Effectiveness of medial open wedge high tibial osteotomy combined with posterior slope angle of tibial plateau correction in treatment of osteoarthritis of limited flexion knee with varus deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Yun ¹ , HU Wenjin ¹ ,  HUANG Jingmin ² , LI Dongchao ¹ , JIA Litao ¹ , ZHONG Congli ¹ , ZHAO Xiaohu ¹

1. Department of Orthopedics, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, 300120, P.R.China;
2. Department of Sports Injuries and Arthroscopic Branch, Tianjin Hospital, Tianjin, 300211, P.R.China;

Corresponding author：

HUANG Jingmin, Email: 584662063@qq.com

Keywords：

Knee; Varus of knee; Osteoarthritis; high tibial osteotomy; posterior tibial slope

DOI：

10.7507/1002-1892.201710014

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo explore the short-term effectiveness of medial open wedge high tibial osteotomy (OWHTO) combined with posterior slope angle of tibial plateau correction to treat the osteoarthritis of limited flexion knee with varus deformity.MethodsThe data of 18 cases (18 knee) with osteoarthritis of limited flexion knee with varus deformity between January 2014 and July 2016 were analyzed retrospectively. There were 6 males and 12 females with an average age of 54.9 years (range, 48-64 years). There were 8 cases of left knee and 10 cases of right knee. The varus of knee ranged from 7.45 to 15.52° (mean, 10.63°). According to Kellgren-Lawrence grading standard, there were 4 cases of grade Ⅱ and 14 of grade Ⅲ. OWHTO was used to adjust the varus deformity, and the posterior slope angle of tibial plateau was adjusted to solve the limited flexion.ResultsThe thickness of osteotomy was 10-19 mm (mean, 14.91 mm). The operation time was 1.2-2.0 hours (mean, 1.4 hours). All incisions healed by first intension. All patients were followed up 1.0-2.5 years, with an average of 1.5 years. At last follow-up, the range of knee flexion and Lysholm score, Hospital for Special Surgery (HSS) score, and International Knee Documentation Committee (IKDC) score were significantly higher than preoperative ones, showing significant differences (P<0.05). X-ray films showed that the osteotomy healed at 3- 7 months (mean, 3.6 months) after operation. At last follow-up, the limb alignment by the relative position of tibial plateau and the posterior slope angle of tibial plateau were significantly improved, showing significant differences when compared with preoperative ones (P<0.05).ConclusionThe OWHTO combined with posterior slope angle of tibial plateau correction can significantly improve the range of flexion and functional score in short-term.

Citation： ZHAO Yun, HU Wenjin, HUANG Jingmin, LI Dongchao, JIA Litao, ZHONG Congli, ZHAO Xiaohu. Effectiveness of medial open wedge high tibial osteotomy combined with posterior slope angle of tibial plateau correction in treatment of osteoarthritis of limited flexion knee with varus deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 157-161. doi: 10.7507/1002-1892.201710014 Copy

