 (6): 754-765.PubMed
23.
Watkins MA, Riddle DL, Lamb RL, Personius WJ: Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther. 1991, 71 (2): 90-96. discussion 96-97PubMed
24.
Gall N, Fickert S, Puhl W, Gunther KP, Stove J: [Predictors of tibial head transposition in the therapy of varus knee osteoarthritis]. Z Orthop Ihre Grenzgeb. 2005, 143 (5): 551-555. 10.1055/s-2005-872472.CrossRefPubMed
25.
Amendola A, Bonasia DE: Results of high tibial osteotomy: review of the literature. Int Orthop. 2010, 34 (2): 155-160. 10.1007/s00264-009-0889-8.CrossRefPubMed
26.
Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ: Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009, 467 (10): 2606-2612. 10.1007/s11999-009-0834-6.CrossRefPubMedPubMedCentral
27.
Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE: High tibial osteotomy. J Am Acad Orthop Surg. 2005, 13 (4): 279-289.CrossRefPubMed
28.
Brouwer RW, Raaij van TM, Bierma-Zeinstra SM, Verhagen AP, Jakma TS, Verhaar JA: Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev. 2007, CD004019-3
29.
Tunggal JA, Higgins GA, Waddell JP: Complications of closing wedge high tibial osteotomy. Int Orthop. 2010, 34 (2): 255-261. 10.1007/s00264-009-0819-9.CrossRefPubMed
30.
Wu LD, Hahne HJ, Hassenpflug T: A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis. Chin J Traumatol. 2004, 7 (6): 348-353.PubMed
31.
Sprenger TR, Doerzbacher JF: Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am. 2003, 85-A (3): 469-474.PubMed
32.
Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A: High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg. 2003, 16 (1): 21-26.PubMed
33.
Vainionpaa S, Laike E, Kirves P, Tiusanen P: Tibial osteotomy for osteoarthritis of the knee. A five to ten-year follow-up study. J Bone Joint Surg Am. 1981, 63 (6): 938-946.PubMed
34.
Aydogdu S, Cullu E, Arac N, Varolgunes N, Sur H: Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study. Knee Surg Sports Traumatol Arthrosc. 2000, 8 (5): 305-308. 10.1007/s001670000138.CrossRefPubMed
35.
Wootton JR, Ashworth MJ, MacLaren CA: Neurological complications of high tibial osteotomy--the fibular osteotomy as a causative factor: a clinical and anatomical study. Ann R Coll Surg Engl. 1995, 77 (1): 31-34.PubMedPubMedCentral
36.
Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H: The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br. 2008, 90 (5): 592-596. 10.1302/0301-620X.90B5.20386.CrossRefPubMed
37.
van Raaij T, Reijman M, Brouwer RW, Jakma TS, Verhaar JN: Survival of closing-wedge high tibial osteotomy: good outcome in men with low-grade osteoarthritis after 10-16 years. Acta Orthop. 2008, 79 (2): 230-234. 10.1080/17453670710015021.CrossRefPubMed
38.
Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C: Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop. 2006, 30 (5): 403-408. 10.1007/s00264-006-0098-7.CrossRefPubMedPubMedCentral
39.
Tang WC, Henderson IJ: High tibial osteotomy: long term survival analysis and patients' perspective. Knee. 2005, 12 (6): 410-413. 10.1016/j.knee.2005.03.006.CrossRefPubMed
40.
Aglietti P, Rinonapoli E, Stringa G, Taviani A: Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res. 1983, 239-251. 176
41.
Huang TL, Tseng KF, Chen WM, Lin RM, Wu JJ, Chen TH: Preoperative tibiofemoral angle predicts survival of proximal tibia osteotomy. Clin Orthop Relat Res. 2005, 188-195. 10.1097/01.blo.0000149818.70975.07. 432
42.
Spahn G, Muckley T, Kahl E, Hofmann GO: Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy. Clin Biomech (Bristol, Avon). 2006, 21 (3): 272-278. 10.1016/j.clinbiomech.2005.10.010.CrossRef
43.
Amin AK, Clayton RA, Patton JT, Gaston M, Cook RE, Brenkel IJ: Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg Br. 2006, 88 (10): 1321-1326. 10.1302/0301-620X.88B10.17697.CrossRefPubMed
44.
Blagojevic M, Jinks C, Jeffery A, Jordan KP: Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010, 18 (1): 24-33. 10.1016/j.joca.2009.08.010.CrossRefPubMed
45.
Lobenhoffer P, Agneskirchner J, Zoch W: [Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator]. Orthopade. 2004, 33 (2): 153-160. 10.1007/s00132-003-0593-0.CrossRefPubMed
46.
Lobenhoffer P, Agneskirchner JD: Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003, 11 (3): 132-138.PubMed
47.
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 (11): 1454-1459. 10.1302/0301-620X.88B11.17743.CrossRefPubMed
48.
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 (3): 447-452.PubMed
49.
Ivarsson I, Gillquist J: Rehabilitation after high tibial osteotomy and unicompartmental arthroplasty. A comparative study. Clin Orthop Relat Res. 1991, 139-144. 266
50.
Weale AE, Newman JH: Unicompartmental arthroplasty and high tibial osteotomy for osteoarthrosis of the knee. A comparative study with a 12- to 17-year follow-up period. Clin Orthop Relat Res. 1994, 134-137. 302
51.
Borjesson M, Weidenhielm L, Mattsson E, Olsson E: Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study. Knee. 2005, 12 (2): 121-127. 10.1016/j.knee.2004.04.002.CrossRefPubMed
52.
Stukenborg-Colsman C, Wirth CJ, Lazovic D, Wefer A: High tibial osteotomy versus unicompartmental joint replacement in unicompartmental knee joint osteoarthritis: 7-10-year follow-up prospective randomised study. Knee. 2001, 8 (3): 187-194. 10.1016/S0968-0160(01)00097-7.CrossRefPubMed
Metadata
Title
Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up
Authors
Turgay Efe
Gafar Ahmed
Thomas J Heyse
Ulrich Boudriot
Nina Timmesfeld
Susanne Fuchs-Winkelmann
Bernd Ishaque
Stefan Lakemeier
Markus D Schofer
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2011
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-12-46

Other articles of this Issue 1/2011

BMC Musculoskeletal Disorders 1/2011 Go to the issue

Research article

Is the presence of Modic changes associated with the outcomes of different treatments? A systematic critical review

Research article

Patient Disease Perceptions and Coping Strategies for Arthritis in a Developing Nation: A Qualitative Study

Research article

Evidence for validity and reliability of a french version of the FAAM

Research article

Cross-cultural adaptation of the Neck Disability Index and Copenhagen Neck Functional Disability Scale for patients with neck pain due to degenerative and discopathic disorders. Psychometric properties of the Polish versions

Study protocol

Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

Research article

Motor performance in chronic low back pain: is there an influence of pain-related cognitions? A pilot study