Abstract
Introduction and Aims: Treatment options for medial gonarthrosis include high tibial osteotomy (HTO). There has been a shift towards opening wedge techniques partially due a perceived higher complication rate with closing wedge techniques. This has not been our experience and we describe the outcome of a large series of closing wedge HTOs.
Method: We reviewed the case records of 313 patients who underwent a total of 374 closing wedge high tibial osteotomies by three surgeons for medial compartment gonarthrosis between 1989 and 2003. The mean outpatient follow-up was 16 months and the mean time post-surgery was 66 months. We identified any post-operative complications and the early clinical outcome including those known to have proceeded to joint replacement. The mean age of patient was 52 years (range 19–72). In all patients a laterally based wedge, mean size nine degrees (range 4–18), was excised and the osteotomy stabilised with one or two stepped staples.
Results: Outcome following closing wedge osteotomy was generally good, only six percent of patients complained of continuing knee pain, although not at a level that required further intervention. Symptoms in 3.5% of knees deteriorated and required total knee replacement at a mean of 63 months (range 16–112) following osteotomy. No intra-operative difficulties were encountered with these replacements. The complication rate was acceptable with an overall rate of 7.8%. One patient required revision shortly after surgery due to inadequate initial correction and one developed a transient peroneal nerve neuropraxia. There were no other neurovascular or intra-operative complications recorded. All the osteotomies united, although nine patients had delayed union, taking a mean of five months for their osteotomies to unite. Other complications included: five patients who had staples removed due to irritation, one who developed a stitch abscess and one who developed a deep wound infection. Two knees had a reduced ROM and required an MUA. In addition, six patients developed symptomatic DVTs, three with pulmonary emboli, but there were no deaths.
Conclusion: In our experience, closing wedge osteotomy for medial gonarthrosis is a safe and reliable procedure with a good early outcome and an acceptable complication rate of 7.8% in this series, with a low incidence of serious complications that compares favourably with the quoted complication rates for opening wedge techniques.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
None of the authors is receiving any financial benefit or support from any source.
