LONG TERM RESULTS OF A COMBINED LATERAL CLOSING AND MEDIAL OPENING WEDGE TECHNIQUE FOR HIGH TIBIAL OSTEOTOMY

Abstract

Background: Long-term studies indicate that the clinical success of high tibial osteotomy deteriorates with time. The purpose of this study was to evaluate the long-term results of a combined lateral closing and medial opening wedge technique for high tibial osteotomy with a minimum 15 years follow-up.

Materials and Methods: From January 1981 to June 1990, ninety-two patients underwent ninety-four high tibial valgus osteotomies. The average preoperative varus deformity was 13.50. The surgical technique consisted of a proximal lateral closing wedge osteotomy and grafting of the lateral wedge to the medial side of osteotomy. No internal fixation was used. A knee brace was used to maintain the 80 to 100 of valgus overcorrection. Seventy patients (72 high tibial osteotomies) with at least fifteen years follow-up were evaluated. Clinical evaluation was done with the Hospital for Special Surgery knee rating scale. Radiologically, femorotibial alignment, posterior tibial slope and the Insall-Salvati ratio were measured.

Results: The mean initial postoperative correction for all knees was to 8.3 ± 2.7 degrees of valgus. Survivorship was 83%, 60% and 45% at fifteen, twenty and twentyfive years after surgery with conversion to a total knee arthroplasty as endpoint of failure. This was 76%, 45% and 32% during the same time interval when a Hospital for Special Surgery knee score of less than 70 points was also considered as end-point. Twenty-six high tibial osteotomies required subsequent arthroplasty at an average of 15.6 years after the index procedure. At the time of the most recent follow-up, the average preoperative knee score of 67 points had improved to 82 points for the knees that had not undergone an arthroplasty. There were two superficial wound infections and one delayed union.

Conclusions: We believe that our technique of a combined lateral closing, medial opening wedge high tibial osteotomy resulted in good long-term outcome due to the off-loading of the diseased medial compartment with minimal complications.