Abstract
The success of a high tibial osteotomy is predicted on proper patient selection, achievement and maintenance of adequate correction and avoidance of complications. It is a successful procedure when the patient’s pain is reduced or eliminated, the knee movement is preserved, and the need for a joint replacement is eliminated or postponed.
475 open wedge procedures using the hemicallotasis technique (HCO) were followed consecutively since a progressive introduction 1993. All patients were followed and compiled in a data base, 307 men, 168 women were included. The indications were arthrosis 439, sequels of fracture 12, correction 12, seqv osteotomy 7, others 5. For the arthritic knees 343 were med gr 1–3 343, med gr 4–5 35, lat arthrosis 37, prearthrosis 4. 32 patients were bilateral operated at one session.
The surgical technique is simple, using a ventral external fixator – the Orthofix T Garche. The technique is in principle extra articular. The patients were followed once/week and complications were compiled. The patient’s perspective of the HCO were evaluated for 58 patients using the KOOS questionare.
Complications as reoperation with reposition of pins 9 cases, septic arthritis 6, non-union 11, early loss of correction 5, nerve palsy 3 (all regress), interrupted treatment 3, DVT 10. For all complications including pin site infection, smoking were the single greatest preoperative risk factor (p< 0.022). 27 patients operated by HCO were converted to a joint replacement. The mean frame time was 99 + 20 days, 94/466 had a frame time > 16 weeks (smoking< 0.001). The patients self asessment were improved during treatment for the KOOS subcategories pain, function, ADL and Quality of life, but during treatment there were no improvement in sport/recreational function.
We found the HCO technique good, surgicallysimple, but there is a need for a close contact between the patient and the treatment team. This technique is probably the best when doing corrections greater than 15 degree. The largest single correction was 33 degree. The risk for septic arthritis using in a principle extra articular technique has to be considered.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
