High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

Abstract

Background: Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment osteoarthrosis of the knee.

Materials and methods: Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA) rating scale.

Results: At a minimum follow-up of 2 years (range 2-9 years) 6-10 degrees of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65) to 77 (55-85) at final follow-up.

Conclusion: Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.

Keywords: Closing wedge osteotomy; genu varum; high tibial osteotomy; knee osteoarthrosis.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1

Diagrammatic representation of HTO. Note ledges of bone from the lateral and posterior cortices of proximal segment

Figure 2

X-rays soon after HTO showing K wires and lateral and posterior ledges from the proximal segment. Note slight anterior positioning of tibial tubercle from the distal fragment

Figure 3

This patient was operated at 64 years of age. Now at 73 years of age, 9 years after HTO the patient has full range of knee flexion

Figure 4

Clinical and functional result of the HTO done on right knee, 6 years after operation