Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-11-2018 | Knee

Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up

Authors: Michael E. Hantes, Prodromos Natsaridis, Antonios A. Koutalos, Yohei Ono, Nikolaos Doxariotis, Konstantinos N. Malizos

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2018

Abstract

Purpose

To report the long-term outcomes of medial open wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in patients younger than 45 years old. It was hypothesized that the correction of knee alignment would result in preservation of knee function in a long-term follow-up.

Methods

Patients under 45 years old, who underwent MOWHTO for symptomatic medial compartment knee osteoarthritis between 2001 and 2005 were retrospectively reviewed after a minimum of 10 years. The osteotomy was performed utilizing a locking plate without the use of bone graft. Patients were evaluated pre- and postoperatively using the International Knee Documentation Committee Score, the Oxford Knee Score, the Knee injury Osteoarthritis Outcome Score and the Short Form-12 Score. Standardized standing whole-limb radiographs were also obtained to assess mechanical tibiofemoral angle (mTFA) and the grade of osteoarthritis.

Results

A total of 20 patients (18 males, 2 females, mean age 35.4 years) with a mean follow-up of 12.3 years were included in the study. During the follow-up period, one patient required conversion to total knee replacement (95% survival rate). All clinical outcome scores (IKDC, KOOS, OKS, and SF-12) significantly improved postoperatively (p < 0.05), with no significant deterioration over time. Preoperative varus alignment with an mTFA of − 5.8 ± 2.4° was corrected to 2.5 ± 1.9° immediately after surgery (p < 0.05), and remained 2.2 ± 1.7° at the last follow-up. Furthermore, no significant radiographic progression of osteoarthritis was observed.

Conclusions

MWOHTO with a locking plate is an effective joint preservation method to treat medial compartment OA in active patients less than 45 years. Clinical and radiological results are satisfactory and the survival rate is 95%, 12 years after the procedure.

Level of evidence

Level IV therapeutic, retrospective, cohort study.

Ahlback S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277(Suppl):7–72

Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after menisectomy. Factors affecting knee after operation. J Bone Joint Surg 66B:666–671CrossRef

Barrios JA, Davis IS, Higginson JS, Royer TD (2009) Lower extremity walking mechanics of young individuals with asymptomatic varus knee alignment. J Orthop Res 27:1414–1419CrossRef

Bayliss LE, Culliford D, Monk AP, Glyn-Jones S, Prieto-Alhambra D, Judge A, Cooper C, Carr AJ, Arden NK, Beard DJ, Price AJ (2017) The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 389(10077):1424–1430CrossRef

Berman AT, Bosacco SJ, Kirshner S, Avolio A Jr (1991) Factors influencing long-term results in high tibial osteotomy. Clin Orthop Relat Res 272:192–198

Brouwer RW, Jakma TS, Bierma-Zeinstra SM, Verhagen AP, Verhaar J (2005) Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 1 :CD004019

Chun CW, Lee JH, Ha JH, Kim JH, Jeong JH (2013) Comparative study of medial opening-wedge high tibial osteotomy using 2 different implants. Arthroscopy 29(6):1063–1071CrossRef

Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of Knee Function International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 63(11):S208–S228CrossRef

Coventry M (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis the knee: a preliminary report. J Bone Joint Surg 47A:984–990CrossRef

10.

Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA (2014) Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 96(17):1425–1432CrossRef

11.

Englund M, Felson DT, Guermazi A, Roemer FW et al (2011) Risk factors for medial meniscal pathology on knee MRI in older US adults: a multicentre prospective cohort study. Ann Rheum Dis 70(10):1733–1739CrossRef

12.

Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96CrossRef

13.

Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180CrossRef

14.

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(3):585–608PubMed

15.

Golovakhа ML, Orljanski W, Benedetto KP, Panchenko S, Büchler P, Henle P, Aghayev E (2014) Comparison of theoretical fixation stability of three devices employed in medial opening wedge high tibial osteotomy: a finite element analysis. BMC Musculoskelet Disord 15:230CrossRef

16.

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(3):332–354CrossRef

17.

Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39(1):64–70CrossRef

18.

