Clinical application and research status of open wedge high tibial osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Maolin , HE Rui , GUO Lin , CHEN Guangxing , DUAN Xiaojun , ZHANG Ying ,  YANG Liu

Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China;

Corresponding author：

YANG Liu, Email: jointsurgery@163.com

Keywords：

High tibial osteotomy; osteoarthritis; axial alignment of the lower extremity

DOI：

10.7507/1002-1892.201901014

Video：

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Objective To summarize the clinical application and research status of open wedge high tibial osteotomy (OWHTO).Methods Relevant literature at home and abroad was reviewed, and the clinical application, effectiveness and complications, technical comparison, and surgical skills of OWHTO were summarized and analyzed.Results OWHTO is an effective treatment for mild to moderate medial compartment osteoarthritis due to knee varus. This method can delay the injury process of medial compartment of the knee, delay the time of total knee arthroplasty, and even avoid joint replacement surgery by adjusting the axial alignment of the lower extremity to the non-pathological lateral compartment through osteotomy and orthopedic. OWHTO has the advantages of small incision, dynamic adjustment of the axial alignment of the lower extremity, accurate correction of malformation, and rapid postoperative recovery.Conclusion With the development of surgical instruments and techniques, OWHTO once again enter the sight of orthopedic surgeons. This technique can solve the pain symptoms of arthritis, correct the tibial varus deformity and reconstruct the axial alignment of the lower extremity, and satisfactory clinical results has been obtained.

Citation： SUN Maolin, HE Rui, GUO Lin, CHEN Guangxing, DUAN Xiaojun, ZHANG Ying, YANG Liu. Clinical application and research status of open wedge high tibial osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(5): 640-643. doi: 10.7507/1002-1892.201901014 Copy

