Opening wedge high tibial osteotomy (HTO) for varus knee osteoarthritis has shown several advantages over the classic closing wedge technique. The aim of the current prospective study was to evaluate mid-term clinical and radiographic results, as well as complications, of medial opening wedge osteotomy using the hemicallotasis technique. Forty-nine high tibial oste-otomies were performed for unilateral varus primary osteoarthritis from 1999 to 2002. A medial incomplete osteotomy was performed after elevating the superficial collateral ligament. Four pins were inserted, two hydroxyapatite-coated in the metaphyseal bone, and two standard conical pins in the diaphyseal bone. The correction started 4–5 days postoperatively. The patient managed the correction by adjusting half of a turn twice each day. When the desired correction was achieved, the device was locked. Eight-to-nine weeks after surgery, the radiographic healing was evaluated, and if adequate, the device was removed on a outpatient basis. The mean age of the patients was 57 years (range, 32–70 years). The mean follow-up was 5 years (range, 4–7 years). The mean hip-knee-ankle angle (HKA) was 167 (range 164–171) deg preoperatively and 182 (range, 176–186) deg at follow up. We did not observe any early or late collapse of the new bone wedge. Union was achieved in all patients, and the mean time to fixation was 69 (range 60–85) days. Knee Society score improved from 52 points preoperatively to 93 at follow up. Eighty-five percent of the patients showed excellent-to-good clinical outcome. None of the knees had required revision surgery at follow-up. No meta-diaphyseal mismatch was noted on both the sagittal and coronal plain at radiographic analysis. Patellar height (IS ratio) reduced, on average, from 1.1 (±0.4) to 0.9 (±0.4), but no patella was found to be baja. Complications included a number of superficial infection uneventfully healed such as two cellulitis with erysipelas-like rushes, and five minor (grade I-II) pin tract infections. There were two technical problems. One obese patient developed an undisplaced inter-condylar fracture of the proximal tibial osteotomized fragment, which subsequently healed and the patient achieved a good clinical outcome. In another patient the anterior pin on the metaphyseal fragment was positioned too anteriorly, and was thereafter repositioned. There were no neurologic or vascular complications. Using the hemicallotasis technique for HTO the authors obtained a precise correction with a relatively low complication rate. The use of an external fixator allowed quick surgery, early weight-bearing, immediate knee motion, avoiding permanent hardware on bone. Conversion to a total knee arthroplasty seems to be easy when this technique has been employed, but the influence of pin tract infection on possible septic failures remains to be determined.

It is well known that tibial osteotomy of arthritic painful genu varum in patients younger than 70 years of age has advantages both for the mechanical effect of symmetrical distribution of joint loading and for the biological effect produced by the bone section on the local venous intraosseus pressure which reduces pain. Patients were selected according to pre-operative X-ray evaluation of the limbs taken with the patient bearing weight on one foot: varus deformity not greater than 25°, knee flexion not greater than 15°, joint movement not less than 90° and absence of femorotibial subluxation or other instabilities. Surgery consists in application of three proximal and two distal screws into the medial side of the tibia. An Orthofix Fixator with self-aligning body is applied and an oblique osteotomy performed medially through a 3-cm skin incision using a drill bit and an osteotome to keep the lateral cortex intact in order to avoid lateral translation of the distal segment.

The patient can correct progressively the deformity himself by distracting the compression-dsistraction unit with an allen wrench. Once the desired correction has been achieved (8°–10°), a control X-ray is taken and the central body locking nut of the fixator tightened. Patients can bear full weight with crutches 4–5 days after surgery.

We have treated a total of 163 patients (92 men, 71 women). Their average age was 60 yearsand average healing time 75 days. Results were excellent in 60%, good in 25%, fair in 10% and poor in 5%. The average post-operative valgus was 9%. The technique and the clinical results are discussed.

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.

Introduction: We present preliminary short term results of medial opening wedge high tibial osteotomy with hemicallotasis using a monolateral external fixator, combined with microfracturing, in younger active patients with established Grade IV medial compartment osteoarthritis.

Methods: Prospectively collected data was analysed for 28 consecutive knees in 27 patients undergoing this procedure. Mean age was 47 years (range 28 to 64), follow up was 23 months (range 7 to 61).

Results: Mean Lysholm scores improved from 63.6 before surgery (range 42 to 85) to 81.6 at latest follow-up (range 46.5–100) (p< 0.001). Similarly, the mean Tegner activity scale improved from 1.7 (range 1 – 4) to 3.3 (range 1 – 6) (p< 0.001). Average IKDC score at last follow-up was 68 (range 35.6 – 100). Mean pain score (visual analogue scale 0 to 10) improved from 5.5 pre-operatively (range 1 – 9), to 3.5 at latest follow-up (range 0 – 8) (p< 0.001). All but 4 patients reported improved pain scores.

Superficial pin site infection occurred in 6 patients (21.4%) and settled with oral antiobiotics in all cases. One patient had persistent patellofemoral (PF) pain.

Discussion: The use of hemicallotasis for high tibial osteotomy (HTO) in association with extensive microfracturing of the medial compartment provides a viable, minimally invasive method for management of the young active patient with medial compartment osteoarthritis, without the risk of serious complications. In the short term even with advanced full thickness cartilage damage, this provides effective pain relief, helps put off more major arthroplasty alternatives and improves activity levels.

Introduction: We present preliminary short term results of medial opening wedge high tibial osteotomy with hemicallotasis using a monolateral external fixator, combined with microfracturing, in younger active patients with established Grade IV medial compartment osteoarthritis.

Methods: Prospectively collected data was analysed for 28 consecutive knees in 27 patients undergoing this procedure. Mean age was 47 years (range 28 to 64); follow up was 23 months (range 7 to 61).

Results: Mean Lysholm scores improved from 63.6 before surgery (range 42 to 85) to 81.6 at latest follow-up (range 46.5–100) (p< 0.001). Similarly, the mean Tegner activity scale improved from 1.7 (range 1–4) to 3.3 (range 1–6) (p< 0.001). Average IKDC score at last follow-up was 68 (range 35.6–100). Mean pain score (visual analogue scale 0 to 10) improved from 5.5 pre-operatively (range 1–9), to 3.5 at latest follow-up (range 0–8) (p< 0.001). All but 4 patients reported improved pain scores, one of whom had patellofemoral pain. Superficial pin site infection occurred in 6 patients (21.4%) and settled with oral antibiotics in all cases.

Discussion: The use of hemicallotasis for high tibial osteotomy in association with extensive microfracturing of medial compartment provides a viable, minimally invasive method for management of the young active patient with medial compartment osteoarthritis, without the risk of serious complications. In the short term even with advanced full thickness damage, this provides effective pain relief, helps put off more major arthroplasty alternatives and allows patients an improved activity level. The external fixator provides a very stable functional stabilization, superior to other available methods of internal fixation.

Objectives

The purpose of this study was to clarify the appearance of the reparative tissue on the articular surface and to analyse the properties of the reparative tissue after hemicallotasis osteotomy (HCO) using MRI T1ρ and T2 mapping.

Objectives

To review the systemic impact of smoking on bone healing as evidenced within the orthopaedic literature.