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.
