OPENING WEDGE HIGH TIBIAL OSTEOTOMY: SUCCESS OR FAILURE

Abstract

Aim: To report outcomes of high tibial osteotomies (HTO) in the treatment of patients with symptomatic varus-osteoarthritic knees.

Methods: Fourteen patients had a medial opening wedge HTO between 2001–2008. Twelve were male, mean age 42.2 years (range 33–49). Follow-up range 8–72 (mean 31 months). Six had simultaneous ACL reconstruction (one a revision another part of multiligament reconstruction). X-rays were taken at follow-up at 6, 12, 24, 36 and 52 weeks. Patients had pre- and post-operative KOOS assessment.

Results: All patients achieved a pain free leg with radiological evidence of union at mean 4.7 months (range 3–9). Two major complications occurred in one patient (PE and sensory neuropraxia). Minor complications in three patients: cellulitis, donor site infection, 1cm limb length discrepancy. Six patients required 7 further procedures: 2 arthroscopic chondral debridements, 2 microfractures and 3 arthroplasties. Tibial knee varus angles improved from mean 4.7° to 0.28°. KOOS scores improved in all domains: pain 28.5 to 52.8 (P< 0.01), symptoms 30.4 to 48.2 (P< 0.01), ADL 31.3 to 54.4 (P< 0.05), sport and recreation 2.5 to 7.5 P=0.125 and QOL 4.69 to 17.2 (P< 0.05). Kaplan-Meier survival analysis with failure defined as conversion to TKR shows a survivorship of 78.8% at 3 years.

Conclusions: Young patients with medial compartment osteoarthritis can have improved pain and function after HTO.

Better results are reported in the literature. However, some papers suggest osteotomies have been carried out in relatively asymptomatic patients and others accept significant pain in longer follow-up intervals without their patient cohorts having been offered alternative pain relieving strategies, such as chondral resurfacing or arthroplasty.

Patients require careful counselling that they will not achieve normal function and have a high incidence of need for further intervention.