TY  - JOUR
T1  - Combined Lateral Closing and Medial Opening-Wedge High Tibial Osteotomy
AU  - Nagi, O.N.
AU  - Kumar, Senthil
AU  - Aggarwal, Sameer
Y1  - 2007/03/01
N1  - 10.2106/JBJS.E.01089
JO  - The Journal of Bone & Joint Surgery
SP  - 542
EP  - 549
VL  - 89
IS  - 3
N2  - Background: Long-term studies have indicated 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
follow-up of fifteen years.Methods: From January 1981 to June 1990, ninety-two patients
(ninety-four knees) had a high tibial valgus osteotomy. The average
preoperative varus deformity was 13.5°. The surgical technique consisted
of a proximal lateral closing-wedge osteotomy and use of the lateral wedge as
a graft on the medial side of the osteotomy. No internal fixation was used. A
knee brace was used to maintain the 8° to 10° of valgus
overcorrection. Seventy-two knees in seventy patients with at least fifteen
years of follow-up were evaluated. Clinical evaluation was done with The
Hospital for Special Surgery knee-rating scale. The femorotibial alignment,
posterior tibial slope, and the Insall-Salvati ratio were measured on
radiographs.Results: The mean initial postoperative correction (and standard
deviation) for all knees was to 8.3° ± 2.7° of valgus
alignment. Survivorship analysis showed that the probability of survival (and
95% confidence interval), with conversion to total knee arthroplasty as the
end point, was 100% at one year, 92% ± 5.8% at ten years, 80%
±7.7% at fifteen years, and 58% ± 4.3% at twenty years. The
survivorship, with a Hospital for Special Surgery knee score of <70 points
as the end point, was 80% ± 4.5% at ten years, 72% ± 5.6% at
fifteen years, and 42% ± 4.2% at twenty years. Twenty-six knees
underwent an arthroplasty at an average of 15.6 years after the index
procedure. For the forty-six knees that had not undergone an arthroplasty, the
knee score improved from an average of 67 points preoperatively to 82 points
at the time of the most recent follow-up. There were two superficial wound
infections and one delayed union.Conclusions: We believe that our technique of a combined lateral
closing and medial opening-wedge high tibial osteotomy can provide good
long-term outcomes because of the off-loading of the diseased medial
compartment with minimal complications.Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.E.01089
UR  - http://dx.doi.org/10.2106/JBJS.E.01089
ER  -