1.	Jackson JP, Waugh W. The technique and complications of upper tibial osteotomy. A review of 226 operations. J Bone Joint Surg (Br), 1974, 56(2): 236-245.
2.	Jackson JP, Waugh W, Green JP. High tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br), 1969, 51(1): 88-94.
3.	Wardle EN. Osteotomy of the tibia and fibula in the treatment of chronic osteoarthritis of the knee. Postgrad Med J, 1964, 40: 536-542.
4.	Conventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report by Mark B. Conventry, MD. From the Section of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. 1965. J Bone Joint Surg (Am), 2001, 83-A(9): 1426.
5.	Schröter S, Lobenhoffer P, Mueller J, et al. Changes of patella position after closed and open wedge high tibial osteotomy: review of the literature. Orthopade, 2012, 41(3): 186, 188-194.
6.	Jang YW, Lim D, Seo H, et al. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy. Arch Orthop Trauma Surg, 2018, 138(7): 911-920.
7.	Ferner F, Lutter C, Dickschas J, et al. Medial open wedge vs. lateral closed wedge high tibial osteotomy-Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. Int Orthop, 2018. [Epub ahead of print].
8.	Lee DK, Kim KK, Ham CU, et al. The learning curve for biplane medial open wedge high tibial osteotomy in 100 consecutive cases assessed using the cumulative summation method. Knee Surg Relat Res, 2018, 30(4): 303-310.
9.	Kubota M, Ohno R, Sato T, et al. The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2018. [Epub ahead of print].
10.	Zhou J, Wang W. Comment on Cho, et al Mobile-bearing unicompartmental knee arthroplasty in old-aged patients demonstrates superior short-term clinical outcomes to open-wedge high tibial osteotomy in middle-aged patients with advanced isolated medial osteoarthritis. Int Orthop, 2018, 42(10): 2365-2366.
11.	Tseng TH, Tsai YC, Lin KY, et al. The correlation of sagittal osteotomy inclination and the anteroposterior translation in medial open-wedge high tibial osteotomy-one of the causes affecting the patellofemoral joint? Int Orthop, 2019, 43(3): 605-610.
12.	Kim HJ, Park J, Shin JY, et al. More accurate correction can be obtained using a three-dimensional printed model in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2018, 26(11): 3452-3458.
13.	Vaishya R, Bijukchhe AR, Agarwal AK, et al. A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis. J Clin Orthop Trauma, 2018, 9(4): 300-306.
14.	Darees M, Putman S, Brosset T, et al. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years’ follow-up. Orthop Traumatol Surg Res, 2018, 104(4): 477-480.
15.	Schuster P, Gesslein M, Schlumberger M, et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med, 2018, 46(6): 1362-1370.
16.	Lind-Hansen TB, Lind MC, Nielsen PT, et al. Open-wedge high tibial osteotomy: RCT 2 years RSA follow-up. J Knee Surg, 2016, 29(8): 664-672.
17.	卿忠, 叶久敏, 马建兵, 等. 下肢机械力线改良精准对线方法在开放楔形胫骨高位截骨术中的应用研究. 中国修复重建外科杂志, 2017, 31(6): 659-664.
18.	张子琦, 梁佳林, 樊立宏, 等. 开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察. 中国修复重建外科杂志, 2018, 32(8): 997-1000.
19.	Kobayashi H, Akamatsu Y, Kumagai K, et al. Radiographic and computed tomographic evaluation of bone union after medial opening wedge high tibial osteotomy with filling gap. Knee, 2017, 24(5): 1108-1117.
20.	Luites JW, Brinkman JM, Wymenga AB, et al. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg (Br), 2009, 91(11): 1459-1465.
21.	Floerkemeier S, Staubli AE, Schroeter S, et al. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 170-180.
22.	Seo SS, Kim OG, Seo JH, et al. Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res, 2016, 28(4): 289-296.
23.	Agarwala S, Sobti A, Naik S, et al. Comparison of closing-wedge and opening-wedge high tibial osteotomies for medial compartment osteoarthritis of knee in Asian population: Mid-term follow-up. J Clin Orthop Trauma, 2016, 7(4): 272-275.
24.	张纪, 杜辉, 黄野, 等. 胫骨高位截骨术: 闭合与开放楔形截骨对比. 临床军医杂志, 2016, 44(2): 128-132.
25.	Spahn G, Klinger HM, Harth P, et al. Cartilage regeneration after high tibial osteotomy. Results of an arthroscopic study. Z Orthop Unfall, 2012, 150(3): 272-279.
26.	Aryee S, Imhoff AB, Rose T, et al. Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials, 2008, 29(26): 3497-3502.
27.	El-Assal MA, Khalifa YE, Abdel-Hamid MM, et al. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 961-966.
28.	黄野. 胫骨高位截骨术治疗膝关节骨关节炎的现状. 中华关节外科杂志(电子版), 2016, 10(5): 470-473.
29.	王兴山, 黄野. 开放楔形胫骨高位截骨术的研究进展. 中华关节外科杂志(电子版), 2016, 10(5): 525-529.
30.	徐亚风, 罗从风, 张长青, 等. 内侧张开胫骨高位截骨术中未植骨的预后研究. 国际骨科学杂志, 2015, 36(2): 146-150.

1. Jackson JP, Waugh W. The technique and complications of upper tibial osteotomy. A review of 226 operations. J Bone Joint Surg (Br), 1974, 56(2): 236-245.
2. Jackson JP, Waugh W, Green JP. High tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg (Br), 1969, 51(1): 88-94.
3. Wardle EN. Osteotomy of the tibia and fibula in the treatment of chronic osteoarthritis of the knee. Postgrad Med J, 1964, 40: 536-542.
4. Conventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report by Mark B. Conventry, MD. From the Section of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. 1965. J Bone Joint Surg (Am), 2001, 83-A(9): 1426.
5. Schröter S, Lobenhoffer P, Mueller J, et al. Changes of patella position after closed and open wedge high tibial osteotomy: review of the literature. Orthopade, 2012, 41(3): 186, 188-194.
6. Jang YW, Lim D, Seo H, et al. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy. Arch Orthop Trauma Surg, 2018, 138(7): 911-920.
7. Ferner F, Lutter C, Dickschas J, et al. Medial open wedge vs. lateral closed wedge high tibial osteotomy-Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. Int Orthop, 2018. [Epub ahead of print].
8. Lee DK, Kim KK, Ham CU, et al. The learning curve for biplane medial open wedge high tibial osteotomy in 100 consecutive cases assessed using the cumulative summation method. Knee Surg Relat Res, 2018, 30(4): 303-310.
9. Kubota M, Ohno R, Sato T, et al. The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2018. [Epub ahead of print].
10. Zhou J, Wang W. Comment on Cho, et al Mobile-bearing unicompartmental knee arthroplasty in old-aged patients demonstrates superior short-term clinical outcomes to open-wedge high tibial osteotomy in middle-aged patients with advanced isolated medial osteoarthritis. Int Orthop, 2018, 42(10): 2365-2366.
11. Tseng TH, Tsai YC, Lin KY, et al. The correlation of sagittal osteotomy inclination and the anteroposterior translation in medial open-wedge high tibial osteotomy-one of the causes affecting the patellofemoral joint? Int Orthop, 2019, 43(3): 605-610.
12. Kim HJ, Park J, Shin JY, et al. More accurate correction can be obtained using a three-dimensional printed model in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc, 2018, 26(11): 3452-3458.
13. Vaishya R, Bijukchhe AR, Agarwal AK, et al. A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis. J Clin Orthop Trauma, 2018, 9(4): 300-306.
14. Darees M, Putman S, Brosset T, et al. Opening-wedge high tibial osteotomy performed with locking plate fixation (TomoFix) and early weight-bearing but without filling the defect. A concise follow-up note of 48 cases at 10 years’ follow-up. Orthop Traumatol Surg Res, 2018, 104(4): 477-480.
15. Schuster P, Gesslein M, Schlumberger M, et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med, 2018, 46(6): 1362-1370.
16. Lind-Hansen TB, Lind MC, Nielsen PT, et al. Open-wedge high tibial osteotomy: RCT 2 years RSA follow-up. J Knee Surg, 2016, 29(8): 664-672.
17. 卿忠, 叶久敏, 马建兵, 等. 下肢机械力线改良精准对线方法在开放楔形胫骨高位截骨术中的应用研究. 中国修复重建外科杂志, 2017, 31(6): 659-664.
18. 张子琦, 梁佳林, 樊立宏, 等. 开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察. 中国修复重建外科杂志, 2018, 32(8): 997-1000.
19. Kobayashi H, Akamatsu Y, Kumagai K, et al. Radiographic and computed tomographic evaluation of bone union after medial opening wedge high tibial osteotomy with filling gap. Knee, 2017, 24(5): 1108-1117.
20. Luites JW, Brinkman JM, Wymenga AB, et al. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg (Br), 2009, 91(11): 1459-1465.
21. Floerkemeier S, Staubli AE, Schroeter S, et al. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc, 2013, 21(1): 170-180.
22. Seo SS, Kim OG, Seo JH, et al. Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res, 2016, 28(4): 289-296.
23. Agarwala S, Sobti A, Naik S, et al. Comparison of closing-wedge and opening-wedge high tibial osteotomies for medial compartment osteoarthritis of knee in Asian population: Mid-term follow-up. J Clin Orthop Trauma, 2016, 7(4): 272-275.
24. 张纪, 杜辉, 黄野, 等. 胫骨高位截骨术: 闭合与开放楔形截骨对比. 临床军医杂志, 2016, 44(2): 128-132.
25. Spahn G, Klinger HM, Harth P, et al. Cartilage regeneration after high tibial osteotomy. Results of an arthroscopic study. Z Orthop Unfall, 2012, 150(3): 272-279.
26. Aryee S, Imhoff AB, Rose T, et al. Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials, 2008, 29(26): 3497-3502.
27. El-Assal MA, Khalifa YE, Abdel-Hamid MM, et al. Opening-wedge high tibial osteotomy without bone graft. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 961-966.
28. 黄野. 胫骨高位截骨术治疗膝关节骨关节炎的现状. 中华关节外科杂志(电子版), 2016, 10(5): 470-473.
29. 王兴山, 黄野. 开放楔形胫骨高位截骨术的研究进展. 中华关节外科杂志(电子版), 2016, 10(5): 525-529.
30. 徐亚风, 罗从风, 张长青, 等. 内侧张开胫骨高位截骨术中未植骨的预后研究. 国际骨科学杂志, 2015, 36(2): 146-150.

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