1.	Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg (Br), 2009, 91(1): 52-57.
2.	Westermann RW, DeBerardino T, Amendola A. Minimizing alteration of posterior tibial slope during opening wedge high tibial osteotomy: a protocol with experimental validation in paired cadaveric knees. Iowa Orthop J, 2014, 34: 16-23.
3.	Schuster P, Schulz M, Mayer P, et al. Open-wedge high tibial osteotomy and combined abrasion/microfracture in severe medial osteoarthritis and varus malalignment: 5-year results and arthroscopic findings after 2 years. Arthroscopy, 2015, 31(7): 1279-1288.
4.	Miniaci A, Ballmer FT, Ballmer PM, et al. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res, 1989, (246): 250-259.
5.	Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3): 282-296.
6.	Paley D, Herzenberg JE, Tetsworth K, et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am, 1994, 25(3): 425-465.
7.	Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. J Bone Joint Surg (Am), 1989, 248: 4-8.
8.	Hernigou P. Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee, 2002, 9(1): 15-20.
9.	McNamara I, Birmingham TB, Fowler P, et al. High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 23-31.
10.	Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
11.	Amis AA. Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 197-205.
12.	Lustig S, Scholes CJ, Costa AJ, et al. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 32-38.
13.	Lee BH, Ha CW, Moon SW, et al. Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy. Knee, 2017, 24(2): 362-371.
14.	Ozel O, Yucel B, Mutlu S, et al. Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc, 2017, 25(1): 314-318.
15.	Dragosloveanu S, Cristea S, Dragosloveanu C. The effect of high tibial osteotomy on the posterior tibial slope. Mdica, 2014, 9(2):173-178.
16.	Han SB, Park HJ, Lee DH. Ability of an intentionally smaller anterior than posterior gap to reduce the sagittal tibial slope in opening wedge high tibial osteotomy. BMC Musculoskelet Disord, 2016, 17: 216.
17.	de Boer JJ, Blankevoort L, Kingma I, et al. In vitro study of inter-individual variation in posterior slope in the knee joint. Clin Biomech (Bristol, Avon), 2009, 24(6): 488-492.
18.	Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Resy, 2011, 29(2): 223-231.

1. Newman J, Pydisetty RV, Ackroyd C. Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg (Br), 2009, 91(1): 52-57.
2. Westermann RW, DeBerardino T, Amendola A. Minimizing alteration of posterior tibial slope during opening wedge high tibial osteotomy: a protocol with experimental validation in paired cadaveric knees. Iowa Orthop J, 2014, 34: 16-23.
3. Schuster P, Schulz M, Mayer P, et al. Open-wedge high tibial osteotomy and combined abrasion/microfracture in severe medial osteoarthritis and varus malalignment: 5-year results and arthroscopic findings after 2 years. Arthroscopy, 2015, 31(7): 1279-1288.
4. Miniaci A, Ballmer FT, Ballmer PM, et al. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res, 1989, (246): 250-259.
5. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3): 282-296.
6. Paley D, Herzenberg JE, Tetsworth K, et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am, 1994, 25(3): 425-465.
7. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee: a preliminary report. J Bone Joint Surg (Am), 1989, 248: 4-8.
8. Hernigou P. Open wedge tibial osteotomy: combined coronal and sagittal correction. Knee, 2002, 9(1): 15-20.
9. McNamara I, Birmingham TB, Fowler P, et al. High tibial osteotomy: evolution of research and clinical applications—a Canadian experience. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 23-31.
10. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3): 585-608.
11. Amis AA. Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 197-205.
12. Lustig S, Scholes CJ, Costa AJ, et al. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 32-38.
13. Lee BH, Ha CW, Moon SW, et al. Three-dimensional relationships between secondary changes and selective osteotomy parameters for biplane medial open-wedge high tibial osteotomy. Knee, 2017, 24(2): 362-371.
14. Ozel O, Yucel B, Mutlu S, et al. Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis. Knee Surg Sports Traumatol Arthrosc, 2017, 25(1): 314-318.
15. Dragosloveanu S, Cristea S, Dragosloveanu C. The effect of high tibial osteotomy on the posterior tibial slope. Mdica, 2014, 9(2):173-178.
16. Han SB, Park HJ, Lee DH. Ability of an intentionally smaller anterior than posterior gap to reduce the sagittal tibial slope in opening wedge high tibial osteotomy. BMC Musculoskelet Disord, 2016, 17: 216.
17. de Boer JJ, Blankevoort L, Kingma I, et al. In vitro study of inter-individual variation in posterior slope in the knee joint. Clin Biomech (Bristol, Avon), 2009, 24(6): 488-492.
18. Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Resy, 2011, 29(2): 223-231.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of medial open wedge high tibial osteotomy combined with posterior slope angle of tibial plateau correction in treatment of osteoarthritis of limited flexion knee with varus deformity

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content