Abstract
Introduction: The treatment of isolated medial compartment osteoarthritis (OA) in the young or physically active patient is a challenging problem for the orthopaedic surgeon.
The rationale for high tibial osteotomy (HTO) in medial compartment OA with varus deformity is to correct varus malalignment and to redistribute load to the non-diseased lateral compartment of the knee. Here we present our early to mid-term clinical and radiological findings.
Methods: Between October 2005 and April 2007 9 patients underwent HTO and TSF application. Pre-operative OA grade was recorded using the Ahlbäck classification. Radiographs were used to calculate the pre and post operative measurements for the tibiofemoral angle, the mechanical axis deviation and the tibial slope. Correction planning was carried out using the Spatialframe software package. All operations were performed by a single experienced consultant orthopaedic surgeon specialising in Ilizarov and limb reconstruction surgery. Pre and post-operative Oxford knee scores were collected for each patient.
Results: Median follow-up was 19 months (range 15–35). Median age at operation was 49 years (range 37–59). On preoperative radiographic examination eight knees were Ahlbäck grade 1 and one knee was Ahlbäck grade 2. The median time spent in the frame was 18 weeks (range 12–37). The median total angle of correction according to correction program given was 14 degrees (range 10–22) and the median duration of correction was 18 days (range 14–36) with 6 patients requiring an additional correction program.
2 patients subsequently underwent matrix induced autologous chondrocyte implant (MACI) for osteochondral defects.
In the primary OA group we found an improvement in mean Oxford knee score after HTO from 28.3 to 37.8/48 post-operatively. 1 patient was non-compliant with the correction and required a total knee replacement (TKR) for continued pain at 36 weeks post frame removal. 1 patient required fibular osteotomy during their correction.
6 (67%) of the 9 patients had a documented pin site infection. The median Otterburn grade was 3 (range 0–4). There were no cases of chronic bone infection.
Conclusions: High tibial osteotomy performed with the Taylor spatial frame presents a viable treatment option in active patients with early medial compartment OA. With TKR as an end point the survival rate of HTO for treatment of OA was 88.9% at a median of 19 months follow-up. Our results also indicate successful use of the technique in combination with MACI.
Correspondence should be addressed to BLRS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