Huizinga MR, Brouwer RW, van Raaij TM (2014) High tibial osteotomy: closed wedge versus combined wedge osteotomy. BMC Musculoskelet Disord 15:124CrossRef

19.

Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP (2002) The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res 20:101–107CrossRef

20.

Ihle C, Ateschrang A, Grünwald L, Stöckle U, Saier T, Schröter S (2016) Health-related quality of life and clinical outcomes following medial open wedge high tibial osteotomy: a prospective study. BMC Musculoskelet Disord 18:17:215CrossRef

21.

Kontodimopoulos N, Pappa E, Niakas D, Tountas Y (2007) Validity of SF-12 summary scores in a Greek general population. Health Qual Life Outcomes 5:55CrossRef

22.

Koshino T, Yoshida T, Ara Y (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444CrossRef

23.

Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11(3):132–138CrossRef

24.

Long WJ, Bryce CD, Hollenbeak CS, Benner RW, Scott WN (2014) Total knee replacement in young, active patients: long-term follow-up and functional outcome: a concise follow-up of a previous report. J Bone Joint Surg Am 96(18):e159CrossRef

25.

Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557CrossRef

26.

Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W (2010) 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 26(12):1607–1616CrossRef

27.

No author listed. 13th annual report of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (2016). http://www.njrcentre.org.uk

28.

Polat G, Balcı H, Çakmak MF, Demirel M, Şen C, Aşık M (2017) Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. J Orthop Surg Res 12(1):44

29.

Raja Izaham RM, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T (2012) Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury 43(6):898–902CrossRef

30.

Röderer G, Gebhard F, Duerselen L, Ignatius A, Claes L (2014) Delayed bone healing following high tibial osteotomy related to increased implant stiffness in locked plating. Injury 45(10):1648–1652CrossRef

31.

Ruangsomboon P, Chareancholvanich K, Harnroongroj T, Pornrattanamaneewong C (2017) Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up. Int Orthop 41(10):2045–2052CrossRef

32.

Saragaglia D, Blaysat M, Inman D, Mercier N (2011) Outcome of opening wedge high tibial osteotomy augmented with a Biosorb® wedge and fixed with a plate and screws in 124 patients with a mean of ten years follow-up. Int Orthop 35(8):1151–1156CrossRef

33.

Sharma L, Chmiel JS, Almagor O, Felson D, Guermazi A et al (2013) The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study. Ann Rheum Dis 72(2):235–240CrossRef

34.

Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195CrossRef

35.

Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653CrossRef

36.

Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthr Cartil 14:190–195CrossRef

37.

Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34(S2):B55–B62CrossRef

38.

Stoffel K, Stachowiak G, Kuster M (2004) Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech 19:944–950CrossRef

39.

Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25(1):46–53CrossRef

40.

van Egmond N, van Grinsven S, van Loon CJ, Gaasbeek RD, van Kampen A (2016) Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthrosc 24(1):34–41CrossRef

41.

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(4):508–514CrossRef

42.

Woodacre T, Ricketts M, Evans JT, Pavlou G, Schranz P, Hockings M, Toms A (2016) Complications associated with opening wedge high tibial osteotomy—a review of the literature and of 15 years of experience. Knee 23(2):276 – 82CrossRef

43.

Yoo MJ, Shin YE (2016) Open wedge high tibial osteotomy and combined arthroscopic surgery in severe medial osteoarthritis and varus malalignment: minimum 5-year results. Knee Surg Relat Res 28(4):270–276CrossRef

44.

Zaki SH, Rae PJ (2009) High tibial valgus osteotomy using the Tomofix plate–medium-term results in young patients. Acta Orthop Belg 75(3):360–367PubMed

Title: Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up
Authors: Michael E. Hantes
Prodromos Natsaridis
Antonios A. Koutalos
Yohei Ono
Nikolaos Doxariotis
Konstantinos N. Malizos
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4816-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 11/2018

Distinct extra-articular invasion patterns of diffuse pigmented villonodular synovitis/tenosynovial giant cell tumor in the knee joints

Do modern total knee replacements improve tibial coverage?

The role of a scientific society in the training and development of an orthopaedic surgeon

One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection

Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty

Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique